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In-hospital outcomes and 6-month follow-up results of patients supported with extracorporeal membrane oxygenation for COVID-19 from the second wave to the end of the pandemic (EuroECMO-COVID): a prospective, international, multicentre, observational study
ME. De Piero, S. Mariani, BCT. van Bussel, D. Jarczak, N. Krenner, EP. de la Sota, PE. Silva, M. Roemmer, M. Kowalewski, S. Carelli, LM. Broman, A. Vuylsteke, P. Fortuna, F. Alessandri, G. Martucci, BV. Patel, G. Lotz, U. Boeken, S. Maier, B....
Language English Country England, Great Britain
Document type Journal Article, Observational Study, Multicenter Study
- MeSH
- COVID-19 * therapy mortality epidemiology MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * methods MeSH
- Hospital Mortality MeSH
- Follow-Up Studies MeSH
- Prospective Studies MeSH
- SARS-CoV-2 MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) for COVID-19 was thoroughly assessed during the first pandemic wave, but data on subsequent waves are limited. We aimed to investigate in-hospital and 6-month survival of patients with COVID-19 supported with ECMO from the second pandemic wave (Sept 15, 2020) until the end of the pandemic (March 21, 2023, announced by WHO). METHODS: EuroECMO-COVID is a prospective, observational study including adults (aged ≥16 years) requiring ECMO respiratory support for COVID-19 from 98 centres in 21 countries. We compared patient characteristics and outcomes between in-hospital survivors and non-survivors. Mixed-effects multivariable logistic regressions were used to investigate factors linked to in-hospital mortality. 6-month survival and overall patient status were determined via patient contact or chart review. This study is registered with ClinicalTrials.gov, NCT04366921, and is complete. FINDINGS: We included 3860 patients (2687 [69·7%] were male and 1169 [30·3%] were female; median age 51 years [SD 11]) from 98 centres in 21 countries. In-hospital mortality was 55·9% (n=2158), with 81·2% (n=1752) deaths occurring during ECMO support. More non-survivors had diabetes, hypertension, cardiovascular disease, and renal failure, and required more pre-ECMO inotropes and vasopressors compared with survivors. Median support duration was 18 days (IQR 10-31) for both groups. Factors linked to in-hospital mortality included older age, pre-ECMO renal failure, pre-ECMO vasopressors use, longer time from intubation to ECMO initiation, and complications, including neurological events, sepsis, bowel ischaemia, renal failure, and bleeding. Of the 1702 (44·1%) in-hospital survivors, 99·7% (n=1697) were alive at 6 months follow-up. Many patients at 6 months follow-up had dyspnoea (501 [32·0%] of 1568 patients), cardiac (122 [7·8%] of 1568 patients), or neurocognitive (168 [10·7%] of 1567 patients) symptoms. INTERPRETATION: Our data for patients undergoing ECMO support for respiratory distress from the second COVID-19 wave onwards confirmed most findings from the first wave regarding patient characteristics and factors correlated to in-hospital mortality. Nevertheless, in-hospital mortality was higher than during the initial pandemic wave while 6-month post-discharge survival remained favourable (99·7%). Persisting post-discharge symptoms confirmed the need for post-ECMO patient follow-up programmes. FUNDING: None.
Adult Critical Care Unit Royal Brompton Hospital London UK
Cardiac Surgery Department Hospital Universitario 12 de Octubre Madrid Spain
Cardiovascular Research Institute Maastricht Maastricht Netherlands
Care and Public Health Research Institute Maastricht University Maastricht Netherlands
Critical Care Department King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia
Critical Care Department Vall d'Hebron Research Institute Barcelona Spain
Department of Anesthesia and Intensive Care North Estonian Regional Hospital Tallin Estonia
Department of Cardiac Surgery Heinrich Heine University Dusseldorf Germany
Department of Cardiac Surgery Rambam Health Care Campus Haifa Israel
Department of Cardiac Vascular and Thoracic Surgery Kepler University Hospital Linz Austria
Department of General and Specialist Surgery Sapienza University of Rome Rome Italy
Department of Intensive Care and Intermediate Care ECMO Center Erfurt Helios Klinikum Erfurt Germany
Department of Intensive Care Maastricht University Medical Centre Maastricht Netherlands
Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Internal Medicine 2 University Hospital of Regensburg Regensburg Germany
ECMO ICU Centro Hospitalar Universitario de Lisboa Central Lisbon Portugal
ECMO Referral Centre ICU USL Sao José Lisbon Portugal
Goethe University Frankfurt University Hospital Frankfurt Frankfurt Germany
References provided by Crossref.org
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- $a De Piero, Maria Elena $u Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands; Critical Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Electronic address: marieledep@gmail.com
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- $a BACKGROUND: Extracorporeal membrane oxygenation (ECMO) for COVID-19 was thoroughly assessed during the first pandemic wave, but data on subsequent waves are limited. We aimed to investigate in-hospital and 6-month survival of patients with COVID-19 supported with ECMO from the second pandemic wave (Sept 15, 2020) until the end of the pandemic (March 21, 2023, announced by WHO). METHODS: EuroECMO-COVID is a prospective, observational study including adults (aged ≥16 years) requiring ECMO respiratory support for COVID-19 from 98 centres in 21 countries. We compared patient characteristics and outcomes between in-hospital survivors and non-survivors. Mixed-effects multivariable logistic regressions were used to investigate factors linked to in-hospital mortality. 6-month survival and overall patient status were determined via patient contact or chart review. This study is registered with ClinicalTrials.gov, NCT04366921, and is complete. FINDINGS: We included 3860 patients (2687 [69·7%] were male and 1169 [30·3%] were female; median age 51 years [SD 11]) from 98 centres in 21 countries. In-hospital mortality was 55·9% (n=2158), with 81·2% (n=1752) deaths occurring during ECMO support. More non-survivors had diabetes, hypertension, cardiovascular disease, and renal failure, and required more pre-ECMO inotropes and vasopressors compared with survivors. Median support duration was 18 days (IQR 10-31) for both groups. Factors linked to in-hospital mortality included older age, pre-ECMO renal failure, pre-ECMO vasopressors use, longer time from intubation to ECMO initiation, and complications, including neurological events, sepsis, bowel ischaemia, renal failure, and bleeding. Of the 1702 (44·1%) in-hospital survivors, 99·7% (n=1697) were alive at 6 months follow-up. Many patients at 6 months follow-up had dyspnoea (501 [32·0%] of 1568 patients), cardiac (122 [7·8%] of 1568 patients), or neurocognitive (168 [10·7%] of 1567 patients) symptoms. INTERPRETATION: Our data for patients undergoing ECMO support for respiratory distress from the second COVID-19 wave onwards confirmed most findings from the first wave regarding patient characteristics and factors correlated to in-hospital mortality. Nevertheless, in-hospital mortality was higher than during the initial pandemic wave while 6-month post-discharge survival remained favourable (99·7%). Persisting post-discharge symptoms confirmed the need for post-ECMO patient follow-up programmes. FUNDING: None.
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