Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Apr 1;19(4):e0298342.
doi: 10.1371/journal.pone.0298342. eCollection 2024.

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

Clemens Wiest  1 , Alois Philipp  2 , Maik Foltan  2 , Florian Geismann  3 , Roland Schneckenpointer  1 , Simon Baumgartner  1 , Florian Sticht  1 , Florian Hitzenbichler  4 , Michael Arzt  1 , Christoph Fisser  1 , Andrea Stadlbauer  2 , Thomas Dienemann  5 , Lars Siegfried Maier  1 , Dirk Lunz  6 , Thomas Mueller  1 , Matthias Lubnow  1
Affiliations

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

Clemens Wiest et al. PLoS One. .

Abstract

Objective: In this retrospective case series, survival rates in different indications for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and differential diagnoses of COVID-19 associated refractory circulatory failure are investigated.

Methods: Retrospective analysis of 28 consecutive COVID-19 patients requiring VA-ECMO. All VA-ECMO's were cannulated peripherally, using a femoro-femoral cannulation.

Results: At VA-ECMO initiation, median age was 57 years (IQR: 51-62), SOFA score 16 (IQR: 13-17) and norepinephrine dosing 0.53μg/kg/min (IQR: 0.35-0.87). Virus-variants were: 61% wild-type, 14% Alpha, 18% Delta and 7% Omicron. Indications for VA-ECMO support were pulmonary embolism (PE) (n = 5, survival 80%), right heart failure due to secondary pulmonary hypertension (n = 5, survival 20%), cardiac arrest (n = 4, survival 25%), acute heart failure (AHF) (n = 10, survival 40%) and refractory vasoplegia (n = 4, survival 0%). Among the patients with AHF, 4 patients suffered from COVID-19 associated heart failure (CovHF) (survival 100%) and 6 patients from sepsis associated heart failure (SHF) (survival 0%). Main Complications were acute kidney injury (AKI) 93%, renal replacement therapy was needed in 79%, intracranial hemorrhage occurred in 18%. Overall survival to hospital discharge was 39%.

Conclusion: Survival on VA-ECMO in COVID-19 depends on VA-ECMO indication, which should be considered in further studies and clinical decision making. A subgroup of patients suffers from acute heart failure due to inflammation, which has to be differentiated into septic or COVID-19 associated. Novel biomarkers are required to ensure reliable differentiation between these entities; a candidate might be soluble interleukin 2 receptor.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Indications for VA-ECMO among patients with COVID-19 and indication specific survival.
AHF: Acute heart failure, SHF: Sepsis associated heart failure. CovHF: COVID-19 associated heart failure. All 4 patients with septic vasoplegia had sepsis due to mycotic infection.
Fig 2
Fig 2. Soluble interleukin 2 receptor (sIL2-R) before VA-ECMO in COVID-19 associated heart failure and septic patients.
CovHF: COVID-19 associated heart failure, SHF: Sepsis associated heart failure.
See this image and copyright information in PMC

References

    1. University CrcoJH. Coronavirus resource center of Johns Hopkins University 2022 [https://coronavirus.jhu.edu.
    1. Wang H, Paulson KR, Pease SA, Watson S, Comfort H, Zheng P, et al.. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. The Lancet. 2022;399(10334):1513–36. - PMC - PubMed
    1. Karagiannidis C, Slutsky AS, Bein T, Windisch W, Weber-Carstens S, Brodie D. Complete countrywide mortality in COVID patients receiving ECMO in Germany throughout the first three waves of the pandemic. Crit Care. 2021;25(1):413. doi: 10.1186/s13054-021-03831-y - DOI - PMC - PubMed
    1. Haroun MW, Patel SR, Sims DB, Jorde UP, Goldstein DJ, Saeed O. Characteristics and Outcomes of COVID-19 Patients Supported by Venoarterial or Veno-Arterial-Venous Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth. 2022;36(8 Pt B):2935–41. - PMC - PubMed
    1. Friedrichson B, Kloka JA, Neef V, Mutlak H, Old O, Zacharowski K, et al.. Extracorporeal membrane oxygenation in coronavirus disease 2019: A nationwide cohort analysis of 4279 runs from Germany. Eur J Anaesthesiol. 2022. doi: 10.1097/EJA.0000000000001670 - DOI - PubMed