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. 2023 May;38(1_suppl):13-23.
doi: 10.1177/02676591221151034. Epub 2023 Jan 10.

Extracorporeal life support provision in COVID-19 patients - An international EuroELSO 2022 update survey

Marcel Fleig  1 , Thomas Müller  2 , Velia M Antonini  3   4 , Jordi Riera  5 , Mirko Belliato  6 , Lars Mikael Broman  7 , Jo-Anne Fowles  8 , Jan Belohlavek  9 , Roberto Lorusso  10 , Leen Vercaemst  11 , Tim Jones  12 , Peter P Roeleveld  13 , Matteo Di Nardo  14 , Nicholas Barrett  15   16 , Justyna Swol  1
Affiliations

Extracorporeal life support provision in COVID-19 patients - An international EuroELSO 2022 update survey

Marcel Fleig et al. Perfusion. 2023 May.

Abstract

Introduction: An analysis on the ECLS use for patients with respiratory or cardiac support in COVID-19 based on an international response to EuroELSO survey, aims to generate a more comprehensive understanding of ECLS role during the recent viral pandemic.

Methods: EuroELSO announced the survey at the 10th annual congress in London, May 2022. The survey covered 26 multiple-choice questions.

Results: The survey returned 69 questionnaires from 62 centers across 22 European countries and seven centers across five non-European countries. Most of the centers providing ECLS for COVID-19 patients had more than 30 runs for respiratory support since December 2019. In the same period, at least 31 runs in adult COVID-19 patients have been performed in 48 of 69 centers (69.6%). The reported pediatric data from 18 centers is limited to less than the patients per center.

Conclusion: Majority of the COVID-19 patients received respiratory ECLS support and adult patients dominated. The indications and contraindications are broadly aligned with available guidelines. Most of the centers considered age >65 or biological age as a relative or absolute contraindication for ECLS in COVID-19. ECLS withdrawal criteria in COVID-19 are controversial because the long-term outcomes after ECLS in COVID-19 and the impact of critical illness and the impact of long-COVID are still not known.

Keywords: COVID-19; ECLS; ECMO; SARS-CoV-2; extracorporeal life support; extracorporeal membrane oxygenation.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Prof. Dr Lorusso is a consultant for Medtronic, Getinge, Abiomed, and LivaNova and medical advisory board member for Xenios and EUROSETS, all unrelated to this work, all honoraria to the university for research funding. Dr Di Nardo is medical advisory board member for EUROSETS. Dr Mirko Belliato medical advisory board member for EUROSETS srl (Italy) and congress speaker for ESTOR spa (Italy) and Hamilton Medical (Swiss). Dr Lars Mikael Broman is a medical advisory board member of Eurosets Srl (Italy), Xenios AG, (Ger), and HemoCue AB (Swe).

Figures

Figure 1.
Figure 1.
Geographical distribution of participants; ECLS – extracorporeal life support.
Figure 2.
Figure 2.
Regional distribution and transport modalities for COVID-19 patients; COVID-19 – Corona Virus Disease 2019, ECLS – extracorporeal life support.
Figure 3.
Figure 3.
Contraindications for the use of ECLS in COVID-19 patients; ECLS – extracorporeal life support, COVID-19 – Corona Virus Disease 2019, MOF – multiorgan failure, IMV – invasive mechanical ventilation, NIV – non-invasive ventilation, HFNO – high-flow nasal oxygen, CRRT – continuous renal replacement therapy.
Figure 4.
Figure 4.
Routine management, anticoagulation, and rehabilitation in COVID-19 patients on ECLS; COVID-19 – Corona Virus Disease 2019, ECLS – extracorporeal life support, BAL/BAS – bronchoalveolar lavage or aspirate, CT – computed tomography, UFH – unfractionated heparin, aPTT – activated partial thromboplastin time, antiXa – anti-factor Xa-activity.
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