Mortality rates of severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation in the Middle Ruhr Region of Germany
Assem Aweimer, Lea Petschulat, Birger Jettkant, Roland Köditz, Johannes Finkeldei, Johannes W Dietrich, Thomas Breuer, Christian Draese, Ulrich H Frey, Tim Rahmel, Michael Adamzik, Dirk Buchwald, Dritan Useini, Thorsten Brechmann, Ingolf Hosbach, Jürgen Bünger, Aydan Ewers, Ibrahim El-Battrawy, Andreas Mügge
Scientific Reports, doi:10.1038/s41598-023-31944-7
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 dayto-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. Premedication 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
Author contributions A.A. and L.P. take responsibility for the content of the manuscript, including the data and analysis. A.A., A.M., T.R., C.D., T.B., J.F., D.B. contributed to the conception and design of the study. A.A., L.P., B.J., R.K., D.B., A.M. analyzed and interpreted the patient data. A.A., L.P. and B.J. performed the statistical analyses. A.A., A.M., I.E. and TB were major contributors in writing the manuscript. J.D., R.K., D.B., T.R., U.F., M.A., J.B., I.H. contributed to interpretation of the data and revised the manuscript. All authors read and approved the final manuscript.
Competing interests The authors declare no competing interests.
References
Arentz, Characteristics and outcomes of 21 critically Ill patients with COVID-19 in Washington State, JAMA,
doi:10.1001/jama.2020.4326
Barbaro, 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,
doi:10.1164/rccm.201409-1634OC
Barbaro, Extracorporeal life support organization. Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international extracorporeal life support organization registry, Lancet,
doi:10.1016/S0140-6736(21)01960-7
Barbaro, Maclaren, Boonstra, Iwashyna, Slutsky et al., Extracorporeal Life Support Organization
Bizzarro, Infections acquired during extracorporeal membrane oxygenation in neonates, children, and adults, Pediatr. Crit. Care Med,
doi:10.1097/PCC.0b013e3181e28894
Cheng, Retrospective study of critically Ill COVID-19 patients with and without extracorporeal membrane oxygenation support in Wuhan, Front. Med,
doi:10.3389/fmed.2021.659793
Combes, Position paper for the organization of extracorporeal membrane oxygenation programs for acute respiratory failure in adult patients, Am. J. Respir. Crit. Care Med,
doi:10.1164/rccm.201404-0630CP
Corrêa, 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,
doi:10.31744/einstein_journal/2021AO6739
Doyle, Blood component use in critical care in patients with COVID-19 infection: A single-centre experience, Br. J. Haematol,
doi:10.1111/bjh.17007
Fraaij, Severe acute respiratory infection caused by swine influenza virus in a child necessitating extracorporeal membrane oxygenation (ECMO), the Netherlands, Eurosurveill
Friedrichson, Extracorporeal membrane oxygenation in coronavirus disease 2019: A nationwide cohort analysis of 4279 runs from Germany, Eur. J. Anaesthesiol,
doi:10.1097/EJA.0000000000001670
Funakoshi, Morita, Kumanogoh, Longer prehospitalization and preintubation periods in intubated non-survivors and ECMO patients with COVID-19: A systematic review and meta-analysis, Front. Med. Lausanne,
doi:10.3389/fmed.2021.727101
Hilder, 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,
doi:10.1186/s13054-017-1888-6
Hoertel, Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study, Mol. Psychiatry,
doi:10.1038/s41380-021-01021-4
Karagiannidis, Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: An observational study, Lancet Respir. Med,
doi:10.1016/S2213-2600(20)30316-7
Karagiannidis, Complete countrywide mortality in COVID patients receiving ECMO in Germany throughout the first three waves of the pandemic, Crit. Care,
doi:10.1186/s13054-021-03831-y
Kelly, Petti, Noah, Covid-19, non-Covid-19 and excess mortality rates not comparable across countries, Epidemiol. Infect,
doi:10.1017/S0950268821001850
Lebreton, Schmidt, Ponnaiah, Folliguet, Para et al., 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,
doi:10.1016/S2213-2600(21)00096-5
Liu, Bilirubin levels as potential indicators of disease severity in coronavirus disease patients: A retrospective cohort study, Front. Med. Lausanne,
doi:10.3389/fmed.2020.598870
Mcelvaney, Characterization of the inflammatory response to severe COVID-19 illness, Am. J. Respir. Crit. Care Med
Mehta, COVID-19: Consider cytokine storm syndromes and immunosuppression, Lancet
Michelozzi, De'donato, Scortichini, Pezzotti, Stafoggia et al., Temporal dynamics in total excess mortality and COVID-19 deaths in Italian cities, BMC Public Health,
doi:10.1186/s12889-020-09335-8
Nicholson, 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,
doi:10.1016/j.eclinm.2021.100765
Oliveira, Wong, Lippi, Henry, Analysis of clinical and demographic heterogeneity of patients dying from COVID-19 in Brazil versus China and Italy, Braz. J. Infect. Dis
Paliogiannis, Zinellu, Bilirubin levels in patients with mild and severe Covid-19: A pooled analysis, Liver Int,
doi:10.1111/liv.14477
Reis, Dos, Moreira-Silva, Silva, Thabane et al., 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,
doi:10.1016/S2214-109X(21)00448-4
Roedl, 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,
doi:10.3390/jcm10225440.PMID:34830721;PMCID:PMC8619058
Schmidt, Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study, Lancet Respir. Med,
doi:10.1016/S2213-2600(20)30328-3
Schmidt, 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,
doi:10.1164/rccm.201311-2023OC
Sukhatme, Reiersen, Vayttaden, Sukhatme, Fluvoxamine: A review of its mechanism of action and its role in COVID-19, Front. Pharmacol,
doi:10.3389/fphar.2021.652688
Supady, Survival after extracorporeal membrane oxygenation in severe COVID-19 ARDS: Results from an international multicenter registry, Crit. Care,
doi:10.1186/s13054-021-03486-9
Supady, Weber, Rieder, Lother, Niklaus et al., 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,
doi:10.1016/S2213-2600(21)00177-6
Valerio, 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,
doi:10.1055/s-0040-1721317
Yang, Yu, Xu, Shu, Xia et al., 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,
doi:10.1016/S2213-2600(20)30079-5
Zhou, Yu, Du, Fan, Liu et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3