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Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation.
Herrmann, Johannes; Lotz, Christopher; Karagiannidis, Christian; Weber-Carstens, Steffen; Kluge, Stefan; Putensen, Christian; Wehrfritz, Andreas; Schmidt, Karsten; Ellerkmann, Richard K; Oswald, Daniel; Lotz, Gösta; Zotzmann, Viviane; Moerer, Onnen; Kühn, Christian; Kochanek, Matthias; Muellenbach, Ralf; Gaertner, Matthias; Fichtner, Falk; Brettner, Florian; Findeisen, Michael; Heim, Markus; Lahmer, Tobias; Rosenow, Felix; Haake, Nils; Lepper, Philipp M; Rosenberger, Peter; Braune, Stephan; Kohls, Mirjam; Heuschmann, Peter; Meybohm, Patrick.
  • Herrmann J; Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany.
  • Lotz C; Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany.
  • Karagiannidis C; Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany.
  • Weber-Carstens S; Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Kluge S; Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Putensen C; Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.
  • Wehrfritz A; Department of Anaesthesiology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen-Nuernberg (FAU), Erlangen, Germany.
  • Schmidt K; Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
  • Ellerkmann RK; Department of Anesthesiology and Intensive Care Medicine, Klinikum Dortmund, Klinikum University Witten/Herdecke, Dortmund, Germany.
  • Oswald D; Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Clinic Centre Westfalen, Dortmund, Germany.
  • Lotz G; Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.
  • Zotzmann V; Department of Cardiology and Angiology I (Heart Center Freiburg - Bad Krozingen), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Moerer O; Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  • Kühn C; Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37085, Göttingen, Germany.
  • Kochanek M; Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
  • Muellenbach R; Department of Internal Medicine, Division I (Hematology/Oncology), University Hospital of Cologne, Cologne, Germany.
  • Gaertner M; Department of Anesthesiology and Critical Care Medicine, ARDS/ECMO-Center, Campus Kassel of the University of Southampton, Kassel, Germany.
  • Fichtner F; Department of Anaesthesia, Perioperative Medicine and Interdisciplinary Intensive Care Medicine, ECLS/ECMO-Center, Asklepios Klinik Langen, Langen, Germany.
  • Brettner F; Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Center, Leipzig, Germany.
  • Findeisen M; ARDS- und ECMO Zentrum München-Nymphenburg, Barmherzige Brüder Krankenhaus München, München, Germany.
  • Heim M; Klinik für Pneumologie, Internistische Intensiv- und Beatmungsmedizin, München Klinik Harlaching, Munich, Germany.
  • Lahmer T; Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany.
  • Rosenow F; School of Medicine, University Hospital Rechts Der Isar, Department of Internal Medicine II, University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
  • Haake N; Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.
  • Lepper PM; Department of Intensive Care Medicine, Imland Klinik Rendsburg, Rendsburg, Germany.
  • Rosenberger P; Department of Internal Medicine V- Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany.
  • Braune S; Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
  • Kohls M; Department of Medical Intensive Care and Emergency Medicine, St. Franziskus-Hospital Muenster, Münster, Germany.
  • Heuschmann P; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
  • Meybohm P; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
Crit Care ; 26(1): 190, 2022 06 28.
Article in English | MEDLINE | ID: covidwho-1910342
ABSTRACT

BACKGROUND:

Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients.

METHODS:

673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival.

RESULTS:

Most patients were between 50 and 70 years of age. PaO2/FiO2 ratio prior to ECMO was 72 mmHg (IQR 58-99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41-0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28-1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events.

CONCLUSIONS:

Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival. TRIAL REGISTRATION Registered in the German Clinical Trials Register (study ID DRKS00022964, retrospectively registered, September 7th 2020, https//www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022964 .
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Crit Care Year: 2022 Document Type: Article Affiliation country: S13054-022-04053-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: Crit Care Year: 2022 Document Type: Article Affiliation country: S13054-022-04053-6