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.
In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study / Lorusso R.; De Piero M.E.; Mariani S.; Di Mauro M.; Folliguet T.; Taccone F.S.; Camporota L.; Swol J.; Wiedemann D.; Belliato M.; Broman L.M.; Vuylsteke A.; Kassif Y.; Scandroglio A.M.; Fanelli V.; Gaudard P.; Ledot S.; Barker J.; Boeken U.; Maier S.; Kersten A.; Meyns B.; Pozzi M.; Pedersen F.M.; Schellongowski P.; Kirali K.; Barrett N.; Riera J.; Mueller T.; Belohlavek J.; Lo Coco V.; Van der Horst I.C.C.; Van Bussel B.C.T.; Schnabel R.M.; Delnoij T.; Bolotin G.; Lorini L.; Schmiady M.O.; Schibilsky D.; Kowalewski M.; Pinto L.F.; Silva P.E.; Kornilov I.; Blandino Ortiz A.; Vercaemst L.; Finney S.; Roeleveld P.P.; Di Nardo M.; Hennig F.; Antonini M.V.; Davidson M.; Jones T.J.; Staudinger T.; Mair P.; Kilo J.; Krapf C.; Erbert K.; Peer A.; Bonaros N.; Kotheletner F.; Krenner Mag N.; Shestakova L.; Hermans G.; Dauwe D.; Meersseman P.; Stockman B.; Nobile L.; Lhereux O.; Nrasseurs A.; Creuter J.; De Backer D.; Giglioli S.; Michiels G.; Foulon P.; Raes M.; Rodrigus I.; Allegaert M.; Jorens P.; Debeucklare G.; Piagnerelli M.; Biston P.; Peperstraete H.; Vandewiele K.; Germay O.; Vandeweghe D.; Havrin S.; Bourgeois M.; Lagny M.-G.; Alois G.; Lavios N.; Misset B.; Courcelle R.; Timmermans P.J.; Yilmaz A.; Vantomout M.; Lehaen J.; Jassen A.; Guterman H.; Strauven M.; Lormans P.; Verhamme B.; Vandewaeter C.; Bonte F.; Vionne D.; Balik M.; Blaha J.; Lips M.; Othal M.; Bursa F.; Spacek R.; Christensen S.; Jorgensen V.; Sorensen M.; Madsen S.A.; Puss S.; Beljantsev A.; Saiydoun G.; Fiore A.; Colson P.; Bazalgette F.; Capdevila X.; Kollen S.; Muller L.; Obadia J.-F.; Dubien P.-Y.; Ajrhourh L.; Guinot P.G.; Zarka J.; Besserve P.; Malfertheiner M.V.; Dreier E.; Heinze B.; Akhyari P.; Lichtenberg A.; Aubin H.; Assman A.; Saeed D.; Thiele H.; Baumgaertel M.; Schmitto J.D.; Ruslan N.; Haverich A.; Thielmann M.; Brenner T.; Ruhpawar A.; Benk C.; Czerny M.; Staudacher D.L.; Beyersdorf F.; Kalbhenn J.; Henn P.; Popov A.-F.; Iuliu T.; Muellenbach R.; Reyher C.; Rolfes C.; Lotz G.; Sonntagbauer M.; Winkels H.; Fichte J.; Stohr R.; Kalverkamp S.; Karagiannidis C.; Schafer S.; Svetlitchny A.; Hopf H.-B.; Jarczak D.; Groesdonk H.; Rommer M.; Hirsch J.; Kaehny C.; Soufleris D.; Gavriilidis G.; Pontikis K.; Kyriakopoulou M.; Kyriakoudi A.; O'Brien S.; Conrick-Martin I.; Carton E.; Makhoul M.; Ben-Ari J.; Hadash A.; Kogan A.; Kassif Lerner R.; Abu-Shakra A.; Matan M.; Balawona A.; Kachel E.; Altshuler R.; Galante O.; Fuchs L.; Almog Y.; Ishay Y.S.; Lichter Y.; Gal-oz A.; Carmi U.; Nini A.; Soroksky A.; Dekel H.; Rozman Z.; Tayem E.; Ilgiyaev E.; Hochman Y.; Miltau D.; Rapoport A.; Eden A.; Kompanietz D.; Yousif M.; Golos M.; Grazioli L.; Ghitti D.; Loforte A.; Di Luca D.; Baiocchi M.; Pacini D.; Cappai A.; Meani P.; Mondino M.; Russo C.F.; Ranucci M.; Fina D.; Cotza M.; Ballotta A.; Landoni G.; Nardelli P.; Fominski E.V.; Brazzi L.; Montrucchio G.; Sales G.; Simonetti U.; Livigni S.; Silengo D.; Arena G.; Sovatzis S.S.; Degani A.; Riccardi M.; Milanesi E.; Raffa G.; Martucci G.; Arcadipane A.; Panarello G.; Chiarini G.; Cattaneo S.; Puglia C.; Benussi S.; Foti G.; Giani M.; Bombino M.; Costa M.C.; Rona R.; Avalli L.; Donati A.; Carozza R.; Gasparri F.; Carsetti A.; Piciche