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. 2022 Jan 13;12(1):6.
doi: 10.1186/s13613-022-00980-3.

Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019

Martina Hermann  1   2 , Daniel Laxar  2 , Christoph Krall  3 , Christina Hafner  1   2 , Oliver Herzog  1 , Oliver Kimberger  1   2 , Sebastian Koenig  1 , Felix Kraft  1 , Mathias Maleczek  1   2 , Klaus Markstaller  1 , Oliver Robak  4 , Bernhard Rössler  1 , Eva Schaden  1   2 , Peter Schellongowski  4 , Mathias Schneeweiss-Gleixner  5 , Thomas Staudinger  4 , Roman Ullrich  1 , Marion Wiegele  1 , Harald Willschke  1   2 , Christian Zauner  5 , Alexander Hermann  6
Affiliations

Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019

Martina Hermann et al. Ann Intensive Care. .

Abstract

Background: Duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults treated with ECMO due to severe COVID-19-related ARDS between 01/2020 and 05/2021. The primary objective was to determine whether duration of IMV prior to ECMO cannulation influenced ICU mortality.

Results: During the study period, 101 patients (mean age 56 [SD ± 10] years; 70 [69%] men; median RESP score 2 [IQR 1-4]) were treated with ECMO for COVID-19. Sixty patients (59%) survived to ICU discharge. Median ICU length of stay was 31 [IQR 20.7-51] days, median ECMO duration was 16.4 [IQR 8.7-27.7] days, and median time from intubation to ECMO start was 7.7 [IQR 3.6-12.5] days. Fifty-three (52%) patients had a pre-ECMO IMV duration of > 7 days. Pre-ECMO IMV duration had no effect on survival (p = 0.95). No significant difference in survival was found when patients with a pre-ECMO IMV duration of < 7 days (< 10 days) were compared to ≥ 7 days (≥ 10 days) (p = 0.59 and p = 1.0).

Conclusions: The role of prolonged pre-ECMO IMV duration as a contraindication for ECMO in patients with COVID-19-related ARDS should be scrutinised. Evaluation for ECMO should be assessed on an individual and patient-centred basis.

Keywords: Acute respiratory distress syndrome; COVID-19; Extracorporeal membrane oxygenation; Invasive mechanical ventilation.

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Conflict of interest statement

TS is a member of the Xenios medical advisory board and has received speaker fees from Getinge, Baxter and Xenios. OK has a consulting affiliation with Philips. PS has received speaker fees from Maquet and a Horizon 2020 Fast Track to Innovation Grant from the European Commission (NCT04115709). The remaining authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Survival probabilities plotted for all patients grouped by pre-ECMO IMV duration with the cut-off point of 7 days. ECMO extracorporeal membrane oxygenation, IMV invasive mechanical ventilation
Fig. 2
Fig. 2
Survival probabilities plotted for all patients grouped by pre-ECMO IMV duration with the cut-off point of 10 days. ECMO extracorporeal membrane oxygenation, IMV invasive mechanical ventilation
Fig. 3
Fig. 3
Boxplots of mean DP and mean peak pressure before ECMO according to ICU survival. 0 = ICU survival, 1 = ICU death, DP driving pressure, ICU intensive care unit
Fig. 4
Fig. 4
Boxplots of mean DP and mean peak pressure during ECMO according to ICU survival. 0 ICU survival, 1 ICU death, DP driving pressure, ICU intensive care unit
See this image and copyright information in PMC

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