tetano
Editor, Senior Moderator
Ann Thorac Surg
. 2021 Jan 21;S0003-4975(21)00104-1.
doi: 10.1016/j.athoracsur.2020.12.050. Online ahead of print.
Mortality Risk Assessment in Covid-19 Veno-Venous Extracorporeal Membrane Oxygenation
Ali Tabatabai[SUP] 1 [/SUP], Mira H Ghneim[SUP] 2 [/SUP], David J Kaczorowski[SUP] 3 [/SUP], Aakash Shah[SUP] 3 [/SUP], Sagar Dave[SUP] 4 [/SUP], Daniel J Haase[SUP] 5 [/SUP], Roumen Vesselinov[SUP] 6 [/SUP], Kristopher B Deatrick[SUP] 3 [/SUP], Joseph Rabin[SUP] 2 [/SUP], Ronald P Rabinowitz[SUP] 7 [/SUP], Samuel Galvagno Jr[SUP] 8 [/SUP], James V O'Connor[SUP] 2 [/SUP], Jay Menaker[SUP] 2 [/SUP], Daniel L Herr[SUP] 2 [/SUP], James S Gammie[SUP] 3 [/SUP], Thomas M Scalea[SUP] 2 [/SUP], Ronson J Madathil[SUP] 3 [/SUP]
Affiliations
Abstract
Background: A life-threatening complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS) refractory to conventional management. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is used to support ARDS patients failing conventional management. Scoring systems to predict mortality in VV-ECMO remain unvalidated in COVID-19 ARDS. We describe the largest COVID-19 VV-ECMO single-center experience to date and assess the utility of standard risk calculators.
Methods: A retrospective review of a prospective database of all COVID-19 VV-ECMO patients, cannulated between March 15[SUP]th[/SUP] and June 27[SUP]th[/SUP], 2020, at a single academic center was performed. Demographic, clinical, and ECMO characteristics were collected. The primary outcome was in hospital mortality; survivor and non-survivor cohorts were compared utilizing univariate and bivariate analyses.
Results: Forty COVID-19 ECMO patients were identified. Of the 33 patients (82.5%) off ECMO at time of analysis, 18 patients (54.5%) survived to hospital discharge and 15 (45.5%) died on ECMO. Non-survivors presented with a statistically significant higher Prediction of Survival on ECMO Therapy (PRESET)-Score (mean ? standard deviation 8.33 ? 0.8 vs. 6.17 ? 1.8, P = 0.001). The PRESET-Score demonstrated accurate mortality prediction. All patients with a PRESET-Score of ≤ 6 survived, and a score ≥ 7 was associated with a dramatic increase in mortality.
Conclusions: These results suggest favorable outcomes are possible in COVID-19 ECMO patients at high volume centers. This study is the first to demonstrate an association between the PRESET-Score and survival in COVID-19 VV-ECMO patients. Standard risk calculators may aid in appropriate COVID-19 ARDS patient selection for ECMO.
. 2021 Jan 21;S0003-4975(21)00104-1.
doi: 10.1016/j.athoracsur.2020.12.050. Online ahead of print.
Mortality Risk Assessment in Covid-19 Veno-Venous Extracorporeal Membrane Oxygenation
Ali Tabatabai[SUP] 1 [/SUP], Mira H Ghneim[SUP] 2 [/SUP], David J Kaczorowski[SUP] 3 [/SUP], Aakash Shah[SUP] 3 [/SUP], Sagar Dave[SUP] 4 [/SUP], Daniel J Haase[SUP] 5 [/SUP], Roumen Vesselinov[SUP] 6 [/SUP], Kristopher B Deatrick[SUP] 3 [/SUP], Joseph Rabin[SUP] 2 [/SUP], Ronald P Rabinowitz[SUP] 7 [/SUP], Samuel Galvagno Jr[SUP] 8 [/SUP], James V O'Connor[SUP] 2 [/SUP], Jay Menaker[SUP] 2 [/SUP], Daniel L Herr[SUP] 2 [/SUP], James S Gammie[SUP] 3 [/SUP], Thomas M Scalea[SUP] 2 [/SUP], Ronson J Madathil[SUP] 3 [/SUP]
Affiliations
- PMID: 33485917
- DOI: 10.1016/j.athoracsur.2020.12.050
Abstract
Background: A life-threatening complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS) refractory to conventional management. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is used to support ARDS patients failing conventional management. Scoring systems to predict mortality in VV-ECMO remain unvalidated in COVID-19 ARDS. We describe the largest COVID-19 VV-ECMO single-center experience to date and assess the utility of standard risk calculators.
Methods: A retrospective review of a prospective database of all COVID-19 VV-ECMO patients, cannulated between March 15[SUP]th[/SUP] and June 27[SUP]th[/SUP], 2020, at a single academic center was performed. Demographic, clinical, and ECMO characteristics were collected. The primary outcome was in hospital mortality; survivor and non-survivor cohorts were compared utilizing univariate and bivariate analyses.
Results: Forty COVID-19 ECMO patients were identified. Of the 33 patients (82.5%) off ECMO at time of analysis, 18 patients (54.5%) survived to hospital discharge and 15 (45.5%) died on ECMO. Non-survivors presented with a statistically significant higher Prediction of Survival on ECMO Therapy (PRESET)-Score (mean ? standard deviation 8.33 ? 0.8 vs. 6.17 ? 1.8, P = 0.001). The PRESET-Score demonstrated accurate mortality prediction. All patients with a PRESET-Score of ≤ 6 survived, and a score ≥ 7 was associated with a dramatic increase in mortality.
Conclusions: These results suggest favorable outcomes are possible in COVID-19 ECMO patients at high volume centers. This study is the first to demonstrate an association between the PRESET-Score and survival in COVID-19 VV-ECMO patients. Standard risk calculators may aid in appropriate COVID-19 ARDS patient selection for ECMO.