. 2022 May 1;136(5):732-748.

doi: 10.1097/ALN.0000000000004168.

Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study

Nicolas Nesseler¹, Guillaume Fadel², Alexandre Mansour³, Marylou Para⁴, Pierre-Emmanuel Falcoz⁵, Nicolas Mongardon⁶, Alizée Porto⁷, Astrid Bertier⁸, Bruno Levy⁹, Cyril Cadoz¹⁰, Pierre-Grégoire Guinot¹¹, Olivier Fouquet¹², Jean-Luc Fellahi¹³, Alexandre Ouattara¹⁴, Julien Guihaire¹⁵, Vito-Giovanni Ruggieri¹⁶, Philippe Gaudard¹⁷, François Labaste¹⁸, Thomas Clavier¹⁹, Kais Brini²⁰, Nicolas Allou²¹, Corentin Lacroix²², Juliette Chommeloux²³, Guillaume Lebreton²⁴, Michael A Matthay²⁵, Sophie Provenchere²⁶, Erwan Flécher²⁷, André Vincentelli²⁸; ECMOSARS Investigators

Collaborators, Affiliations

Collaborators

ECMOSARS Investigators:
Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Hadrien Roze, Olivier Huet, Marc-Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, André Ly, Arnaud Meffert, Jean-Claude Merle, Lucile Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas d'Ostrevy, Marie-Catherine Morgan, Maxime Nguyen, Lucie Gaide-Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Elie Fadel, Dominique Fabre, Antoine Girault, Iolande Ion, Jean Baptiste Menager, Delphine Mitilian, Olaf Mercier, François Stephan, Jacques Thes, Jerôme Jouan, Thibault Duburcq, Valentin Loobuyck, Sabrina Manganiello, Mouhammed Moussa, Agnes Mugnier, Natacha Rousse, Olivier Desebbe, Roland Henaine, Matteo Pozzi, Jean-Christophe Richard, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, Charles Chanavaz, Sebastien Gette, Guillaume Louis, Erick Portocarrero, Nicolas Bischoff, Antoine Kimmoun, Mathieu Mattei, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Bertrand Rozec, Mickaël Vourc'h, Stéphane Aubert, Florian Bazalgette, Claire Roger, Pierre Jaquet, Brice Lortat-Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Morgan Roué, Romain Sonneville, Alexy Tran-Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Claudio Barbanti, Anatole Harrois, Jordi Matiello, Thomas Kerforne, Nicolas Brechot, Alain Combes, Jean Michel Constantin, Cosimo D'Alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Muriel Fartoukh, Guillaume Hekimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Marc Pineton de Chambrun, Matthieu Schmidt, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Roxane Nicolas, Maud Jonas, Charles Vidal, Salvatore Muccio, Dario Di Perna, Bruno Mourvillier, Amedeo Anselmi, Karl Bounader, Maxime Esvan, Claire Fougerou-Leurent, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Seguin, Emmanuel Besnier, Dorothée Carpentier, Anne Olland, Fanny Bounes, Vincent Minville, Antoine Guillon, Yannick Fedun, James T Ross

