ABSTRACT
Background: Patients with coronavirus disease 2019 (COVID-19) and severe acute respiratory distress syndrome (ARDS) need in 10.5 to 15% veno-venous ECMO (V-V ECMO) therapy. The worldwide mortality in COVID-19 patients on ECMO has been described as extremely high with a mortality rate of 40 to 70%. Method(s): We collected data from 56 patients with severe ARDS who received V-V ECMO in 2020 to January 2022 at the University Hospital Magdeburg due to COVID-19 infection. We recorded demographic, pre-, intra-, and posttreatment data retrospectively. We divided the patients into two groups (survivors and nonsurvivors) to build the final prediction model based on our statistic and to detect relevant mortality risk factors. Result(s): Only 39.3% of patients survived the intensive care unit. Compared groups didn't differ in associated diseases. Most of the non-survivors were male (14 [63.6%] vs. 28 [82.4%], p = 0.114). Nonsurvivors showed a higher incidence of bleeding complications (10 [45.5%] vs. 23 [67.6%], p = 0,099), especially hemothorax (1 [4.5%] vs. 7 [20.6%], p = 0.094) and endobronchial bleeding (0 vs. 5 [14.7%], p = 0.059) as well as a higher incidence of bacterial superinfection (9 [40.1%] vs. 22 [64.7%], p = 0.080). Moreover, groups differed concerning the incidence of acute kidney injury without dialysis (1 [4.5% vs. 9 [26.5%], p = 0.036), and acute liver failure (1 [4.5%] vs. 7 [20.6%], p = 0.094). According to the results of bivariate regression analysis, male sex (odd ratio [OR]: 2.66;95% confidence interval [CI]: 0.773-9.194;p = 0.120), major bleeding events (OR: 2.50;95% CI: 0.831-7.574;p = 0.103), bacterial superinfection (OR: 2.65;95% CI: 0.879-7.981;p = 0.084), acute kidney injury without dialysis (OR: 7.56;95% CI: 0.884-64.636;p = 0.065), and acute liver failure (OR: 5.44;95% CI: 0.621-47.756, p = 0.126) were tendentious significant predictors of death. Subsequently, according to the results of multivariate analysis, the most significant factors of mortality were major bleeding events (OR: 3.27;95% CI: 0.888-12.047, p = 0.075) and the bacterial superinfection (OR: 2.81;95% CI: 0.800-9.888, p = 0.107). The mortality prediction model explained 31.8% (Nagelkerke R2) of the variance in-hospital mortality and correctly classified 71.4% of the cases. Conclusion(s): Major bleeding events and bacterial superinfection might be relevant mortality factors in COVID-19 patients on V-V ECMO therapy. Especially prevention of superinfection and strictly anticoagulation management might result in lower mortality rates.