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. 2022 Oct 7;4(10):e0770.
doi: 10.1097/CCE.0000000000000770. eCollection 2022 Oct.

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19-Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis

Senta Jorinde Raasveld  1 , Fabio Silvio Taccone  2 , Lars Mikael Broman  3   4 , Greet Hermans  5   6 , Philippe Meersseman  5   6 , Manuel Quintana Diaz  7 , Thijs S R Delnoij  8   9 , Marcel van de Poll  9 , Elisa Gouvea Bogossian  2 , Floor L F van Baarle  1 , Koray Durak  10 , Rashad Zayat  10 , Annemieke Oude Lansink-Hartgring  11 , Christiaan L Meuwese  12 , Joris J van der Heijden  13 , Erwin de Troy  14 , Dieter Dauwe  14 , Erik Scholten  15 , Franciska van der Velde  16 , Jacinta J Maas  16 , Dinis Dos Reis Miranda  12 , Marijn Kuijpers  17 , Judith van den Brule  18 , Walter M van den Bergh  11 , Alexander P J Vlaar  1
Affiliations

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19-Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis

Senta Jorinde Raasveld et al. Crit Care Explor. .

Abstract

Although venovenous extracorporeal membrane oxygenation (VV ECMO) has been used in case of COVID-19 induced acute respiratory distress syndrome (ARDS), outcomes and criteria for its application should be evaluated.

Objectives: To describe patient characteristics and outcomes in patients receiving VV ECMO due to COVID-19-induced ARDS and to assess the possible impact of COVID-19 on mortality.

Design setting and participants: Multicenter retrospective study in 15 ICUs worldwide. All adult patients (> 18 yr) were included if they received VV ECMO with ARDS as main indication. Two groups were created: a COVID-19 cohort from March 2020 to December 2020 and a "control" non-COVID ARDS cohort from January 2018 to July 2019.

Main outcomes and measures: Collected data consisted of patient demographics, baseline variables, ECMO characteristics, and patient outcomes. The primary outcome was 60-day mortality. Secondary outcomes included patient characteristics, COVID-19-related therapies before and during ECMO and complication rate. To assess the influence of COVID-19 on mortality, inverse probability weighted (IPW) analyses were used to correct for predefined confounding variables.

Results: A total of 193 patients with COVID-19 received VV ECMO. The main indication for VV ECMO consisted of refractory hypoxemia, either isolated or combined with refractory hypercapnia. Complications with the highest occurrence rate included hemorrhage, an additional infectious event or acute kidney injury. Mortality was 35% and 45% at 28 and 60 days, respectively. Those mortality rates did not differ between the first and second waves of COVID-19 in 2020. Furthermore, 60-day mortality was equal between patients with COVID-19 and non-COVID-19-associated ARDS receiving VV ECMO (hazard ratio 60-d mortality, 1.27; 95% CI, 0.82-1.98; p = 0.30).

Conclusions and relevance: Mortality for patients with COVID-19 who received VV ECMO was similar to that reported in other COVID-19 cohorts, although no differences were found between the first and second waves regarding mortality. In addition, after IPW, mortality was independent of the etiology of ARDS.

Keywords: COVID-19; acute respiratory distress syndrome; extracorporeal membrane oxygenation; mortality; venovenous extracorporeal membrane oxygenation.

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Conflict of interest statement

Dr. Broman is a member of the Medical Advisory Boards of Eurosets Srl., Medolla, Italy, and Xenios AG, Heilbronn, Germany. Dr. Taccone is a member of the Medical Advisory Boards of Eurosets Srl., Medolla, Italy, and Xenios AG, Heilbronn, Germany. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Additional therapies: oxygenation-improving maneuvers during extracorporeal membrane oxygenation (ECMO). Red first wave (ICU admission from March 1, 2020, to June 1, 2020), blue second wave in 2020 (ICU admission from June 1, 2020, to December 31, 2020).
Figure 2.
Figure 2.
Additional therapies: medication during extracorporeal membrane oxygenation (ECMO). Red first wave (ICU admission from March 1, 2020, to June 1, 2020), blue second wave in 2020 (ICU admission from June 1, 2020, to December 31, 2020). IVIG = IV immunoglobulin therapy.
See this image and copyright information in PMC

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