BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. INTERPRETATION: Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. FUNDING: None.

2nd Department of Internal Medicine Cardiovascular Medicine General Teaching Hospital Prague Czech Republic; 1st Faculty of Medicine Charles University Prague Czech Republic

Anestesia e Rianimazione 2 Cardiopolmonare Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Pavia Italy

Cardiothoracic Critical Care Unit Whythenshawe Hospital Manchester UK

Cardiothoracic Intensive Care Unit University Hospital Copenhagen Denmark

Cardiovascular Surgery Department Kosuyolu High Specialization Education and Research Hospital Istanbul Türkiye

Critical Care Department Val d'Hebron Research Institute Barcelona Spain

Department of Adult Critical Care Guy's and St Thomas' NHS Foundation Health Centre for Human and Applied Physiological Sciences London UK

Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy

Department of Anesthesiology and Critical Care Medicine Arnaud de Villeneuve Hospital Centre Hospitalier Universitaire Montpellier Montpellier France; Le laboratoire de Physiologie et Médecine Expérimentale du Coeur et des Muscles Université de Montpellier INSERM CNRS Montpellier France

Department of Cardiac Surgery Assistance Publique Hôpitaux de Paris Hôpitaux Universitaires Henri Mondor Créteil France

Department of Cardiac Surgery Heinrich Heine University Dusseldorf Germany

Department of Cardiac Surgery Louis Pradel Hospital Lyon France

Department of Cardiac Surgery Medical University Hospital of Vienna Vienna Austria

Department of Cardiac Surgery Universitair Ziekenhuis Leuven Gasthuisberg University Hospital Leuven Belgium

Department of Cardio Thoracic Surgery Heart and Vascular Centre Maastricht University Medical Centre Maastricht Netherlands; Cardiovascular Research Institute Maastricht Maastricht Netherlands

Department of Cardio Thoracic Surgery Heart and Vascular Centre Maastricht University Medical Centre Maastricht Netherlands; Cardiovascular Research Institute Maastricht Maastricht Netherlands; Cardiovascular Research Institute Maastricht Maastricht Netherlands

Department of Cardiovascular Surgery Heart Center University Freiburg Bad Krozingen Germany; Faculty of Medicine University of Freiburg Freiburg Germany

Department of Intensive Care Erasme Hospital Université Libre de Bruxelles Brussels Belgium

Department of Internal Medicine 2 University Hospital of Regensburg Regensburg Germany

Department of Medicine 1 Intensive Care Unit Comprehensive Cancer Center Center of Excellence in Medical Intensive Care Medical University of Vienna Vienna Austria

Department of Medicine Paracelsus Medical University Nuremberg Germany

Department of Surgical Sciences Anesthesia and Intensive Care Medicine Città della Salute e della Scienza Hospital University of Turin Turin Italy

ECMO Centre Karolinska Karolinska University Hospital Stockholm Sweden; Department of Physiology and Pharmacology Karolinska Institutet Stockholm Sweden

ECMO Retrieval Service and Critical Care Royal Papworth Hospital NHS Foundation Trust Cambridge Biomedical Campus Cambridge UK

Heart Transplantation Unit Leviev Cardiothoracic and Vascular Center Sheba Medical Center Ramat Gan Israel

Intensive Care Unit Royal Brompton and Harefield hospitals London UK

Medizinische Klinik Uniklinik Rheinisch Westfälische Technische Hochschule Aachen Germany

Lancet Respir Med. 2023 Feb;11(2):113-115. doi: 10.1016/S2213-2600(22)00487-8. PubMed

Lancet Respir Med. 2023 May;11(5):e42. doi: 10.1016/S2213-2600(23)00134-0. PubMed

Lancet Respir Med. 2023 May;11(5):e41. doi: 10.1016/S2213-2600(23)00010-3. PubMed

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ClinicalTrials.gov
NCT04366921