Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation.

COVID-19 / therapy Extracorporeal Membrane Oxygenation Humans Intensive Care Units Pandemics Respiratory Distress Syndrome / therapy Survival Analysis
Acute respiratory distress syndrome (ARDS) COVID-19 Case-volume relationship Extracorporeal life support Intensive care

Journal

Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902

Informations de publication

Date de publication:
28 06 2022
Historique:
received: 23 03 2022
accepted: 07 06 2022
entrez: 28 6 2022
pubmed: 29 6 2022
medline: 1 7 2022
Statut: epublish

Résumé

Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients. 673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival. Most patients were between 50 and 70 years of age. PaO Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival. Registered in the German Clinical Trials Register (study ID: DRKS00022964, retrospectively registered, September 7th 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022964 .

Sections du résumé

BACKGROUND
Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients.
METHODS
673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival.
RESULTS
Most patients were between 50 and 70 years of age. PaO
CONCLUSIONS
Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival.
TRIAL REGISTRATION
Registered in the German Clinical Trials Register (study ID: DRKS00022964, retrospectively registered, September 7th 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022964 .

Identifiants

DOI: 10.1186/s13054-022-04053-6 PMID: 35765102 PMC: PMC9238175
pubmed: 35765102
doi: 10.1186/s13054-022-04053-6
pii: 10.1186/s13054-022-04053-6
pmc: PMC9238175
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

190

Investigateurs

Martha E Hübsch (ME)
Quirin Notz (Q)
Daniel Röder (D)
Peter Kranke (P)
Michaela L Merten (ML)
Dominik Jarczak (D)
Kevin Roedl (K)
Jens-Christian Schewe (JC)
Stefan F Ehrentraut (SF)
Stefan Kreyer (S)
Ixchel Castellanos (I)
Thorsten Brenner (T)
Frank Herbstreit (F)
Florian Espeter (F)
Jan Wiefhoff (J)
Björn Ellger (B)
Florian J Raimann (FJ)
Michael Sonntagbauer (M)
Tobias Wengenmayer (T)
Dawid Staudacher (D)
Ruslan Natanov (R)
Caroline Rolfes (C)
Christian Reyher (C)
Iuliu-Emilian Torje (IE)
Patricia Glaser (P)
Vanessa Rembold (V)
Rainer Haseneder (R)
Jan Sackarnd (J)
Johannes Lepper (J)
Andre Becker (A)
Guy Danziger (G)
Carlos Metz (C)
Valbona Mirakaj (V)
Stefanie Calov (S)
Anna Grau (A)
Kirsten Haas (K)
Katrin Ungethüm (K)
Karl Bihlmaier (K)

Informations de copyright

© 2022. The Author(s).

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Auteurs

Johannes Herrmann (J)

Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany.

Christopher Lotz (C)

Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany.

Christian Karagiannidis (C)

Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany.

Steffen Weber-Carstens (S)

Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.

Stefan Kluge (S)

Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Christian Putensen (C)

Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany.

Andreas Wehrfritz (A)

Department of Anaesthesiology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen-Nuernberg (FAU), Erlangen, Germany.

Karsten Schmidt (K)

Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.

Richard K Ellerkmann (RK)

Department of Anesthesiology and Intensive Care Medicine, Klinikum Dortmund, Klinikum University Witten/Herdecke, Dortmund, Germany.

Daniel Oswald (D)

Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Clinic Centre Westfalen, Dortmund, Germany.

Gösta Lotz (G)

Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.

Viviane Zotzmann (V)

Department of Cardiology and Angiology I (Heart Center Freiburg - Bad Krozingen), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Interdisciplinary Medical Intensive Care (IMIT), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Onnen Moerer (O)

Department of Anesthesiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37085, Göttingen, Germany.

Christian Kühn (C)

Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.

Matthias Kochanek (M)

Department of Internal Medicine, Division I (Hematology/Oncology), University Hospital of Cologne, Cologne, Germany.

Ralf Muellenbach (R)

Department of Anesthesiology and Critical Care Medicine, ARDS/ECMO-Center, Campus Kassel of the University of Southampton, Kassel, Germany.

Matthias Gaertner (M)

Department of Anaesthesia, Perioperative Medicine and Interdisciplinary Intensive Care Medicine, ECLS/ECMO-Center, Asklepios Klinik Langen, Langen, Germany.

Falk Fichtner (F)

Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Center, Leipzig, Germany.

Florian Brettner (F)

ARDS- und ECMO Zentrum München-Nymphenburg, Barmherzige Brüder Krankenhaus München, München, Germany.

Michael Findeisen (M)

Klinik für Pneumologie, Internistische Intensiv- und Beatmungsmedizin, München Klinik Harlaching, Munich, Germany.

Markus Heim (M)

Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany.

Tobias Lahmer (T)

School of Medicine, University Hospital Rechts Der Isar, Department of Internal Medicine II, University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.

Felix Rosenow (F)

Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Muenster, Germany.

Nils Haake (N)

Department of Intensive Care Medicine, Imland Klinik Rendsburg, Rendsburg, Germany.

Philipp M Lepper (PM)

Department of Internal Medicine V- Pneumology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany.

Peter Rosenberger (P)

Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.

Stephan Braune (S)

Department of Medical Intensive Care and Emergency Medicine, St. Franziskus-Hospital Muenster, Münster, Germany.

Mirjam Kohls (M)

Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.

Peter Heuschmann (P)

Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.
Clinical Trial Center Würzburg, Universitätsklinikum Würzburg, Würzburg, Germany.

Patrick Meybohm (P)

Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Oberduerrbacherstr. 6, 97080, Würzburg, Germany. Meybohm_P@ukw.de.

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Classifications MeSH

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