ABSTRACT
Objective: To describe the most frequent complications and causes of death of COVID-19 patients requiring extracorporeal respiratory support. Methods: Descriptive analysis of the ECMOVIBER registry, including 25 ECMO centers in Spain (23) and Portugal (2). All adult (>18 years old) COVID-19 patients requiring veno-venous ECMO between 1st March and 1st December 2020 were included. The follow up period ended 1st December 2020. Demographic data, comorbidities and complications during ECMO [acute kidney injury, ventilator associated pneumonia (VAP), hemorrhage and thrombosis] were recorded. Results are described using median (interquartile range) or frequency (percentage). Results: A total of 316 patients [age 55 (47-60), 253 (80%) male] were included. Only 21 (7%) patients had prior respiratory disease and 12 (4%) chronic kidney disease. One hundred and thirty-one (41%) patients received anticoagulation prior to cannulation and 94 (30%) suffered concomitant bacterial coinfection prior to ECMO initiation. Eighty-two (26%) patients developed acute kidney injury of which 73 (89%) required continuous renal replacement therapy;50 (16%) suffered at least one thrombotic episode during the extracorporeal support (47 deep venous thrombosis, 3 pulmonary embolism) and 41 (13%) presented haemorrhagic shock. In 109 (34%) patients clots in the circuit were identified and 20 of them (18%) required at least one circuit change. The most frequent infectious complication was VAP [154 patients (49%)]. One hundred and twenty (38%) patients died on ECMO and 9 (3%) after decannulation. The most frequently reported causes of death were multiorgan dysfunction [37 (29%)], persistent respiratory failure due to COVID- 19 [23 (18%)] and septic shock [20 (15%)]. Death during cannulation occurred in 11 cases (3% of the total population). Conclusions: Complications during extracorporeal respiratory support in COVID-19 patients are frequent. VAP may complicate up to half of the cases. Persistent COVID-19 was the cause of death of almost one fifth of the population.
ABSTRACT
Objective: To analyze the complications developed in patients with COVID-19 supported with ECMO and to evaluate their impact in outcomes. Methods: Prospective observational study including all the COVID-19 patients with ECMO support in the ICU of the VHUH from 15 March to 30 July. Infectious, renal, thrombotic, hemorrhagic and other complications during support were prospectively registered. Continuous variables expressed as median (interquartile range) and categorical variables as number (percentage). The impact of complications in mortality was analyzed using Chi-squared or Fisheŕs exact test as appropriate. Results: Twenty-four patients [55 (46-57) years, 58% male, BMI 32.1 (27-35)] received ECMO support [23 (96%) VV-ECMO] during 11 (5.7-19.2) days. The longest run lasted 67 days (awake ECMO). Eighteen (75%) patients could be decannulated and 16 (67%) were discharged alive from the ICU. Fifteen (63%) patients suffered hemorrhagic complications and 12 (48%) thrombotic events, with 7 (29%) patients needing circuit change. Ventilator-associated pneumonia (VAP) was diagnosed in 8 (33%) patients and acute kidney injury (AKI) in 7 (29%). Other complications were air leak (5 patients), fungal infection (4), CMV replication (3) and cardiac tamponade (1). Hemorrhage and thrombosis were not associated with mortality (P=1.0 and P=0.6, respectively). VAP and AKI were neither associated with mortality (P=0.3 both). Conclusions: Complications are frequent in COVID-19 patients supported with ECMO, especially thrombotic and hemorrhagic. VAP and AKI might be studied in further studies to confirm their association with a higher risk of mortality.