Herrmann, Johannes, Lotz, Christopher, Karagiannidis, Christian, Weber-Carstens, Steffen, Kluge, Stefan, Putensen, Christian, Wehrfritz, Andreas ORCID: 0000-0002-0399-0535, Schmidt, Karsten, Ellerkmann, Richard K., Oswald, Daniel, Lotz, Gosta, Zotzmann, Viviane, Moerer, Onnen ORCID: 0000-0002-4210-388X, Kuehn, Christian, Kochanek, Matthias, Muellenbach, Ralf, Gaertner, Matthias ORCID: 0000-0001-5600-8325, Fichtner, Falk, Brettner, Florian, Findeisen, Michael, Heim, Markus, Lahmer, Tobias, Rosenow, Felix, Haake, Nils, Lepper, Philipp M., Rosenberger, Peter, Braune, Stephan, Kohls, Mirjam ORCID: 0000-0003-4943-7791, Heuschmann, Peter and Meybohm, Patrick (2022). Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation. Crit. Care, 26 (1). LONDON: BMC. ISSN 1466-609X

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Abstract

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. PaO2/FiO(2) ratio prior to ECMO was 72 mmHg (IQR: 58-99). ICU survival was 31.4%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42%) patients fulfilling modified EOLIA criteria had a higher survival (38%) (p = 0.0014, OR 0.64 (CI 0.41-0.99)). Survival differed between low, intermediate, and high-volume centers with 20%, 30%, and 38%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28-1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events. 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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Herrmann, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lotz, ChristopherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Karagiannidis, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weber-Carstens, SteffenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kluge, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Putensen, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wehrfritz, AndreasUNSPECIFIEDorcid.org/0000-0002-0399-0535UNSPECIFIED
Schmidt, KarstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ellerkmann, Richard K.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oswald, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lotz, GostaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zotzmann, VivianeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Moerer, OnnenUNSPECIFIEDorcid.org/0000-0002-4210-388XUNSPECIFIED
Kuehn, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kochanek, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muellenbach, RalfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gaertner, MatthiasUNSPECIFIEDorcid.org/0000-0001-5600-8325UNSPECIFIED
Fichtner, FalkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Brettner, FlorianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Findeisen, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Heim, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lahmer, TobiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rosenow, FelixUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haake, NilsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lepper, Philipp M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rosenberger, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Braune, StephanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kohls, MirjamUNSPECIFIEDorcid.org/0000-0003-4943-7791UNSPECIFIED
Heuschmann, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meybohm, PatrickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-697584
DOI: 10.1186/s13054-022-04053-6
Journal or Publication Title: Crit. Care
Volume: 26
Number: 1
Date: 2022
Publisher: BMC
Place of Publication: LONDON
ISSN: 1466-609X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ORGANIZATION; MORTALITY; DEFINITION; SUPPORT; DISEASE; COHORT; VOLUMEMultiple languages
Critical Care MedicineMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/69758

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