In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Lorusso, Roberto; De Piero, Maria Elena; Mariani, Silvia; Di Mauro, Michele; Folliguet, Thierry; Taccone, Fabio Silvio; Camporota, Luigi; Swol, Justyna; Wiedemann, Dominik; Belliato, Mirko; Broman, Lars Mikael; Vuylsteke, Alain; Kassif, Yigal; Scandroglio, Anna Mara; Fanelli, Vito; Gaudard, Philippe; Ledot, Stephane; Barker, Julian; Boeken, Udo; Maier, Sven; Kersten, Alexander; Meyns, Bart; Pozzi, Matteo; Pedersen, Finn M; Schellongowski, Peter; Kirali, Kaan; Barrett, Nicholas; Riera, Jordi; Mueller, Thomas; Belohlavek, Jan; Lorusso, Roberto; De Piero, Maria Elena; Mariani, Silvia; Di Mauro, Michele; Folliguet, Thierry; Taccone, Fabio Silvio; Camporota, Luigi; Swol, Justyna; Wiedemann, Dominik; Belliato, Mirko; Broman, Lars Mikael; Vuylsteke, Alain; Kassif, Yigal; Scandroglio, Anna Mara; Fanelli, Vito; Gaudard, Philippe; Ledot, Stephane; Barker, Julian; Boeken, Udo; Maier, Sven; Kersten, Alexander; Meyns, Bart; Pozzi, Matteo; Pedersen, Finn M; Schellongowski, Peter; Kirali, Kaan; Barrett, Nicholas; Riera, Jordi; Mueller, Thomas; Belohlavek, Jan; Lo Coco, Valeria; Van der Horst, Iwan C C; Van Bussel, Bas C T; Schnabel, Ronny M; Delnoij, Thijs; Bolotin, Gil; Lorini, Luca; Schmiady, Martin O; Schibilsky, David; Kowalewski, Mariusz; Pinto, Luis F; Silva, Pedro E; Kornilov, Igor; Blandino Ortiz, Aaron; Vercaemst, Leen; Finney, Simon; Roeleveld, Peter P; Di Nardo, Matteo; Hennig, Felix; Antonini, Marta Velia; Davidson, Mark; Jones, Tim J; Staudinger, Thomas; Mair, Peter; Kilo, Juliane; Krapf, Christoph; Erbert, Kathrin; Peer, Andreas; Bonaros, Nikolaos; Kotheletner, Florian; Krenner Mag, Niklas; Shestakova, Liana; Hermans, Greet; Dauwe, Dieter; Meersseman, Philippe; Stockman, Bernard; Nobile, Leda; Lhereux, Olivier; Nrasseurs, Alexandre; Creuter, Jacques; De Backer, Daniel; Giglioli, Simone; Michiels, Gregoire; Foulon, Pierre; Raes, Matthias; Rodrigus, Inez; Allegaert, Matthias; Jorens, Philippe; Debeucklare, Gerd; Piagnerelli, Michael; Biston, Patrick; Peperstraete, Harlinde; Vandewiele, Komeel; Germay, Olivier; Vandeweghe, Dimitri; Havrin, Sven; Bourgeois, Marc; Lagny, Marc-Gilbert; Alois, Genette; Lavios, Nathalie; Misset, Benoit; Courcelle, Romain; Timmermans, Philippe J; Yilmaz, Alaaddin; Vantomout, Michiel; Lehaen, Jerone; Jassen, Ame; Guterman, Herbert; Strauven, Maarten; Lormans, Piet; Verhamme, Bruno; Vandewaeter, catherine; Bonte, Frederik; Vionne, Dominique; Balik, Martin; Blàha, Jan; Lips, Michal; Othal, Michal; Bursa, Filip; Spacek, Radim; Christensen, Steffen; Jorgensen, Vibeke; Sorensen, Marc; Madsen, Soren A; Puss, Severin; Beljantsev, Aleksandr; Saiydoun, gabriel; Fiore, Antonio; Colson, Pascal; Bazalgette, Florian; Capdevila, Xavier; Kollen, Sebastien; Muller, Laurent; Obadia, Jean-Francois; Dubien, Pierre-Yves; Ajrhourh, Lucrezia; Guinot, Pierre G; Zarka, Jonathan; Besserve, Patricia; Malfertheiner, Maximilian V; Dreier, Esther; Heinze, Birgit; Akhyari, Payam; Lichtenberg, Artur; Aubin, Hug; Assman, Alexander; Saeed, Diyar; Thiele, Holger; Baumgaertel, Matthias; Schmitto, Jan D; Ruslan, Natanov; Haverich, Axel; Thielmann, Matthias; Brenner, Thorsten; Ruhpawar, Arjang; Benk, Christoph; Czerny, Martin; Staudacher, Dawid