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Observational Study
. 2025 Apr;13(4):307-317.
doi: 10.1016/S2213-2600(24)00369-2. Epub 2025 Feb 23.

In-hospital outcomes and 6-month follow-up results of patients supported with extracorporeal membrane oxygenation for COVID-19 from the second wave to the end of the pandemic (EuroECMO-COVID): a prospective, international, multicentre, observational study

Maria Elena De Piero  1 , Silvia Mariani  2 , Bas C T van Bussel  3 , Dominik Jarczak  4 , Niklas Krenner  5 , Enrique Perez de la Sota  6 , Pedro E Silva  7 , Magdalena Roemmer  8 , Mariusz Kowalewski  9 , Simone Carelli  10 , Lars Mikael Broman  11 , Alain Vuylsteke  12 , Philip Fortuna  13 , Francesco Alessandri  14 , Gennaro Martucci  15 , Brijesh V Patel  16 , Gosta Lotz  17 , Udo Boeken  18 , Sven Maier  19 , Bursa Filip  20 , Bart Meyns  21 , Matthias Haenggi  22 , Severin Puss  23 , Peter Schellongowski  24 , Kaan Kirali  25 , Gil Bolotin  26 , Nicholas Barrett  27 , Jordi Riera  28 , Thomas Mueller  29 , Jan Belohlavek  30 , Roberto Lorusso  31 ; EuroECMO-COVID Study Group
Collaborators, Affiliations
Observational Study

In-hospital outcomes and 6-month follow-up results of patients supported with extracorporeal membrane oxygenation for COVID-19 from the second wave to the end of the pandemic (EuroECMO-COVID): a prospective, international, multicentre, observational study

Maria Elena De Piero et al. Lancet Respir Med. 2025 Apr.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) for COVID-19 was thoroughly assessed during the first pandemic wave, but data on subsequent waves are limited. We aimed to investigate in-hospital and 6-month survival of patients with COVID-19 supported with ECMO from the second pandemic wave (Sept 15, 2020) until the end of the pandemic (March 21, 2023, announced by WHO).

Methods: EuroECMO-COVID is a prospective, observational study including adults (aged ≥16 years) requiring ECMO respiratory support for COVID-19 from 98 centres in 21 countries. We compared patient characteristics and outcomes between in-hospital survivors and non-survivors. Mixed-effects multivariable logistic regressions were used to investigate factors linked to in-hospital mortality. 6-month survival and overall patient status were determined via patient contact or chart review. This study is registered with ClinicalTrials.gov, NCT04366921, and is complete.

Findings: We included 3860 patients (2687 [69·7%] were male and 1169 [30·3%] were female; median age 51 years [SD 11]) from 98 centres in 21 countries. In-hospital mortality was 55·9% (n=2158), with 81·2% (n=1752) deaths occurring during ECMO support. More non-survivors had diabetes, hypertension, cardiovascular disease, and renal failure, and required more pre-ECMO inotropes and vasopressors compared with survivors. Median support duration was 18 days (IQR 10-31) for both groups. Factors linked to in-hospital mortality included older age, pre-ECMO renal failure, pre-ECMO vasopressors use, longer time from intubation to ECMO initiation, and complications, including neurological events, sepsis, bowel ischaemia, renal failure, and bleeding. Of the 1702 (44·1%) in-hospital survivors, 99·7% (n=1697) were alive at 6 months follow-up. Many patients at 6 months follow-up had dyspnoea (501 [32·0%] of 1568 patients), cardiac (122 [7·8%] of 1568 patients), or neurocognitive (168 [10·7%] of 1567 patients) symptoms.

Interpretation: Our data for patients undergoing ECMO support for respiratory distress from the second COVID-19 wave onwards confirmed most findings from the first wave regarding patient characteristics and factors correlated to in-hospital mortality. Nevertheless, in-hospital mortality was higher than during the initial pandemic wave while 6-month post-discharge survival remained favourable (99·7%). Persisting post-discharge symptoms confirmed the need for post-ECMO patient follow-up programmes.

Funding: None.

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Conflict of interest statement

Declaration of interests RL, JB, NB are past chairmen of the European ELSO Steering Committee. TM is a board member of ELSO. SM and LMB are European ELSO Scientific Committee members. JB is a European ELSO Steering Committee member. RL reports speaker fees from Abiomed, is a member of the Medical Advisory Board of Xenios and Eurosets, and has a consultant contract as well as research grants from Medtronic and LivaNova, all honoraria paid to his institution and unrelated to the submitted work. NB reports a research grant for the VA ECMO unloading study (HERACLES), is an advisory board member for Hemovent with no remuneration, and is part of the safety monitoring board of Tight K, unrelated to the submitted work. LMB is advisory Board for Eurosets, Fresenius, and HemoCue, and reports lecture fees for Hemovent, Getinge, Fresenius and Eurosets, unrelated to the present work. JB reports consultancy and lecture fees from Abiomed, Getinge, and Resuscitec. PES received support for meeting attendance from Getinge. BVP reports lectures fees from Medtronic and is on the advisory boards of Inspira Technologies and Novartis, unrelated to the present work. PS reports speaker fees from Fresenius Medical Care. All other authors declare no competing interests.

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