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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.
Lorusso R., De Piero M.E., Mariani S., Di Mauro M., Folliguet T., Taccone F.S., et al. (2023). In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study. THE LANCET RESPIRATORY MEDICINE, 11(2), 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
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.
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.
Lorusso R., De Piero M.E., Mariani S., Di Mauro M., Folliguet T., Taccone F.S., et al. (2023). In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study. THE LANCET RESPIRATORY MEDICINE, 11(2), 151-162 [10.1016/S2213-2600(22)00403-9].
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.; Vuylste...espandi
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