Extracorporeal membrane oxygenation in critically ill covid-19 patients and predictors of mortality: The aachen experience

The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill COVID-19patients remains unclear. Our study aims to analyze the outcomes and risk factors from patients treated with ECMO. Methods: This retrospective, single-center study includes seventeen COVID-19 patients treated with ECMO. Univariate andmultivariate parametric survival regression identified predictors of survival. Result: Nine patients (53%) were successfully weaned from ECMO and discharged. The incidence of in-hospital mortalitywas 47%. In a univariate analysis, only four out of 83 pre-ECMO variables were significantly different;IL-6, PCT, and NT-proBNP were significantly higher in non-survivors compared with survivors. The Respiratory Extracorporeal MembraneOxygenation Survival Prediction (RESP) score was significantly lower in survivors. After a multivariate parametric survivalregression, IL-6, NT-proBNP and RESP scores remained significant independent predictors, with hazard ratios (HR) of 1.069[95% CI: 0.986-1.160], p = 0.016 1.001 [95% CI: 1.000-1.001], p = 0.012;and 0.843 [95% CI: 0.564-1.260], p = 0.040,respectively. A prediction model consisting of IL-6, NT-proBNP, and RESP score showed an area under the curve (AUC) of0.87, with a sensitivity of 87.5% and specificity of 77.8%, compared with an AUC of 0.79 for the RESP score alone. Conclusion: The present study suggests that ECMO is a potentially lifesaving treatment for select critically ill COVID-19patients. Considering IL-6 and NT-per-BNP, in addition to the RESP score, may enhance outcome predictions.

[S2k Guideline - Recommendations for Inpatient Therapy of Patients with COVID-19]. / S2k-Leitlinie ­ Empfehlungen zur stationären Therapie von Patienten mit COVID-19.

Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.