Alexander Supady1,2,3, Jeff DellaVolpe4, Fabio Silvio Taccone5, Dominik Scharpf6, Matthias Ulmer7, Philipp M Lepper8, Maximilian Halbe9, Stephan Ziegeler10, Alexander Vogt11, Raj Ramanan12, David Boldt13, Stephanie-Susanne Stecher14, Andrea Montisci15, Tobias Spangenberg16, Olivier Marggraf17, Chandra Kunavarapu4, Lorenzo Peluso5, Sebastian Muenz6, Monica Buerle7, Naveen G Nagaraj9, Sebastian Nuding11, Catalin Toma12, Vadim Gudzenko13, Hans Joachim Stemmler18, Federico Pappalardo19, Georg Trummer20, Christoph Benk20, Guido Michels21, Daniel Duerschmied1,2, Constantin von Zur Muehlen1,2, Christoph Bode1,2, Klaus Kaier2,22, Daniel Brodie23, Tobias Wengenmayer1,2, Dawid L Staudacher1,2. 1. Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. 2. Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany. 3. Heidelberg Institute of Global Health, University of Heidelberg, 69120 Heidelberg, Germany. 4. Methodist Hospital, San Antonio, TX 78229, USA. 5. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium. 6. SLK-Hospital Heilbronn, 74078 Heilbronn, Germany. 7. RKH Hospital Ludwigsburg, 71640 Ludwigsburg, Germany. 8. Department of Internal Medicine V-Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, D-66421 Homburg, Germany. 9. Heart Center, University Hospital Zurich, 8006 Zurich, Switzerland. 10. Department of Anesthesiology, Intensive Care Medicine and Pain Management, Hospital Ibbenbueren, 49477 Ibbenbueren, Germany. 11. Department of Medicine III, University Clinic Halle (Saale), 06097 Halle (Saale), Germany. 12. University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA. 13. UCLA Healthcare System, Los Angeles, CA 90095, USA. 14. Medical Department II, LMU Hospital Munich, 80331 Munich, Germany. 15. Istituto Clinico Sant'Ambrogio, University of Milan, 20149 Milan, Italy. 16. Department of Cardiology, Angiology and Intensive Care, Marien Hospital Hamburg, 22087 Hamburg, Germany. 17. Asklepios Clinic North, 22417 Hamburg, Germany. 18. Medical Department III, LMU Hospital Munich, 80331 Munich, Germany. 19. Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, 90127 Palermo, Italy. 20. Department of Cardiovascular Surgery, Heart Center, University of Freiburg, 79106 Freiburg, Germany. 21. Department of Acute and Emergency Care, St. Antonius Hospital Eschweiler, 52249 Eschweiler, Germany. 22. Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany. 23. Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY 10032, USA.
Abstract
The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. METHODS: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. RESULTS: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic-AUROC) ranged between 0.548 and 0.605. CONCLUSIONS: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.
The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. METHODS: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. RESULTS: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic-AUROC) ranged between 0.548 and 0.605. CONCLUSIONS: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19ARDSpatients treated with V-V ECMO.