Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study. (29th March 2022)

• Record Type: Journal Article
• Authors: Nesseler, Nicolas; Fadel, Guillaume; Mansour, Alexandre; Para, Marylou; Falcoz, Pierre-Emmanuel; Mongardon, Nicolas; Porto, Alizée; Bertier, Astrid; Levy, Bruno; Cadoz, Cyril; Guinot, Pierre-Grégoire; Fouquet, Olivier; Fellahi, Jean-Luc; Ouattara, Alexandre; Guihaire, Julien; Ruggieri, Vito-Giovanni; Gaudard, Philippe; Labaste, François; Clavier, Thomas; Brini, Kais; Allou, Nicolas; Lacroix, Corentin; Chommeloux, Juliette; Lebreton, Guillaume; Matthay, Michael A.; Provenchere, Sophie; Flécher, Erwan; Vincentelli, André
• Other Names: Pierrot Marc author non-byline.; Chocron Sidney author non-byline.; Flicoteaux Guillaume author non-byline.; Mauriat Philippe author non-byline.; Roze Hadrien author non-byline.; Huet Olivier author non-byline.; Fischer Marc-Olivier author non-byline.; Alessandri Claire author non-byline.; Bellaïche Raphel author non-byline.; Constant Ophélie author non-byline.; de Roux Quentin author non-byline.; Ly André author non-byline.; Meffert Arnaud author non-byline.; Merle Jean-Claude author non-byline.; Picard Lucile author non-byline.; Skripkina Elena author non-byline.; Folliguet Thierry author non-byline.; Fiore Antonio author non-byline.; d'Ostrevy Nicolas author non-byline.; Morgan Marie-Catherine author non-byline.; Nguyen Maxime author non-byline.; Gaide-Chevronnay Lucie author non-byline.; Terzi Nicolas author non-byline.; Colin Gwenhaël author non-byline.; Fabre Olivier author non-byline.; Astaneh Arash author non-byline.; Issard Justin author non-byline.; Fadel Elie author non-byline.; Fabre Dominique author non-byline.; Girault Antoine author non-byline.; Ion Iolande author non-byline.; Menager Jean Baptiste author non-byline.; Mitilian Delphine author non-byline.; Mercier Olaf author non-byline.; Stephan François author non-byline.; Thes Jacques author non-byline.; Jouan Jerôme author non-byline.; Duburcq Thibault author non-byline.; Loobuyck Valentin author non-byline.; Manganiello Sabrina author non-byline.; Moussa Mouhammed author non-byline.; Mugnier Agnes author non-byline.; Rousse Natacha author non-byline.; Desebbe Olivier author non-byline.; Henaine Roland author non-byline.; Pozzi Matteo author non-byline.; Richard Jean-Christophe author non-byline.; Riad Zakaria author non-byline.; Guervilly Christophe author non-byline.; Hraiech Sami author non-byline.; Papazian Laurent author non-byline.; Castanier Matthias author non-byline.; Chanavaz Charles author non-byline.; Gette Sebastien author non-byline.; Louis Guillaume author non-byline.; Portocarrero Erick author non-byline.; Bischoff Nicolas author non-byline.; Kimmoun Antoine author non-byline.; Mattei Mathieu author non-byline.; Perez Pierre author non-byline.; Bourdiol Alexandre author non-byline.; Hourmant Yannick author non-byline.; Mahé Pierre-Joachim author non-byline.; Rozec Bertrand author non-byline.; Vourc'h Mickaël author non-byline.; Aubert Stéphane author non-byline.; Bazalgette Florian author non-byline.; Roger Claire author non-byline.; Jaquet Pierre author non-byline.; Lortat-Jacob Brice author non-byline.; Mordant Pierre author non-byline.; Nataf Patrick author non-byline.; Patrier Juliette author non-byline.; Roué Morgan author non-byline.; Sonneville Romain author non-byline.; Tran-Dinh Alexy author non-byline.; Wicky Paul-Henri author non-byline.; Al Zreibi Charles author non-byline.; Cholley Bernard author non-byline.; Guyonvarch Yannis author non-byline.; Hamada Sophie author non-byline.; Barbanti Claudio author non-byline.; Harrois Anatole author non-byline.; Matiello Jordi author non-byline.; Kerforne Thomas author non-byline.; Brechot Nicolas author non-byline.; Combes Alain author non-byline.; Constantin Jean Michel author non-byline.; D'Alessandro Cosimo author non-byline.; Demondion Pierre author non-byline.; Demoule Alexandre author non-byline.; Dres Martin author non-byline.; Fartoukh Muriel author non-byline.; Hekimian Guillaume author non-byline.; Juvin Charles author non-byline.; Leprince Pascal author non-byline.; Levy David author non-byline.; Luyt Charles Edouard author non-byline.; Pineton de Chambrun Marc author non-byline.; Schmidt Matthieu author non-byline.; Schoell Thibaut author non-byline.; Fillâtre Pierre author non-byline.; Massart Nicolas author non-byline.; Nicolas Roxane author non-byline.; Jonas Maud author non-byline.; Vidal Charles author non-byline.; Muccio Salvatore author non-byline.; Di Perna Dario author non-byline.; Mourvillier Bruno author non-byline.; Anselmi Amedeo author non-byline.; Bounader Karl author non-byline.; Esvan Maxime author non-byline.; Fougerou-Leurent Claire author non-byline.; Launey Yoann author non-byline.; Lebouvier Thomas author non-byline.; Parasido Alessandro author non-byline.; Reizine Florian author non-byline.; Seguin Philippe author non-byline.; Besnier Emmanuel author non-byline.; Carpentier Dorothée author non-byline.; Olland Anne author non-byline.; Bounes Fanny author non-byline.; Minville Vincent author non-byline.; Guillon Antoine author non-byline.; Fedun Yannick author non-byline.; Ross James T. author non-byline.;
• Is Part Of: Anesthesiology. Volume 136:Number 5(2022)
• Page Start: 732
• Page End: 748
• Publication Date: 2022-03-29
• Subjects: Anesthesiology -- Periodicals; Anesthetics -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1097/ALN.0000000000004168
• Languages: English
• ISSNs: 0003-3022