Affiliations

¹ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France; University of Rennes, University Hospital of Rennes, National Research Institute for Agriculture, National Institute of Health and Medical Research, Institute of Nutrition, Metabolism, and Cancer, Mixed Research Unit_1341, Mixed Research Unit_1241, Rennes, France.
² Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, Pitié-Salpétriêre Hospital, Paris, France.
³ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France.
⁴ Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Public Assistance-Hospitals of Paris, Paris, France; University of Paris, Mixed Research Unit_1148, Laboratory of Vascular Translational Science, Paris, France.
⁵ National Institute of Health and Medical Research, Mixed Research Unit_1260, Regenerative Nanomedicine, Translational Medicine Federation, Strasbourg, France; University of Strasbourg, Pharmacy and Medical School, Strasbourg, France; University Hospital of Strasbourg, Thoracic Surgery Department, New Hospital Civil, Strasbourg, France.
⁶ Department of Anesthesia and Critical Care, Medical-University Department, Surgery, Anesthesiology, Surgical Intensive Care Units, University Hospital Department Ageing Thorax-Vessels-Blood, Public Assistance-Hospitals of Paris, Henri Mondor University Hospitals, Créteil, France; University of East Paris Créteil, School of Medicine, Créteil, France; U955-Mondor Institute of Biomedical Research, Equipe 03, Pharmacology and Technologies for Cardiovascular Diseases, National Institute of Health and Medical Research, University of East Paris Créteil, National Veterinary School of Alfort, Maisons-Alfort, France.
⁷ Department of Cardiac Surgery, Timone Hospital, Marseille Public University Hospital System, 13005, Marseille, France.
⁸ Intensive Care Unit, Bicêtre Hospital, Public Assistance-Hospitals of Paris, Paris, France.
⁹ Intensive Care Unit, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandœuvre-lès-Nancy, France; National Institute of Health and Medical Research U1116, Faculty of Medicine, Vandoeuvre-lès-Nancy, France; University of Lorraine, Nancy, France.
¹⁰ Polyvalent Intensive Care Unit, Mercy Hospital, Regional Hospital, Metz-Thionville, France.
¹¹ Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, France.
¹² Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Mitochondrial and Cardiovascular Pathophysiology Institute, French National Centre for Scientific Research, Mixed Research Unit_6214, National Institute of Health and Medical Research U1083, University of Angers, Angers, France.
¹³ Department of Anesthesia and Critical Care, Louis Pradel Hospital, University Hospital of Lyon, Lyon, France; CarMeN Laboratory, National Institute of Health and Medical Research, Mixed Research Unit_1060, Claude Bernard Lyon University, Lyon, France.
¹⁴ University Hospital of Bordeaux, Department of Anesthesia and Critical Care, Magellan Medico-Surgical Center, Bordeaux, France; National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France.
¹⁵ Department of Cardiac Surgery, National Institute of Health and Medical Research, Mixed Research Unit_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, University of Paris-Saclay School of Medicine, Le Plessis Robinson, France.
¹⁶ Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
¹⁷ Department of Anesthesia and Critical Care, PhyMedExp, Montpellier University, National Institute of Health and Medical Research, French National Centre for Scientific Research, University Hospital of Montpellier, Montpellier, France.
¹⁸ Anesthesiology and Intensive Care Department, University Hospital of Toulouse, Toulouse, France; Metabolic and Cardiovascular Diseases Institute, National Institute of Health and Medical Research U1048, University of Toulouse, Paul Sabatier University, Toulouse, France.
¹⁹ Department of Anesthesiology, Critical Care and Perioperative Medicine, University Hospital of Rouen, Rouen, France.
²⁰ Polyvalent and Cardiac Intensive Care Unit, Montsouris Mutualist Institute, Paris, France.
²¹ Polyvalent Intensive Care Unit, Félix Guyon-Saint-Denis University Hospital, La Réunion, Saint Denis, France.
²² Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France.
²³ Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Intensive Care Unit, Cardiology Unit, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
²⁴ Sorbonne Université, University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular Surgery, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
²⁵ Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California.
²⁶ University of Paris, Department of Anesthesiology and Intensive Care, Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris, France; Clinical Investigation Center 1425, Public Assistance-Hospitals of Paris, National Institute of Health and Medical Research, Paris, France.
²⁷ Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory, National Institute of Health and Medical Research U1099, Rennes, France.
²⁸ Department of Cardiac Surgery, University Hospital of Lille, Lille, France.

PMID: 35348610
PMCID: PMC9006801
DOI: 10.1097/ALN.0000000000004168

Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study

Nicolas Nesseler et al. Anesthesiology. 2022.

. 2022 May 1;136(5):732-748.

doi: 10.1097/ALN.0000000000004168.

Authors

Collaborators

ECMOSARS Investigators:
Marc Pierrot, Sidney Chocron, Guillaume Flicoteaux, Philippe Mauriat, Hadrien Roze, Olivier Huet, Marc-Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, André Ly, Arnaud Meffert, Jean-Claude Merle, Lucile Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas d'Ostrevy, Marie-Catherine Morgan, Maxime Nguyen, Lucie Gaide-Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Elie Fadel, Dominique Fabre, Antoine Girault, Iolande Ion, Jean Baptiste Menager, Delphine Mitilian, Olaf Mercier, François Stephan, Jacques Thes, Jerôme Jouan, Thibault Duburcq, Valentin Loobuyck, Sabrina Manganiello, Mouhammed Moussa, Agnes Mugnier, Natacha Rousse, Olivier Desebbe, Roland Henaine, Matteo Pozzi, Jean-Christophe Richard, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, Charles Chanavaz, Sebastien Gette, Guillaume Louis, Erick Portocarrero, Nicolas Bischoff, Antoine Kimmoun, Mathieu Mattei, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Bertrand Rozec, Mickaël Vourc'h, Stéphane Aubert, Florian Bazalgette, Claire Roger, Pierre Jaquet, Brice Lortat-Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Morgan Roué, Romain Sonneville, Alexy Tran-Dinh, Paul-Henri Wicky, Charles Al Zreibi, Bernard Cholley, Yannis Guyonvarch, Sophie Hamada, Claudio Barbanti, Anatole Harrois, Jordi Matiello, Thomas Kerforne, Nicolas Brechot, Alain Combes, Jean Michel Constantin, Cosimo D'Alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Muriel Fartoukh, Guillaume Hekimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Marc Pineton de Chambrun, Matthieu Schmidt, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Roxane Nicolas, Maud Jonas, Charles Vidal, Salvatore Muccio, Dario Di Perna, Bruno Mourvillier, Amedeo Anselmi, Karl Bounader, Maxime Esvan, Claire Fougerou-Leurent, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Seguin, Emmanuel Besnier, Dorothée Carpentier, Anne Olland, Fanny Bounes, Vincent Minville, Antoine Guillon, Yannick Fedun, James T Ross

