Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation

被引：30

作者：

Herrmann, Johannes ^{[1
]}

Lotz, Christopher ^{[1
]}

Karagiannidis, Christian ^{[2
]}

Weber-Carstens, Steffen ^{[3
]}

Kluge, Stefan ^{[4
]}

Putensen, Christian ^{[5
]}

Wehrfritz, Andreas ^{[6
]}

Schmidt, Karsten ^{[7
]}

Ellerkmann, Richard K. ^{[8
]}

Oswald, Daniel ^{[9
]}

Lotz, Gosta ^{[10
]}

Zotzmann, Viviane ^{[11
,12
]}

Moerer, Onnen ^{[13
]}

Kuehn, Christian ^{[14
]}

Kochanek, Matthias ^{[15
]}

Muellenbach, Ralf ^{[16
]}

Gaertner, Matthias ^{[17
]}

Fichtner, Falk ^{[18
]}

Brettner, Florian ^{[19
]}

Findeisen, Michael ^{[20
]}

Heim, Markus ^{[21
]}

Lahmer, Tobias ^{[22
]}

Rosenow, Felix ^{[23
]}

Haake, Nils ^{[24
]}

Lepper, Philipp M. ^{[25
]}

Rosenberger, Peter ^{[26
]}

Braune, Stephan ^{[27
]}

Kohls, Mirjam ^{[28
]}

Heuschmann, Peter ^{[28
,29
]}

Meybohm, Patrick ^{[1
]}

机构：

[1] Univ Hosp Wuerzburg, Dept Anaesthesiol Intens Care Emergency & Pain Me, Oberduerrbacherstr 6, D-97080 Wurzburg, Germany

[2] Witten Herdecke Univ Hosp, Dept Pneumol & Crit Care Med, Cologne Merheim Hosp, ARDS & ECMO Ctr,Kliniken Stadt Koln, Cologne, Germany

[3] Charite Univ Med Berlin, Dept Anesthesiol & Operat Intens Care Med, Berlin, Germany

[4] Univ Med Ctr Hamburg Eppendorf, Dept Intens Care, Hamburg, Germany

[5] Univ Hosp Bonn, Dept Anesthesiol & Intens Care Med, Bonn, Germany

[6] Friedrich Alexander Univ, Univ Hosp Erlangen, Dept Anaesthesiol, Erlangen Nuernberg FAU, Erlangen, Germany

[7] Univ Duisburg Essen, Univ Hosp Essen, Dept Anesthesiol & Intens Care Med, Essen, Germany

[8] Klinikum Univ Witten Herdecke, Klinikum Dortmund, Dept Anesthesiol & Intens Care Med, Dortmund, Germany

[9] Clin Ctr Westfalen, Dept Anesthesiol Intens Care Med & Pain Therapy, Dortmund, Germany

[10] Goethe Univ Frankfurt, Univ Hosp Frankfurt, Dept Anaesthesiol Intens Care Med & Pain Therapy, Frankfurt, Germany

[11] Univ Freiburg, Dept Cardiol & Angiol 1, Heart Ctr Freiburg Bad Krozingen, Med Ctr,Fac Med, Freiburg, Germany

[12] Univ Freiburg, Interdisciplinary Med Intens Care IMIT, Med Ctr, Fac Med, Freiburg, Germany

[13] Univ Med Ctr Gottingen, Dept Anesthesiol, Robert Koch Str 40, D-37085 Gottingen, Germany

[14] Hannover Med Sch, Dept Cardiothorac Transplantat & Vasc Surg, Hannover, Germany

[15] Univ Hosp Cologne, Div Hematol Oncol, Dept Internal Med, Cologne, Germany

[16] Univ Southampton, ARDS ECMO Ctr, Dept Anesthesiol & Crit Care Med, Campus Kassel, Kassel, Germany

[17] Asklepios Klin Langen, Dept Anaesthesia Perioperat Med & Interdisciplina, ECLSE CMO Ctr, Langen, Germany

[18] Univ Leipzig, Dept Anesthesiol & Intens Care Med, Med Ctr, Leipzig, Germany

[19] Barmherzige Bruder Krankenhaus Munchen, ARDS & ECMO Zentrum Munchen Nymphenburg, Munich, Germany

[20] Munchen Klin Harlaching, Klin Pneumol Internist Intens & Beatmungsmed, Munich, Germany

[21] Tech Univ Munich, Sch Med, Dept Anaesthesiol & Intens Care Med, Munich, Germany

[22] Univ Munich, Sch Med, Univ Hosp Rechts Isar, Dept Internal Med, Ismaninger Str 22, D-81675 Munich, Germany

[23] Univ Hosp Muenster, Dept Cardiol Coronary & Peripheral Vasc Dis 1, Heart Failure, Munster, Germany

[24] Imland Klin Rendsburg, Dept Intens Care Med, Rendsburg, Germany

[25] Saarland Univ, Dept Internal Med Pneumol Allergol & Crit Care Me, Homburg, Germany

[26] Eberhard Karls Univ Tubingen, Univ Tubingen Hosp, Dept Anesthesiol & Intens Care Med, Tubingen, Germany

[27] St Franziskus Hosp Muenster, Dept Med Intens Care & Emergency Med, Munster, Germany

[28] Univ Wurzburg, Inst Clin Epidemiol & Biometry, Wurzburg, Germany

[29] Univ Klinikum Wurzburg, Clin Trial Ctr Wurzburg, Wurzburg, Germany

来源：

CRITICAL CARE | 2022年 / 26卷 / 01期

关键词：

COVID-19; Acute respiratory distress syndrome (ARDS); Intensive care; Extracorporeal life support; Case-volume relationship; ORGANIZATION; MORTALITY; DEFINITION; SUPPORT; DISEASE; COHORT; VOLUME;

D O I：

10.1186/s13054-022-04053-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients. Methods: 673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival. Results: Most patients were between 50 and 70 years of age. PaO2/FiO(2) ratio prior to ECMO was 72 mmHg (IQR: 58-99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41-0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28-1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events. Conclusions: Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival.

