Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
29 03 2023
29 03 2023
Historique:
received:
16
05
2022
accepted:
20
03
2023
medline:
31
3
2023
entrez:
29
3
2023
pubmed:
30
3
2023
Statut:
epublish
Résumé
The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients' outcome in severe COVID-19 with respiratory failure, but data on ECMO remains controversial. The aim of the study was to determine the characteristics of patients under invasive mechanical ventilation (IMV) with or without veno-venous ECMO support and to evaluate outcome parameters. Ventilated patients with COVID-19 with and without additional ECMO support were analyzed in a retrospective multicenter study regarding clinical characteristics, respiratory and laboratory parameters in day-to-day follow-up. Recruitment of patients was conducted during the first three COVID-19 waves at four German university hospitals of the Ruhr University Bochum, located in the Middle Ruhr Region. From March 1, 2020 to August 31, 2021, the charts of 149 patients who were ventilated for COVID-19 infection, were included (63.8% male, median age 67 years). Fifty patients (33.6%) received additional ECMO support. On average, ECMO therapy was initiated 15.6 ± 9.4 days after symptom onset, 10.6 ± 7.1 days after hospital admission, and 4.8 ± 6.4 days after the start of IMV. Male sex and higher SOFA and RESP scores were observed significantly more often in the high-volume ECMO center. Pre-medication with antidepressants was more often detected in survivors (22.0% vs. 6.5%; p = 0.006). ECMO patients were 14 years younger and presented a lower rate of concomitant cardiovascular diseases (18.0% vs. 47.5%; p = 0.0004). Additionally, cytokine-adsorption (46.0% vs. 13.1%; p < 0.0001) and renal replacement therapy (76.0% vs. 43.4%; p = 0.0001) were carried out more frequently; in ECMO patients thrombocytes were transfused 12-fold more often related to more than fourfold higher bleeding complications. Undulating C-reactive protein (CRP) and massive increase in bilirubin levels (at terminal stage) could be observed in deceased ECMO patients. In-hospital mortality was high (Overall: 72.5%, ECMO: 80.0%, ns). Regardless of ECMO therapy half of the study population deceased within 30 days after hospital admission. Despite being younger and with less comorbidities ECMO therapy did not improve survival in severely ill COVID-19 patients. Undulating CRP levels, a massive increase of bilirubin level and a high use of cytokine-adsorption were associated with worse outcomes. In conclusion, ECMO support might be helpful in selected severe cases of COVID-19.
Identifiants
pubmed: 36991018
doi: 10.1038/s41598-023-31944-7
pii: 10.1038/s41598-023-31944-7
pmc: PMC10054204
doi:
Substances chimiques
Bilirubin
RFM9X3LJ49
Types de publication
Multicenter Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5143Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s).
Références
Stokes, E. K. et al. Coronavirus disease 2019 case surveillance - United States, January 22-May 30, 2020. MMWR Morb. Mortal Wkly. Rep. 69(24), 759–765. https://doi.org/10.15585/mmwr.mm6924e2 (2020).
doi: 10.15585/mmwr.mm6924e2
pubmed: 32555134
pmcid: 7302472
Osuchowski, M. F. et al. The COVID-19 puzzle: Deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respir Med. 9(6), 622–642. https://doi.org/10.1016/S2213-2600(21)00218-6 (2021).
doi: 10.1016/S2213-2600(21)00218-6
pubmed: 33965003
pmcid: 8102044
Nicholson, C. J. et al. Estimating risk of mechanical ventilation and in-hospital mortality among adult COVID-19 patients admitted to Mass General Brigham: The VICE and DICE scores. EClinicalMedicine. 33, 100765. https://doi.org/10.1016/j.eclinm.2021.100765 (2021).
doi: 10.1016/j.eclinm.2021.100765
pubmed: 33655204
pmcid: 7906522
Alshahrani, M. S. et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann. Intensive Care 8(1), 3. https://doi.org/10.1186/s13613-017-0350-x.PMID:29330690;PMCID:PMC5768582 (2018).
doi: 10.1186/s13613-017-0350-x.PMID:29330690;PMCID:PMC5768582
pubmed: 29330690
pmcid: 5768582
Fraaij, P. L. et al. Severe acute respiratory infection caused by swine influenza virus in a child necessitating extracorporeal membrane oxygenation (ECMO), the Netherlands, October 2016. Eurosurveill 21, 30416 (2016).
