Antonino G Marullo1, Elena Cavarretta1,2, Giuseppe Biondi Zoccai3,2, Massimo Mancone4, Mariangela Peruzzi1,2, Fernando Piscioneri4, Patrizio Sartini4, Francesco Versaci5, Andrea Morelli4, Fabio Miraldi4, Giacomo Frati1,6. 1. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy. 2. Mediterranea Cardiocentro, Naples, Italy. 3. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - giuseppe.biondizoccai@uniroma1.it. 4. Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Latina, Italy. 5. Division of Cardiology, Santa Maria Goretti Hospital, Latina, Italy. 6. IRCCS NEUROMED, Pozzilli, Isernia, Italy.
Abstract
BACKGROUND: Infection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically ill patients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe. METHODS: Freely available data on ECMO in COVID-19 patients reported by the European Extracorporeal Life Support Organization (EuroELSO) were extracted and analyzed after conversion into long format. The primary outcome was the incidence of death during ECMO. Bootstrapping and logistic regression were used for inferential estimates. RESULTS: Details from a total of 333 patients treated in 90 institutions spanning 17 countries were obtained, with 22% women and mean age of 52 years. Death rate was 17.1% (95% confidence interval: 13.1% to 21.1%), even if significant between-center differences were found, with some institutions reporting 100% case fatality. Exploratory inferential analysis showed no nominally statistically significant association between death and gender (P=0.788), but a significant association was found with age, mainly due to increased case fatality in subjects >60 years (odds ratio: 4.80 [95% confidence interval 1.64 to 14.04], P=0.004). CONCLUSIONS: ECMO may play an important role in critically ill patients with COVID-19 refractory to less invasive treatments. The increased risk of early death in older patients may be used to prioritize ECMO indication in resource-conscious settings, if confirmed externally.
BACKGROUND:Infection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically illpatients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe. METHODS: Freely available data on ECMO in COVID-19patients reported by the European Extracorporeal Life Support Organization (EuroELSO) were extracted and analyzed after conversion into long format. The primary outcome was the incidence of death during ECMO. Bootstrapping and logistic regression were used for inferential estimates. RESULTS: Details from a total of 333 patients treated in 90 institutions spanning 17 countries were obtained, with 22% women and mean age of 52 years. Death rate was 17.1% (95% confidence interval: 13.1% to 21.1%), even if significant between-center differences were found, with some institutions reporting 100% case fatality. Exploratory inferential analysis showed no nominally statistically significant association between death and gender (P=0.788), but a significant association was found with age, mainly due to increased case fatality in subjects >60 years (odds ratio: 4.80 [95% confidence interval 1.64 to 14.04], P=0.004). CONCLUSIONS: ECMO may play an important role in critically illpatients with COVID-19 refractory to less invasive treatments. The increased risk of early death in older patients may be used to prioritize ECMO indication in resource-conscious settings, if confirmed externally.
Authors: McKenzie M Hayes; Brian P Fallon; Ryan P Barbaro; Niki Manusko; Robert H Bartlett; John M Toomasian Journal: ASAIO J Date: 2021-09-01 Impact factor: 3.826