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.

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

Adult Critical Care Unit Royal Brompton Hospital London UK

Anaesthesiology and Intensive Care Department University Hospital Ostrava and Faculty of Medicine University of Ostrava Ostrava Czech Republic

Cardiac Surgery Department Hospital Universitario 12 de Octubre Madrid Spain

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

Cardio Thoracic Surgery Department Heart and Vascular Centre Maastricht University Medical Centre Maastricht Netherlands; Cardiovascular Research Institute Maastricht Maastricht Netherlands; Cardiac Surgery Unit Cardio Thoracic and Vascular Department Fondazione IRCCS San Gerardo Monza Italy

Cardio Thoracic Surgery Department Heart and Vascular Centre Maastricht University Medical Centre Maastricht Netherlands; Cardiovascular Research Institute Maastricht Maastricht Netherlands; Critical Care Department King Faisal Specialist Hospital and Research Center Riyadh Saudi Arabia

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

Clinical Department of Cardiac Surgery and Transplantology National Medical Institute of the Ministry of Interior Warsaw Poland; Thoracic Research Centre Collegium Medicum Nicolaus Copernicus University Innovative Medical Forum Bydgoszcz Poland

Critical Care Department Vall 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 Istituto Mediterraneo per i trapianti e Terapie ad alta specializzazione Palermo Italy

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 Surgery Universitair Ziekenhuis Leuven Gasthuisberg University Hospital Leuven Belgium

Department of Cardiac Vascular and Thoracic Surgery Kepler University Hospital Linz Austria

Department of Cardiovascular Surgery Medical Center University Freiburg Faculty of Medicine University of Freiburg Freiburg Germany

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; Cardiovascular Research Institute Maastricht Maastricht Netherlands; Care and Public Health Research Institute Maastricht University Maastricht Netherlands

Department of Intensive Care Medicine Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany

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

Dipartimento di Scienze dell'Emergenza Anestesiologiche e della Rianimazione Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy; Dipartimento di Scienze Biotecnologiche di Base Cliniche Intensivologiche e Perioperatorie Università Cattolica del Sacro Cuore Rome Italy

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

ECMO ICU Centro Hospitalar Universitario de Lisboa Central Lisbon Portugal

ECMO Referral Centre ICU USL Sao José Lisbon Portugal

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

Goethe University Frankfurt University Hospital Frankfurt Frankfurt Germany

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ClinicalTrials.gov
NCT04366921