引用

页数：14

共 32 条

[1] ECMO during the COVID-19 pandemic: when is it unjustified? [J].

Abrams, Darryl ;

Lorusso, Roberto ;

Vincent, Jean-Louis ;

Brodie, Daniel .

CRITICAL CARE, 2020, 24 (01)

[2] Predictive factors of bleeding events in adults undergoing extracorporeal membrane oxygenation [J].

Aubron, Cecile ;

DePuydt, Joris ;

Belon, Franois ;

Bailey, Michael ;

Schmidt, Matthieu ;

Sheldrake, Jayne ;

Murphy, Deirdre ;

Scheinkestel, Carlos ;

Cooper, D. Jamie ;

Capellier, Gilles ;

Pellegrino, Vincent ;

Pilcher, David ;

McQuilten, Zoe .

ANNALS OF INTENSIVE CARE, 2016, 6

[3] Extracorporeal membrane oxygenation for COVID-19: evolving outcomes from the international Extracorporeal Life Support Organization Registry [J].

Barbaro, Ryan P. ;

MacLaren, Graeme ;

Boonstra, Philip S. ;

Combes, Alain ;

Agerstrand, Cara ;

Annich, Gail ;

Diaz, Rodrigo ;

Fan, Eddy ;

Hryniewicz, Katarzyna ;

Lorusso, Roberto ;

Paden, Matthew L. ;

Stead, Christine M. ;

Swol, Justyna ;

Iwashyna, Theodore J. ;

Slutsky, Arthur S. ;

Brodie, Daniel .

LANCET, 2021, 398 (10307) :1230-1238

[4] Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry [J].

Barbaro, Ryan P. ;

MacLaren, Graeme ;

Boonstra, Philip S. ;

Iwashyna, Theodore J. ;

Slutsky, Arthur S. ;

Fan, Eddy ;

Bartlett, Robert H. ;

Tonna, Joseph E. ;

Hyslop, Robert ;

Fanning, Jeffrey J. ;

Rycus, Peter T. ;

Hyer, Steve J. ;

Anders, Marc M. ;

Agerstrand, Cara L. ;

Hryniewicz, Katarzyna ;

Diaz, Rodrigo ;

Lorusso, Roberto ;

Combes, Alain ;

Brodie, Daniel .

LANCET, 2020, 396 (10257) :1071-1078

[5] Association of Hospital-Level Volume of Extracorporeal Membrane Oxygenation Cases and Mortality Analysis of the Extracorporeal Life Support Organization Registry [J].

Barbaro, Ryan P. ;

Odetola, Folafoluwa O. ;

Kidwell, Kelley M. ;

Paden, Matthew L. ;

Bartlett, Robert H. ;

Davis, Matthew M. ;

Annich, Gail M. .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2015, 191 (08) :894-901

[6] Procedural volume and outcomes in patients undergoing VA-ECMO support [J].

Becher, Peter Moritz ;

Gossling, Alina ;

Schrage, Benedikt ;

Twerenbold, Raphael ;

Fluschnik, Nina ;

Seiffert, Moritz ;

Bernhardt, Alexander M. ;

Reichenspurner, Hermann ;

Blankenberg, Stefan ;

Westermann, Dirk .

CRITICAL CARE, 2020, 24 (01)

[7] Risk of mortality in patients infected with SARS-CoV-2 variant of concern 202012/1: matched cohort study [J].

Challen, Robert ;

Brooks-Pollock, Ellen ;

Read, Jonathan M. ;

Dyson, Louise ;

Tsaneva-Atanasova, Krasimira ;

Danon, Leon .

BMJ-BRITISH MEDICAL JOURNAL, 2021, 372

[8]

Cheng YC, 2020, KIDNEY INT, V97, P829, DOI 10.1016/j.kint.2020.03.005

[9] Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome [J].

Combes, A. ;

Hajage, D. ;

Capellier, G. ;

Demoule, A. ;

Lavoue, S. ;

Guervilly, C. ;

Da Silva, D. ;

Zafrani, L. ;

Tirot, P. ;

Veber, B. ;

Maury, E. ;

Levy, B. ;

Cohen, Y. ;

Richard, C. ;

Kalfon, P. ;

Bouadma, L. ;

Mehdaoui, H. ;

Beduneau, G. ;

Lebreton, G. ;

Brochard, L. ;

Ferguson, N. D. ;

Fan, E. ;

Slutsky, A. S. ;

Brodie, D. ;

Mercat, A. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (21) :1965-1975

[10] Position Paper for the Organization of Extracorporeal Membrane Oxygenation Programs for Acute Respiratory Failure in Adult Patients [J].

Combes, Alain ;

Brodie, Daniel ;

Bartlett, Robert ;

Brochard, Laurent ;

Brower, Roy ;

Conrad, Steve ;

De Backer, Daniel ;

Fan, Eddy ;

Ferguson, Niall ;

Fortenberry, James ;

Fraser, John ;

Gatiinoni, Luciano ;

Lynch, William ;

MacLaren, Graeme ;

Mercat, Alain ;

Mueller, Thomas ;

Ogino, Mark ;

Peek, Giles ;

Pellegrino, Vince ;

Pesenti, Antonio ;

Ranieri, Marco ;

Slutsky, Arthur ;

Vuylsteke, Alain .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2014, 190 (05) :488-496

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