L; Beyersdorf, Fridhelm; Kalbhenn, Johannes; Henn, Philipp; Popov, Aron-Frederik; Iuliu, Torje; Muellenbach, Ralf; Reyher, Christian; Rolfes, Caroline; Lotz, Gosta; Sonntagbauer, Michael; Winkels, Helen; Fichte, Julia; Stohr, Robert; Kalverkamp, Sebastian; Karagiannidis, Christian; Schafer, Simone; Svetlitchny, Alexei; Fichte, Julia; Hopf, Hans-Bernd; Jarczak, Dominik; Groesdonk, Heinirich; Rommer, Magdalena; Hirsch, Jan; Kaehny, Christian; Soufleris, Dimitros; Gavriilidis, Georgios; Pontikis, Kostantinos; Kyriakopoulou, Magdalini; Kyriakoudi, Anna; O'Brien, Serena; Conrick-Martin, Ian; Carton, Edmund; Makhoul, Maged; Ben-Ari, Josef; Hadash, Amir; Kogan, Alexander; Kassif Lerner, Reut; Abu-Shakra, Anas; Matan, Moshe; Balawona, Ahmad; Kachel, Erez; Altshuler, Roman; Galante, Ori; Fuchs, Lior; Almog, Yaniv; Ishay, Yaron S; Lichter, Yael; Gal-oz, Amir; Carmi, Uri; Nini, Asaph; Soroksky, Arie; Dekel, Hagi; Rozman, Ziv; Tayem, Emad; Ilgiyaev, Eduard; Hochman, Yuval; Miltau, daniel; Rapoport, Avigal; Eden, Arieh; Kompanietz, Dmitry; Yousif, Michael; Golos, Miri; Grazioli, Lorenzo; Ghitti, Davide; Loforte, Antonio; Di Luca, Daniela; Baiocchi, Massimo; Pacini, Davide; Cappai, Antioco; Meani, Paolo; Mondino, Michele; Russo, Claudio F; Ranucci, Marco; Fina, Dario; Cotza, Marco; Ballotta, Andrea; Landoni, Giovanni; Nardelli, Pasquale; Fominski, Eygeny V; Brazzi, Luca; Montrucchio, Giorgia; Sales, Gabriele; Simonetti, Umberto; Livigni, Sergio; Silengo, Daniela; Arena, Giulia; Sovatzis, Stefania S; Degani, Antonella; Riccardi, Mariachiara; Milanesi, Elisa; Raffa, Giuseppe; Martucci, Gennaro; Arcadipane, Antonio; Panarello, Giovanna; Chiarini, Giovanni; Cattaneo, Sergio; Puglia, Carmine; Benussi, Stefano; Foti, Giuseppe; Giani, Marco; Bombino, Michela; Costa, Maria Cristina; Rona, Roberto; Avalli, Leonello; Donati, Abele; Carozza, Roberto; Gasparri, Francesco; Carsetti, Andrea; Picichè, Marco; Marinello, Anna; Danzi, Vinicio; Zanin, Anita; Condello, Ignazio; Fiore, Flavio; Moscarelli, Marco; Nasso, Giuseppe; Speziale, Giuseppe; Sandrelli, Luca; Montalto, Andrea; Musumeci, Francesco; Circelli, Alessandro; Russo, Emanuele; Agnoletti, Vanni; Rociola, Ruggero; Milano, Aldo D; Pilato, Emanuele; Comentale, Giuseppe; Montisci, Andrea; Alessandri, Francesco; Tosi, Antonella; Pugliese, Francesco; Giordano, Giovanni; Carelli, Simone; Grieco, Domenico L; Dell'Anna, Antonio M; Antonelli, Massimo; Ramoni, Enrico; Zulueta, Josè; Del Giglio, Mauro; Petracca, Sebastiano; Bertini, Pietro; Guarracino, Fabio; De Simone, Luigi; Angeletti, Paolo M; Forfori, Francesco; Taraschi, Francesco; Quintiliani, Veronica N; Samalavicius, Robertas; Jankuviene, Agne; Scupakova, Nadezda; Urbonas, Karolis; Kapturauskas, Juozas; Soerensen, Gro; Suwalski, Piotr; Linhares Santos, Luis; Marques, Ana; Miranda, Marisa; Teixeira, Sonia; Salgueiro, Andrea; Pereira, Filipe; Ketskalo, Michail; Tsarenko, Sergey; Shilova, Alexandra; Afukov, Ivan; Popugaev, Konstantin; Minin, Sergei; Shelukhin, Daniil; Malceva, Olga; Gleb, Moroz; Skopets, Alexander; Kornelyuk, Roman; Kulikov, Alexandr; Okhrimchuk, Vadim; Turchaninov, Alexandr; Shelukhin, Daniil; Petrushin, Maxim; Sheck, Anastasia; Mekulov, Akhmed; Ciryateva, Svetlana; Urusov, Dmitry; Gorjup, Vojka; Golicnik, Alenka; Goslar, Tomaz; Ferrer, Ricard; Martinez-Martinez, Maria; Argudo, Eduard; Palmer, Neiser; De