doi: 10.2807/1560-7917.ES.2016.21.48.30416
Roedl, K. et al. Clinical characteristics, complications and outcomes of patients with severe acute respiratory distress syndrome related to COVID-19 or influenza requiring extracorporeal membrane oxygenation-A retrospective cohort study. J. Clin. Med. 10(22), 5440. https://doi.org/10.3390/jcm10225440.PMID:34830721;PMCID:PMC8619058 (2021).
doi: 10.3390/jcm10225440.PMID:34830721;PMCID:PMC8619058
pubmed: 34830721
pmcid: 8619058
Lebreton, G., Schmidt, M., Ponnaiah, M., Folliguet, T., Para, M., Guihaire, J., Lansac, E., Sage, E., Cholley, B., Mégarbane, B., Cronier, P., Zarka, J., Da Silva, D., Besset, S., Morichau-Beauchant, T., Lacombat, I., Mongardon, N., Richard, C., Duranteau, J., Cerf, C., Saiydoun, G., Sonneville, R., Chiche, J. D., Nataf, P., Longrois, D., Combes, A., Leprince, P.; Paris ECMO-COVID-19 investigators. Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: A multicentre cohort study. Lancet Respir. Med. 9(8), 851–862 (2021). doi: https://doi.org/10.1016/S2213-2600(21)00096-5 . Erratum in: Lancet Respir. Med. 9(6), e55 (2021). Erratum in: Lancet Respir. Med. 9(7), e62 (2021).
Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., Yu, T., Wang, Y., Pan, S., Zou, X., Yuan, S., Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir. Med. 8(5), 475–481 (2020). doi: https://doi.org/10.1016/S2213-2600(20)30079-5 . Erratum in: Lancet Respir. Med. 8(4), e26 (2020).
Arentz, M. et al. Characteristics and outcomes of 21 critically Ill patients with COVID-19 in Washington State. JAMA 323(16), 1612–1614. https://doi.org/10.1001/jama.2020.4326 (2020).
doi: 10.1001/jama.2020.4326
pubmed: 32191259
pmcid: 7082763
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., Cao, B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 395(10229), 1054–1062 (2020). https://doi.org/10.1016/S0140-6736(20)30566-3 . Epub 2020 Mar 11. Erratum in: Lancet 395(10229), 1038 (2020). Erratum in: Lancet 395(10229), 1038 (2020).
Barbaro, R. P. et al. Extracorporeal life support organization. Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international extracorporeal life support organization registry. Lancet 398(10307), 1230–1238. https://doi.org/10.1016/S0140-6736(21)01960-7 (2021).
doi: 10.1016/S0140-6736(21)01960-7
pubmed: 34599878
pmcid: 8480964
Barbaro, R. P., MacLaren, G., Boonstra, P. S., Iwashyna, T. J., Slutsky, A. S., Fan, E., Bartlett, R. H., Tonna, J. E., Hyslop, R., Fanning, J. J., Rycus, P. T., Hyer, S. J., Anders, M. M., Agerstrand, C. L., Hryniewicz, K., Diaz, R., Lorusso, R., Combes, A., Brodie, D., Extracorporeal Life Support Organization. Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the extracorporeal life support organization registry. Lancet 396(10257), 1071–1078 (2020). https://doi.org/10.1016/S0140-6736(20)32008-0 . Epub 2020 Sep 25. Erratum in: Lancet 396(10257), 1070 (2020).
Karagiannidis, C. et al. Observational study of changes in utilization and outcomes in mechanical ventilation in COVID-19. PLoS ONE 17(1), e0262315. https://doi.org/10.1371/journal.pone.0262315 (2022).
doi: 10.1371/journal.pone.0262315
pubmed: 35030205
pmcid: 8759661
Schmidt, M. et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study. Lancet Respir. Med. 8(11), 1121–1131. https://doi.org/10.1016/S2213-2600(20)30328-3 (2020).
doi: 10.1016/S2213-2600(20)30328-3
pubmed: 32798468
pmcid: 7426089
Karagiannidis, C. et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: An observational study. Lancet Respir. Med. 8(9), 853–862. https://doi.org/10.1016/S2213-2600(20)30316-7 (2020).