M.; Marinello A.; Danzi V.; Zanin A.; Condello I.; Fiore F.; Moscarelli M.; Nasso G.; Speziale G.; Sandrelli L.; Montalto A.; Musumeci F.; Circelli A.; Russo E.; Agnoletti V.; Rociola R.; Milano A.D.; Pilato E.; Comentale G.; Montisci A.; Alessandri F.; Tosi A.; Pugliese F.; Giordano G.; Carelli S.; Grieco D.L.; Dell'Anna A.M.; Antonelli M.; Ramoni E.; Zulueta J.; Del Giglio M.; Petracca S.; Bertini P.; Guarracino F.; De Simone L.; Angeletti P.M.; Forfori F.; Taraschi F.; Quintiliani V.N.; Samalavicius R.; Jankuviene A.; Scupakova N.; Urbonas K.; Kapturauskas J.; Soerensen G.; Suwalski P.; Linhares Santos L.; Marques A.; Miranda M.; Teixeira S.; Salgueiro A.; Pereira F.; Ketskalo M.; Tsarenko S.; Shilova A.; Afukov I.; Popugaev K.; Minin S.; Shelukhin D.; Malceva O.; Gleb M.; Skopets A.; Kornelyuk R.; Kulikov A.; Okhrimchuk V.; Turchaninov A.; Petrushin M.; Sheck A.; Mekulov A.; Ciryateva S.; Urusov D.; Gorjup V.; Golicnik A.; Goslar T.; Ferrer R.; Martinez-Martinez M.; Argudo E.; Palmer N.; De Pablo Sanchez R.; Juan Higuera L.; Arnau Blasco L.; Marquez J.A.; Sbraga F.; Fuset M.P.; De Gopegui P.R.; Claraco L.M.; De Ayala J.A.; Peiro M.; Ricart P.; Martinez S.; Chavez F.; Fabra M.; Sandoval E.; Toapanta D.; Carraminana A.; Tellez A.; Ososio J.; Milan P.; Rodriguez J.; Andoni G.; Gutierrez C.; Perez de la Sota E.; Eixeres-Esteve A.; Garcia-Maellas M.T.; Gutierrez-Gutierrez J.; Arboleda-Salazar R.; Santa Teresa P.; Jaspe A.; Garrido A.; Castaneda G.; Alcantara S.; Martinez N.; Perez M.; Villanueva H.; Vidal Gonzalez A.; Paez J.; Santon A.; Perez C.; Lopez M.; Rubio Lopez M.I.; Gordillo A.; Naranjo-Izurieta J.; Munoz J.; Alcalde I.; Onieva F.; Gimeno Costa R.; Perez F.; Madrid I.; Gordon M.; Albacete Moreno C.L.; Perez D.; Lopez N.; Martinenz D.; Blanco-Schweizer P.; Diez C.; Perez D.; Prieto A.; Renedo G.; Bustamante E.; Cicuendez R.; Citores R.; Boado V.; Garcia K.; Voces R.; Domezain M.; Nunez Martinez J.M.; Vicente R.; Martin D.; Andreu A.; Gomez Casal V.; Chico I.; Menor E.M.; Vara S.; Gamacho J.; Perez-Chomon H.; Javier Gonzales F.; Barrero I.; Martin-Villen L.; Fernandez E.; Mendoza M.; Navarro J.; Colomina Climent J.; Gonzales-Perez A.; Muniz-Albaceita G.; Amado L.; Rodriguez R.; Ruiz E.; Eiras M.; Grins E.; Magnus R.; Kanetoft M.; Eidevald M.; Watson P.; Vogt P.R.; Steiger P.; Aigner T.; Weber A.; Grunefelder J.; Kunz M.; Grapow M.; Aymard T.; Reser D.; Agus G.; Consiglio J.; Haenggi M.; Hansjoerg J.; Iten M.; Doeble T.; Zenklusen U.; Bechtold X.; Faedda G.; Iafrate M.; Rohjer A.; Bergamaschi L.; Maessen J.; Reis Miranda D.; Endeman H.; Gommers D.; Meuwese C.; Maas J.; Van Gijlswijk M.J.; Van Berg R.N.; Candura D.; Van der Linden M.; Kant M.; Van der Heijden J.J.; Scholten E.; Van Belle-van Haren N.; Lagrand W.K.; Vlaar A.P.; De Jong S.; Cander B.; Sargin M.; Ugur M.; Kaygin M.A.; Daly K.; Agnew N.; Head L.; Kelly L.; Anoma G.; Russell C.; Aquino V.; Scott I.; Flemming L.; Gillon S.; Moore O.; Gelandt E.; Auzinger G.; Patel S.; Loveridge R.. - In: THE LANCET RESPIRATORY MEDICINE. - ISSN 2213-2600. - ELETTRONICO. - 11:2(2023), pp. 151-162. [10.1016/S2213-2600(22)00403-9]
In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study
Lo Coco V.;Loforte A.;Pacini D.;Pilato E.;Comentale G.;Pugliese F.;
2023
Abstract
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
