Six-Month Survival After Extracorporeal Membrane Oxygenation for Severe COVID-19
: Biancari Fausto, Mariscalco Giovanni, Dalén Magnus, Settembre Nicla, Welp Henryk, Perrotti Andrea, Wiebe Karsten, Leo Enrico, Loforte Antonio, Chocron Sidney, Pacini Davide, Juvonen Tatu, Broman L. Mikael, Perna Dario Di, Yusuff Hakeem, Harvey Chris, Mongardon Nicolas, Maureira Juan P., Levy Bruno, Falk Lars, Ruggieri Vito G., Zipfel Svante, Folliguet Thierry, Fiore Antonio
Publisher: W.B. Saunders
: 2021
Journal of Cardiothoracic and Vascular Anesthesia
: Journal of Cardiothoracic and Vascular Anesthesia
: 35
: 7
: 1999
: 2006
: 1532-8422
DOI: https://doi.org/10.1053/j.jvca.2021.01.027
: https://www.sciencedirect.com/science/article/pii/S1053077021000628?via=ihub
: https://research.utu.fi/converis/portal/detail/Publication/53711725
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.