doi: 10.1016/S2213-2600(20)30316-7
pubmed: 32735842
pmcid: 7386882
Karagiannidis, C. et al. Complete countrywide mortality in COVID patients receiving ECMO in Germany throughout the first three waves of the pandemic. Crit. Care 25(1), 413. https://doi.org/10.1186/s13054-021-03831-y (2021).
doi: 10.1186/s13054-021-03831-y
pubmed: 34844657
pmcid: 8628273
Kelly, G., Petti, S. & Noah, N. Covid-19, non-Covid-19 and excess mortality rates not comparable across countries. Epidemiol. Infect. 149, e176. https://doi.org/10.1017/S0950268821001850 (2021).
doi: 10.1017/S0950268821001850
pubmed: 34338184
Oliveira, M. H. S., Wong, J., Lippi, G. & Henry, B. M. Analysis of clinical and demographic heterogeneity of patients dying from COVID-19 in Brazil versus China and Italy. Braz. J. Infect. Dis. 24, 273–275 (2020).
doi: 10.1016/j.bjid.2020.05.002
pubmed: 32479748
pmcid: 7256538
Michelozzi, P., de'Donato, F., Scortichini, M., Pezzotti, P., Stafoggia, M., De Sario, M., Costa, G., Noccioli, F., Riccardo, F., Bella, A., Demaria, M., Rossi, P., Brusaferro, S., Rezza, G., Davoli, M. Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities. BMC Public Health 20(1), 1238 (2020). https://doi.org/10.1186/s12889-020-09335-8 . Erratum in: BMC Public Health 20(1), 1325 (2020).
Henriques, T. S. et al. Multiscale Poincaré plots for visualizing the structure of heartbeat time series. BMC Med. Inform. Decis. Mak. 9(16), 17. https://doi.org/10.1186/s12911-016-0252-0.PMID:26860191;PMCID:PMC4746786 (2016).
doi: 10.1186/s12911-016-0252-0.PMID:26860191;PMCID:PMC4746786
Schmidt, M. et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score. Am. J. Respir. Crit. Care Med. 189(11), 1374–1382. https://doi.org/10.1164/rccm.201311-2023OC (2014).
doi: 10.1164/rccm.201311-2023OC
pubmed: 24693864
Hilder, M. et al. Comparison of mortality prediction models in acute respiratory distress syndrome undergoing extracorporeal membrane oxygenation and development of a novel prediction score: the PREdiction of Survival on ECMO Therapy-Score (PRESET-Score). Crit. Care 21(1), 301. https://doi.org/10.1186/s13054-017-1888-6 (2017).
doi: 10.1186/s13054-017-1888-6
pubmed: 29233160
pmcid: 5728043
Friedrichson, B. et al. Extracorporeal membrane oxygenation in coronavirus disease 2019: A nationwide cohort analysis of 4279 runs from Germany. Eur. J. Anaesthesiol. 39(5), 445–451. https://doi.org/10.1097/EJA.0000000000001670 (2022).
doi: 10.1097/EJA.0000000000001670
pubmed: 35180152
Williamson, E. J. et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 584(7821), 430–436. https://doi.org/10.1038/s41586-020-2521-4 (2020).
doi: 10.1038/s41586-020-2521-4
pubmed: 32640463
pmcid: 7611074
Cheng, W. et al. Retrospective study of critically Ill COVID-19 patients with and without extracorporeal membrane oxygenation support in Wuhan, China. Front. Med. (Lausanne) 8, 659793. https://doi.org/10.3389/fmed.2021.659793 (2021).
doi: 10.3389/fmed.2021.659793
pubmed: 34712673
Corrêa, T. D. et al. Clinical characteristics and outcomes of COVID-19 patients admitted to the intensive care unit during the first year of the pandemic in Brazil: A single center retrospective cohort study. Einstein (Sao Paulo) 19, eAO6739. https://doi.org/10.31744/einstein_journal/2021AO6739 (2021).
doi: 10.31744/einstein_journal/2021AO6739
pubmed: 34878071
Supady, A. et al. Survival after extracorporeal membrane oxygenation in severe COVID-19 ARDS: Results from an international multicenter registry. Crit. Care 25(1), 90. https://doi.org/10.1186/s13054-021-03486-9 (2021).
