COVID-19-associated acute respiratory distress syndrome (ARDS) can be efficiently treated with extracorporeal membrane oxygenation (ECMO), according to the findings of a multicenter cohort study published in The Lancet Respiratory Medicine.
In France, ECMO for severe ARDS was considered early on during the COVID-19 pandemic even though early reports from China indicated unfavorable outcomes and some argued that ECMO could even be deleterious. Therefore, researchers conducted a study to analyze 302 adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 intensive care units (ICU) within the Greater Paris area between March 8, 2020, and June 3, 2020. The researchers reported on the characteristics and 90-day clinical outcomes of patients who received ECMO for SARS-CoV-2 infection.
Before ECMO, 285 (94%) patients were placed in the prone position, median driving pressure was 18 cm H2O, and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg. During ECMO, 43% (115/270) patients had a major bleeding event, 43% (130/301) patients received renal replacement therapy, and 18% (53/294) had a pulmonary embolism. A total of 46% (138/302) of patients were alive 90 days after ECMO.
The most common causes of death were multiorgan failure (53 patients) and septic shock (47 patients). Shorter time between intubation and ECMO, younger age, lower pre-ECMO renal component of the Sequential Organ Failure Assessment (SOFA) score, and treatment in centers managing at least 30 venovenous ECMO cases were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation.
“Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources,” the researchers concluded,
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Lebreton G, Schmidt M, Ponnaiah M, et al; on behalf of the 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. Published online April 19, 2021. doi:10.1016/S2213-2600(21):00096-5