Tweet
Crit Care
. 2021 Oct 9;25(1):355.
doi: 10.1186/s13054-021-03780-6.
Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris
Matthieu Schmidt # 1 2 3 , Elise Langouet # 4 , David Hajage 5 , Sarah Aissi James 4 , Juliette Chommeloux 6 4 , Nicolas Bréchot 6 4 , Petra Barhoum 6 4 , Lucie Lefèvre 6 4 , Antoine Troger 6 4 , Marc Pineton de Chambrun 6 4 , Guillaume Hékimian 6 4 , Charles-Edouard Luyt 6 4 , Martin Dres 7 8 9 , Jean-Michel Constantin 10 , Muriel Fartoukh 7 11 , Pascal Leprince 6 12 , Guillaume Lebreton 6 12 , Alain Combes 6 4 7 , GRC RESPIRE Sorbonne Université
Affiliations
- PMID: 34627350
- DOI: 10.1186/s13054-021-03780-6
Abstract
Background: Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020.
Methods: We included consecutive adults diagnosed with COVID-19 in Paris-Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression.
Results: Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27-47%) and 48% (37-60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02-5.07). ECMO-related complications did not differ between study periods.
Conclusions: 90-day mortality of ECMO-supported COVID-19-ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome.
Keywords: Acute respiratory distress syndrome (ARDS); COVID-19; Extracorporeal membrane oxygenation; Outcomes; SARS-CoV-2; Venovenous ECMO.