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. 2021 Feb 27;11(3):170.
doi: 10.3390/membranes11030170.

Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation-A Retrospective International Multicenter Study

Alexander Supady  1   2   3 , Jeff DellaVolpe  4 , Fabio Silvio Taccone  5 , Dominik Scharpf  6 , Matthias Ulmer  7 , Philipp M Lepper  8 , Maximilian Halbe  9 , Stephan Ziegeler  10 , Alexander Vogt  11 , Raj Ramanan  12 , David Boldt  13 , Stephanie-Susanne Stecher  14 , Andrea Montisci  15 , Tobias Spangenberg  16 , Olivier Marggraf  17 , Chandra Kunavarapu  4 , Lorenzo Peluso  5 , Sebastian Muenz  6 , Monica Buerle  7 , Naveen G Nagaraj  9 , Sebastian Nuding  11 , Catalin Toma  12 , Vadim Gudzenko  13 , Hans Joachim Stemmler  18 , Federico Pappalardo  19 , Georg Trummer  20 , Christoph Benk  20 , Guido Michels  21 , Daniel Duerschmied  1   2 , Constantin von Zur Muehlen  1   2 , Christoph Bode  1   2 , Klaus Kaier  2   22 , Daniel Brodie  23 , Tobias Wengenmayer  1   2 , Dawid L Staudacher  1   2
Affiliations

Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation-A Retrospective International Multicenter Study

Alexander Supady et al. Membranes (Basel). .

Abstract

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival.

Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival.

Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic-AUROC) ranged between 0.548 and 0.605.

Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

Keywords: COVID-19; SARS-CoV-2; acute respiratory distress syndrome; extracorporeal membrane oxygenation.

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Conflict of interest statement

All authors have completed the ICMJE form (available upon request from the corresponding author). FS Taccone reports personal fees from Eurosets outside the submitted work. C Benk and G Trummer are shareholders of Resuscitec GmbH and received personal fees from Resuscitec GmbH outside the submitted work. C Benk and G Trummer hold patents US 10695407 and EU 3016675 issued to Resuscitec GmbH. D Brodie reports grants from ALung Technologies, personal fees from Baxter, personal fees from Xenios, personal fees from BREETHE, and unpaid consultancy for Hemovent outside the submitted work. G Michels reports personal fees from ZOLL, Sedana Medical, Orion Pharma, and Getinge outside the submitted work; the conflicts of interest are not related to the present work. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flow-chart illustrating patient recruitment, case exclusion, and number of survivors and non-survivors in the study collective.
Figure 2
Figure 2
Kaplan–Meier curve displaying the survival over the course of the 30-day study period in the entire cohort.
Figure 3
Figure 3
Receiver operating characteristic (ROC) analyses for the scores analyzed and Kaplan-Meier curves displaying the survival in the groups above and below the cut-off values, respectively, over the course of the 30-day study period. A1: ROC analysis RESP score. A2: Kaplan-Meier curve RESP score. B1: ROC analysis SOFA score. B2: Kaplan-Meier curve SOFA score. C1: ROC analysis SAPS II. C2: Kaplan-Meier curve SAPS II. D1: ROC analysis PRESERVE score. D2: Kaplan-Meier curve PRESERVE score. E1: ROC analysis APACHE II score. E2: Kaplan-Meier curve APACHE II score.
See this image and copyright information in PMC

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