doi: 10.1186/s13054-021-03486-9
pubmed: 33648538
pmcid: 7919616
Funakoshi, K., Morita, T. & Kumanogoh, A. Longer prehospitalization and preintubation periods in intubated non-survivors and ECMO patients with COVID-19: A systematic review and meta-analysis. Front. Med. Lausanne 15(8), 727101. https://doi.org/10.3389/fmed.2021.727101 (2021).
doi: 10.3389/fmed.2021.727101
Barbaro, R. P. et al. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am. J. Respir. Crit. Care Med. 191(8), 894–901. https://doi.org/10.1164/rccm.201409-1634OC (2015).
doi: 10.1164/rccm.201409-1634OC
pubmed: 25695688
pmcid: 4435456
Combes, A. et al. Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients. Am. J. Respir. Crit. Care Med. 190(5), 488–496. https://doi.org/10.1164/rccm.201404-0630CP (2014).
doi: 10.1164/rccm.201404-0630CP
pubmed: 25062496
Bercker, S. et al. ECMO use in Germany: An analysis of 29,929 ECMO runs. PLoS ONE 16(12), e0260324. https://doi.org/10.1371/journal.pone.0260324 (2021).
doi: 10.1371/journal.pone.0260324
pubmed: 34874960
pmcid: 8651096
Peckham, H. et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat. Commun. 11(1), 6317. https://doi.org/10.1038/s41467-020-19741-6.PMID:33298944;PMCID:PMC7726563 (2020).
doi: 10.1038/s41467-020-19741-6.PMID:33298944;PMCID:PMC7726563
pubmed: 33298944
pmcid: 7726563
Nielsen, J., Nørgaard, S. K., Lanzieri, G., Vestergaard, L. S. & Moelbak, K. Sex-differences in COVID-19 associated excess mortality is not exceptional for the COVID-19 pandemic. Sci. Rep. 11(1), 20815. https://doi.org/10.1038/s41598-021-00213-w.PMID:34675280;PMCID:PMC8531278 (2021).
doi: 10.1038/s41598-021-00213-w.PMID:34675280;PMCID:PMC8531278
pubmed: 34675280
pmcid: 8531278
Niessen, A. et al. Sex differences in COVID-19 mortality in the Netherlands. Infection https://doi.org/10.1007/s15010-021-01744-0 (2022).
doi: 10.1007/s15010-021-01744-0
pubmed: 35759174
pmcid: 9243733
McElvaney, O. J. et al. Characterization of the inflammatory response to severe COVID-19 illness. Am. J. Respir. Crit. Care Med. 202, 812–821 (2020).
doi: 10.1164/rccm.202005-1583OC
pubmed: 32584597
pmcid: 7491404
Mehta, P. et al. COVID-19: Consider cytokine storm syndromes and immunosuppression. Lancet 395, 1033–1034 (2020).
doi: 10.1016/S0140-6736(20)30628-0
pubmed: 32192578
pmcid: 7270045
Supady, A., Weber, E., Rieder, M., Lother, A., Niklaus, T., Zahn, T., Frech, F., Müller, S., Kuhl, M., Benk, C., Maier, S., Trummer, G., Flügler, A., Krüger, K., Sekandarzad, A., Stachon, P., Zotzmann, V., Bode, C., Biever, P. M., Staudacher, D., Wengenmayer, T., Graf, E., Duerschmied D. Cytokine adsorption in patients with severe COVID-19 pneumonia requiring extracorporeal membrane oxygenation (CYCOV): A single centre, open-label, randomised, controlled trial. Lancet Respir. Med. 9(7), 755–762 (2021). https://doi.org/10.1016/S2213-2600(21)00177-6 . Erratum in: Lancet Respir. Med. (2021).