Pablo Sanchez, Raul; Juan Higuera, Lucas; Arnau Blasco, Lucas; Marquez, Josè A; Sbraga, Fabrizio; Fuset, Mari Paz; De Gopegui, Pablo Ruiz; Claraco, Luis M; De Ayala, Josè A; Peiro, Maranta; Ricart, Pilar; Martinez, Sergio; Chavez, Fernando; Fabra, Marc; Sandoval, elena; Toapanta, David; Carraminana, Albert; Tellez, Adrian; Ososio, Jeysson; Milan, Pablo; Rodriguez, Jorge; Andoni, Garcia; Gutierrez, Carola; Perez de la Sota, Enrique; Eixeres-Esteve, Andrea; Garcia-Maellas, Maria Teresa; Gutierrez-Gutierrez, Judit; Arboleda-Salazar, Rafael; Santa Teresa, Patricia; Jaspe, Alexis; Garrido, Alberto; Castaneda, Galo; Alcantara, Sara; Martinez, Nuria; Perez, Marina; Villanueva, Hector; Vidal Gonzalez, Anxela; Paez, Juan; Santon, Arnoldo; Perez, Cesar; Lopez, Marta; Rubio Lopez, Maria Isabel; Gordillo, Antonio; Naranjo-Izurieta, Jose; Munoz, Javier; Alcalde, Immaculada; Onieva, Fernando; Gimeno Costa, Ricardo; Perez, Francisco; Madrid, Isabel; Gordon, Monica; Albacete Moreno, Carlos L; Perez, Daniel; Lopez, Nayara; Martinenz, Domingo; Blanco-Schweizer, Pablo; Diez, Cristina; Perez, David; Prieto, Ana; Renedo, Gloria; Bustamante, Elena; Cicuendez, Ramon; Citores, Rafael; Boado, Victoria; Garcia, Katherine; Voces, Roberto; Domezain, Monica; Nunez Martinez, Jose Maria; Vicente, Raimundo; Martin, David; Andreu, Antonio; Gomez Casal, Vanesa; Chico, Ignacio; Menor, Eva Maria; Vara, Sabela; Gamacho, Jose; Perez-Chomon, Helen; Javier Gonzales, Francisco; Barrero, Irene; Martin-Villen, Luis; Fernandez, Esperanza; Mendoza, Maria; Navarro, Joaquin; Colomina Climent, Joaquin; Gonzales-Perez, Alfredo; Muniz-Albaceita, Guillermo; Amado, Laura; Rodriguez, Raquel; Ruiz, Emilio; Eiras, Maria; Grins, Edgars; Magnus, Rosen; Kanetoft, Mikael; Eidevald, Marcus; Watson, Pia; Vogt, Paul R; Steiger, Peter; Aigner, Tobias; Weber, Alberto; Grunefelder, Jurg; Kunz, Martin; Grapow, Martin; Aymard, Thierry; Reser, Diana; Agus, Gianluca; Consiglio, Jolanda; Haenggi, Matthias; Hansjoerg, Jenni; Iten, Manuela; Doeble, Thomas; Zenklusen, Urs; Bechtold, Xavier; Faedda, Giovanni; Iafrate, Manuel; Rohjer, Amanda; Bergamaschi, Layla; Maessen, Jos; Reis Miranda, Dinis; Endeman, H; Gommers, D; Meuwese, C; Maas, Jacinta; Van Gijlswijk, MJ; Van Berg, RN; Candura, Dario; Van der Linden, Marcel; Kant, Merijin; Van der Heijden, JJ; Scholten, Eric; Van Belle-van Haren, Nicole; Lagrand, WK; Vlaar, Alexander P; De Jong, Syste; Cander, Basar; Sargin, Murat; Ugur, Murat; Kaygin, Mehmet A; Daly, Kathleen; Agnew, Nicola; Head, Laura; Kelly, Laura; Anoma, Gunawardena; Russell, Clare; Aquino, Verna; Scott, Ian; Flemming, Lucy; Gillon, Stuart; Moore, Olivia; Gelandt, Elton; Auzinger, George; Patel, Sameer; Loveridge, Robert;
• Is Part Of: Lancet. Volume 11:Issue 2(2023)
• Page Start: 151
• Page End: 162
• Publication Date: 2023-02
• Subjects: Respiratory organs -- Diseases -- Periodicals; 616.2005
• DOI: 10.1016/S2213-2600(22)00403-9
• Languages: English
• ISSNs: 2213-2600

Abstract

Summary: 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.