University of Oulu

Biancari, F., Mariscalco, G., Dalén, M., Settembre, N., Welp, H., Perrotti, A., Wiebe, K., Leo, E., Loforte, A., Chocron, S., Pacini, D., Juvonen, T., Broman, L. M., Perna, D. D., Yusuff, H., Harvey, C., Mongardon, N., Maureira, J. P., Levy, B., … Fiore, A. (2021). Six-Month Survival After Extracorporeal Membrane Oxygenation for Severe COVID-19. Journal of Cardiothoracic and Vascular Anesthesia, 35(7), 1999–2006. https://doi.org/10.1053/j.jvca.2021.01.027

Six-month survival after extracorporeal membrane oxygenation for severe COVID-19

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Author: Biancari, Fausto1,2,3; Mariscalco, Giovanni4; Dalen, Magnus5;
Organizations: 1Helsinki Univ Hosp, Heart & Lung Ctr, Haartmaninkatu 4,POB 340, Helsinki 00029, Finland.
2Univ Oulu, Res Unit Surg Anesthesia & Crit Care, Oulu, Finland.
3Univ Turku, Dept Surg, Turku, Finland.
4Univ Hosp Leicester, Glenfield Hosp, Dept Intens Care Med & Cardiac Surg, Leicester, Leics, England.
5Karolinska Inst, Karolinska Univ Hosp, Dept Mol Med & Surg, Dept Cardiothorac Surg, Stockholm, Sweden.
6Univ Lorraine, Nancy Univ Hosp, Dept Vasc & Endovasc Surg, Nancy, France.
7Munster Univ Hosp, Dept Cardiothorac Surg, Munster, Germany.
8Univ Hosp Jean Minjoz, Dept Thorac & Cardiovasc Surg, Besancon, France.
9A Manzoni Hosp, Div Vasc Surg, Lecce, Italy.
10Univ Bologna, S Orsola Hosp, Dept Cardiothorac Transplantat & Vasc Surg, Bologna, Italy.
11Karolinska Inst, Karolinska Univ Hosp, Dept Physiol & Pharmacol, ECMO Ctr Karolinska, Stockholm, Sweden.
12Univ Reims, Robert Debre Univ Hosp, Div Cardiothorac & Vasc Surg, Reims, France.
13Hop Henri Mondor, Assistance Publ Hop Paris, Serv Anesthesie Reanimat Chirurg, Creteil, France.
14Univ Lorraine, Nancy Univ Hosp, Dept Cardiovasc Surg & Heart Transplantat, Nancy, France.
15Univ Lorraine, Nancy Univ Hosp, Med Intens Care Unit Brabois, Nancy, France.
16Hamburg Univ Hosp, Ctr Heart, Hamburg, Germany.
17Hop Henri Mondor, Assistance Publ Hop Paris, Serv Chirurg Thorac & Cardiovasc, Creteil, France.
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2021091346063
Language: English
Published: Elsevier, 2021
Publish Date: 2021-09-13
Description:

Abstract

Objectives: The authors evaluated the outcome of adult patients with coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (ARDS) requiring the use of extracorporeal membrane oxygenation (ECMO).

Design: Multicenter retrospective, observational study.

Setting: Ten tertiary referral university and community hospitals.

Participants: Patients with confirmed severe COVID-19–related ARDS.

Interventions: Venovenous or venoarterial ECMO.

Measurements and Main Results: One hundred thirty-two patients (mean age 51.1 ± 9.7 years, female 17.4%) were treated with ECMO for confirmed severe COVID-19–related ARDS. Before ECMO, the mean Sequential Organ Failure Assessment score was 10.1 ± 4.4, mean pH was 7.23 ± 0.09, and mean PaO₂/fraction of inspired oxygen ratio was 77 ± 50 mmHg. Venovenous ECMO was adopted in 122 patients (92.4%) and venoarterial ECMO in ten patients (7.6%) (mean duration, 14.6 ± 11.0 days). Sixty-three (47.7%) patients died on ECMO and 70 (53.0%) during the index hospitalization. Six-month all-cause mortality was 53.0%. Advanced age (per year, hazard ratio [HR] 1.026, 95% CI 1.000–1–052) and low arterial pH (per unit, HR 0.006, 95% CI 0.000–0.083) before ECMO were the only baseline variables associated with increased risk of six-month mortality.

Conclusions: The present findings suggested that about half of adult patients with severe COVID-19–related ARDS can be managed successfully with ECMO with sustained results at six months. Decreased arterial pH before ECMO was associated significantly with early mortality. Therefore, the authors hypothesized that initiation of ECMO therapy before severe metabolic derangements subset may improve survival rates significantly in these patients. These results should be viewed in the light of a strict patient selection policy and may not be replicated in patients with advanced age or multiple comorbidities. Clinical Trial Registration: identifier, NCT04383678.

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Series: Journal of cardiothoracic and vascular anesthesia
ISSN: 1053-0770
ISSN-E: 1532-8422
ISSN-L: 1053-0770
Volume: 35
Issue: 7
Pages: 1999 - 2006
DOI: 10.1053/j.jvca.2021.01.027
OADOI: https://oadoi.org/10.1053/j.jvca.2021.01.027
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Subjects:
Funding: M.D. was financially supported by a research grant from The Swedish Heart-Lung Foundation (grant number 20200412).
Copyright information: © 2021 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/)
  https://creativecommons.org/licenses/by-nc-nd/4.0/