Affiliations

¹ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France; University of Rennes, University Hospital of Rennes, National Research Institute for Agriculture, National Institute of Health and Medical Research, Institute of Nutrition, Metabolism, and Cancer, Mixed Research Unit_1341, Mixed Research Unit_1241, Rennes, France.
² Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, Pitié-Salpétriêre Hospital, Paris, France.
³ Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France.
⁴ Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Public Assistance-Hospitals of Paris, Paris, France; University of Paris, Mixed Research Unit_1148, Laboratory of Vascular Translational Science, Paris, France.
⁵ National Institute of Health and Medical Research, Mixed Research Unit_1260, Regenerative Nanomedicine, Translational Medicine Federation, Strasbourg, France; University of Strasbourg, Pharmacy and Medical School, Strasbourg, France; University Hospital of Strasbourg, Thoracic Surgery Department, New Hospital Civil, Strasbourg, France.
⁶ Department of Anesthesia and Critical Care, Medical-University Department, Surgery, Anesthesiology, Surgical Intensive Care Units, University Hospital Department Ageing Thorax-Vessels-Blood, Public Assistance-Hospitals of Paris, Henri Mondor University Hospitals, Créteil, France; University of East Paris Créteil, School of Medicine, Créteil, France; U955-Mondor Institute of Biomedical Research, Equipe 03, Pharmacology and Technologies for Cardiovascular Diseases, National Institute of Health and Medical Research, University of East Paris Créteil, National Veterinary School of Alfort, Maisons-Alfort, France.
⁷ Department of Cardiac Surgery, Timone Hospital, Marseille Public University Hospital System, 13005, Marseille, France.
⁸ Intensive Care Unit, Bicêtre Hospital, Public Assistance-Hospitals of Paris, Paris, France.
⁹ Intensive Care Unit, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandœuvre-lès-Nancy, France; National Institute of Health and Medical Research U1116, Faculty of Medicine, Vandoeuvre-lès-Nancy, France; University of Lorraine, Nancy, France.
¹⁰ Polyvalent Intensive Care Unit, Mercy Hospital, Regional Hospital, Metz-Thionville, France.
¹¹ Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, France.
¹² Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Mitochondrial and Cardiovascular Pathophysiology Institute, French National Centre for Scientific Research, Mixed Research Unit_6214, National Institute of Health and Medical Research U1083, University of Angers, Angers, France.
¹³ Department of Anesthesia and Critical Care, Louis Pradel Hospital, University Hospital of Lyon, Lyon, France; CarMeN Laboratory, National Institute of Health and Medical Research, Mixed Research Unit_1060, Claude Bernard Lyon University, Lyon, France.
¹⁴ University Hospital of Bordeaux, Department of Anesthesia and Critical Care, Magellan Medico-Surgical Center, Bordeaux, France; National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France.
¹⁵ Department of Cardiac Surgery, National Institute of Health and Medical Research, Mixed Research Unit_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, University of Paris-Saclay School of Medicine, Le Plessis Robinson, France.
¹⁶ Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.
¹⁷ Department of Anesthesia and Critical Care, PhyMedExp, Montpellier University, National Institute of Health and Medical Research, French National Centre for Scientific Research, University Hospital of Montpellier, Montpellier, France.
¹⁸ Anesthesiology and Intensive Care Department, University Hospital of Toulouse, Toulouse, France; Metabolic and Cardiovascular Diseases Institute, National Institute of Health and Medical Research U1048, University of Toulouse, Paul Sabatier University, Toulouse, France.
¹⁹ Department of Anesthesiology, Critical Care and Perioperative Medicine, University Hospital of Rouen, Rouen, France.
²⁰ Polyvalent and Cardiac Intensive Care Unit, Montsouris Mutualist Institute, Paris, France.
²¹ Polyvalent Intensive Care Unit, Félix Guyon-Saint-Denis University Hospital, La Réunion, Saint Denis, France.
²² Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France.
²³ Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Intensive Care Unit, Cardiology Unit, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
²⁴ Sorbonne Université, University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular Surgery, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.
²⁵ Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California.
²⁶ University of Paris, Department of Anesthesiology and Intensive Care, Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris, France; Clinical Investigation Center 1425, Public Assistance-Hospitals of Paris, National Institute of Health and Medical Research, Paris, France.
²⁷ Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory, National Institute of Health and Medical Research U1099, Rennes, France.
²⁸ Department of Cardiac Surgery, University Hospital of Lille, Lille, France.

PMID: 35348610
PMCID: PMC9006801
DOI: 10.1097/ALN.0000000000004168

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.

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Figures

**Fig. 1.**
Flow chart of extracorporeal membrane oxygenation (ECMO) patients included in the study.

See this image and copyright information in PMC

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Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study

Collaborators

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Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19: A Nationwide Cohort Study

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