Oskotsky, T. et al. Mortality risk among patients with COVID-19 prescribed selective serotonin reuptake inhibitor antidepressants. JAMA Netw. Open 4(11), e2133090. https://doi.org/10.1001/jamanetworkopen.2021.33090 (2021).
doi: 10.1001/jamanetworkopen.2021.33090
pubmed: 34779847
pmcid: 8593759
Hoertel, N. et al. Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study. Mol. Psychiatry 26(9), 5199–5212. https://doi.org/10.1038/s41380-021-01021-4 (2021).
doi: 10.1038/s41380-021-01021-4
pubmed: 33536545
Sukhatme, V. P., Reiersen, A. M., Vayttaden, S. J. & Sukhatme, V. V. Fluvoxamine: A review of its mechanism of action and its role in COVID-19. Front. Pharmacol. 20(12), 652688. https://doi.org/10.3389/fphar.2021.652688 (2021).
doi: 10.3389/fphar.2021.652688
Reis, G., Dos Santos Moreira-Silva, E. A., Silva, D. C. M., Thabane, L., Milagres, A. C., Ferreira, T. S., Dos Santos, C. V. Q., de Souza Campos, V. H., Nogueira, A. M. R., de Almeida, A. P. F. G., Callegari, E. D., de Figueiredo Neto, A. D., Savassi, L. C. M., Simplicio, M. I. C., Ribeiro, L. B., Oliveira, R., Harari, O., Forrest, J. I., Ruton, H., Sprague, S., McKay, P., Glushchenko, A. V., Rayner, C. R., Lenze, E. J., Reiersen, A. M., Guyatt, G. H., Mills, E. J., TOGETHER investigators. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: The TOGETHER randomised, platform clinical trial. Lancet Glob. Health 10(1), e42–e51 (2022). https://doi.org/10.1016/S2214-109X(21)00448-4 . Erratum in: Lancet Glob. Health. 10(4), e481 (2022)
Chen, W. et al. Plasma CRP level is positively associated with the severity of COVID-19. Ann. Clin. Microbiol. Antimicrob. 19(1), 18. https://doi.org/10.1186/s12941-020-00362-2 (2020).
doi: 10.1186/s12941-020-00362-2
pubmed: 32414383
pmcid: 7227180
Valerio, L. et al. Lodigiani C course of D-dimer and C-reactive protein levels in survivors and nonsurvivors with COVID-19 pneumonia: A retrospective analysis of 577 patients. Thromb. Haemost. 121(1), 98–101. https://doi.org/10.1055/s-0040-1721317 (2021).
doi: 10.1055/s-0040-1721317
pubmed: 33212544
Yitbarek, G. Y. et al. The role of C-reactive protein in predicting the severity of COVID-19 disease: A systematic review. SAGE Open Med. 11(9), 20503121211050756. https://doi.org/10.1177/20503121211050755.PMID:34659766;PMCID:PMC8516378 (2021).
doi: 10.1177/20503121211050755.PMID:34659766;PMCID:PMC8516378
Liu, Z. et al. Bilirubin levels as potential indicators of disease severity in coronavirus disease patients: A retrospective cohort study. Front. Med. Lausanne 9(7), 598870. https://doi.org/10.3389/fmed.2020.598870 (2020).
doi: 10.3389/fmed.2020.598870
Paliogiannis, P. & Zinellu, A. Bilirubin levels in patients with mild and severe Covid-19: A pooled analysis. Liver Int. 40(7), 1787–1788. https://doi.org/10.1111/liv.14477 (2020).
doi: 10.1111/liv.14477
pubmed: 32304343
pmcid: 7264680
Nesseler, N. et al. Clinical review: The liver in sepsis. Crit. Care. 16(5), 235. https://doi.org/10.1186/cc11381 (2012).
doi: 10.1186/cc11381
pubmed: 23134597
pmcid: 3682239
Henry, B. M. COVID-19, ECMO, and lymphopenia: A word of caution. Lancet Respir. Med. 8(4), e24. https://doi.org/10.1016/S2213-2600(20)30119-3 (2020).
doi: 10.1016/S2213-2600(20)30119-3
pubmed: 32178774
pmcid: 7118650
Bizzarro, M. J. et al. Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults. Pediatr. Crit. Care Med. 12(3), 277–281. https://doi.org/10.1097/PCC.0b013e3181e28894 (2011).
doi: 10.1097/PCC.0b013e3181e28894
pubmed: 20495508
Doyle, A. J. et al. Blood component use in critical care in patients with COVID-19 infection: A single-centre experience. Br. J. Haematol. 191(3), 382–385. https://doi.org/10.1111/bjh.17007 (2020).
doi: 10.1111/bjh.17007
pubmed: 32640484
pmcid: 7362152