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. 2025 May;40(4):993-1003.
doi: 10.1177/02676591241267228. Epub 2024 Jul 24.

Worldwide application and valuation of extracorporeal membrane oxygenation support during the COVID-19 pandemic (WAVES)

Akram M Zaaqoq  1 , Silver Heinsar  2   3 , Hwan-Jin Yoon  4   5 , Nicole White  2   4 , Matthew J Griffee  6 , Jacky Y Suen  2 , Gianluigi L Bassi  2   7 , Jonathon P Fanning  2 , Ahmad Labib Shehatta  8 , Peta M A Alexander  9 , Jeffrey P Jacobs  10 , Heidi J Dalton  11 , Roberto Lorusso  12 , Sung-Min Cho  13   14 , Giles J Peek  10 , John F Fraser  2 ; COVID-19 Critical Care Consortium (COVID Critical)
Affiliations

Worldwide application and valuation of extracorporeal membrane oxygenation support during the COVID-19 pandemic (WAVES)

Akram M Zaaqoq et al. Perfusion. 2025 May.

Abstract

ObjectiveThe outcomes of COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) varied. We aim to investigate the variability concerning location and timeframe. We conducted a retrospective analysis of data from 351 institutions in 53 countries. The primary outcome was survival to hospital discharge or death up to 90 days from ECMO start. The associations between calendar time (month and year) of ECMO initiation and the primary outcome were examined by Cox regression modeling. Multivariable survival analyses were adjusted for the time of ECMO start, age, body mass index, APACHE II, SOFA, and the duration of mechanical ventilation before ECMO.Results1060 adult COVID-19 patients enrolled in the COVID-19 Critical Care Consortium (COVID Critical) international registry and required VV-ECMO support. The study period is from January 2020 to December 2021. The median age was 51 years old, and 70% were male patients. Most patients were from Europe (39.3%) and North America (37.4%). The in-hospital mortality of the entire cohort was 47.12%. In North America and Europe, there was an increased probability of death from May 2020 through February 2021. Latin America showed a steady rate of survival until late in the study. South Asia, the Middle East, and Africa showed an increased chance of mortality around May 2020. In the Asian-Pacific region, after February 2021, there was an increased probability of death. The time of ECMO initiation and advanced patient age were associated with increased mortality.ConclusionVariability in the outcomes of COVID-19 patients on VV-ECMO existed within different regions. This variability reflects the differences in resources, policies, patient selection, management, and possibly COVID-19 virus subtypes. Our findings might help guide global response in the future by early adoption of patient selection protocols, worldwide policies, and delivery of resources.

Keywords: (MeSH terms): severe acute respiratory syndrome-related coronavirus; COVID-19; extracorporeal membrane oxygenation; venovenous extracorporeal membrane oxygenation.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Gianluigi Li Bassi is a recipient of the BITRECS fellowship; the “BITRECS” project has received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement no. 754,550 and from the “La Caixa” Foundation (ID 100010434), under the agreement LCF/PR/GN18/50310006. Jacky Y Suen is funded by the Advance Queensland fellowship program. Sung-Min Cho is funded by NIH (1K23HL157610) and serves as a consultant for Hyperfine. Peta Alexander is funded by U.S. DoD PRMRP Clinical Trial Award #W81XWH2210301, NIH (R13HD104432) and FDA UCSF-Stanford Center of Excellence in Regulatory Sciences and Innovation (U01FD004979/U01FD005978). Peta Alexander is Treasurer of ELSO Board of Directors.

Figures

Figure 1.
Figure 1.
The survival probability after adjustment by the start month of veno-venous extracorporeal membrane oxygenation support in all regions.
Figure 2.
Figure 2.
The trend in the probability of death over the study period based on the month of veno-venous extracorporeal membrane oxygenation initiation in different regions.
Figure 3.
Figure 3.
The probability of death and discharge in different regions based on the time of initiation comparing patients started on veno-venous extracorporeal membrane oxygenation (V-V ECMO) at the wave trough to patients started on V-V ECMO during the wave.
See this image and copyright information in PMC

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