Abstract

Abstract : Background: Despite expanding use, knowledge on extracorporeal membrane oxygenation support during the COVID-19 pandemic remains limited. The objective was to report characteristics, management, and outcomes of patients receiving extracorporeal membrane oxygenation with a diagnosis of COVID-19 in France and to identify pre-extracorporeal membrane oxygenation factors associated with in-hospital mortality. A hypothesis of similar mortality rates and risk factors for COVID-19 and non–COVID-19 patients on venovenous extracorporeal membrane oxygenation was made. Methods: The Extracorporeal Membrane Oxygenation for Respiratory Failure and/or Heart failure related to Severe Acute Respiratory Syndrome-Coronavirus 2 (ECMOSARS) registry included COVID-19 patients supported by extracorporeal membrane oxygenation in France. This study analyzed patients included in this registry up to October 25, 2020, and supported by venovenous extracorporeal membrane oxygenation for respiratory failure with a minimum follow-up of 28 days after cannulation. The primary outcome was in-hospital mortality. Risk factors for in-hospital mortality were analyzed. Results: Among 494 extracorporeal membrane oxygenation patients included in the registry, 429 were initially supported by venovenous extracorporeal membrane oxygenation and followed for at least 28 days. The median (interquartile range) age was 54 yr (46 to 60 yr), and 338 of 429 (79%) were men. Management before extracorporeal membrane oxygenation cannulation included prone positioning for 411 of 429 (96%), neuromuscular blockage for 419 of 427 (98%), and NO for 161 of 401 (40%). A total of 192 of 429 (45%) patients were cannulated by a mobile extracorporeal membrane oxygenation unit. In-hospital mortality was 219 of 429 (51%), with a median follow-up of 49 days (33 to 70 days). Among pre-extracorporeal membrane oxygenation modifiable exposure variables, neuromuscular blockage use (hazard ratio, 0.286; 95% CI, 0.101 to 0.81) and duration of ventilation (more than 7 days compared to less than 2 days; hazard ratio, 1.74; 95% CI, 1.07 to 2.83) were independently associated with in-hospital mortality. Both age (per 10-yr increase; hazard ratio, 1.27; 95% CI, 1.07 to 1.50) and total bilirubin at cannulation (6.0 mg/dl or more compared to less than 1.2 mg/dl; hazard ratio, 2.65; 95% CI, 1.09 to 6.5) were confounders significantly associated with in-hospital mortality. Conclusions: In-hospital mortality was higher than recently reported, but nearly half of the patients survived. A high proportion of patients were cannulated by a mobile extracorporeal membrane oxygenation unit. Several factors associated with mortality were identified. Venovenous extracorporeal membrane oxygenation support should be considered early within the first week of mechanical ventilation initiation. Abstract : In this investigation, most patients were cannulated by a mobile extracorporeal membrane oxygenation unit without a negative impact on mortality. Based on this report, venovenous extracorporeal membrane oxygenation support should be considered within the first week of mechanical ventilation initiation for optimal outcomes.