Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation
Johannes Herrmann,
Christopher Lotz,
Christian Karagiannidis,
Steffen Weber-Carstens,
Stefan Kluge,
Christian Putensen,
Andreas Wehrfritz,
Karsten Schmidt,
Richard K. Ellerkmann,
Daniel Oswald,
Gösta Lotz,
Viviane Zotzmann,
Onnen Moerer,
Christian Kühn,
Matthias Kochanek,
Ralf Muellenbach,
Matthias Gaertner,
Falk Fichtner,
Florian Brettner,
Michael Findeisen,
Markus Heim,
Tobias Lahmer,
Felix Rosenow,
Nils Haake,
Philipp M. Lepper,
Peter Rosenberger,
Stephan Braune,
Mirjam Kohls,
Peter Heuschmann,
Patrick Meybohm,
for the German ECMO COVID Study Group
Affiliations
Johannes Herrmann
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg
Christopher Lotz
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg
Christian Karagiannidis
Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Center, Kliniken Der Stadt Köln, Witten/Herdecke University Hospital
Steffen Weber-Carstens
Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin
Stefan Kluge
Department of Intensive Care, University Medical Center Hamburg-Eppendorf
Christian Putensen
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn
Andreas Wehrfritz
Department of Anaesthesiology, University Hospital Erlangen, Friedrich-Alexander University, Erlangen-Nuernberg (FAU)
Karsten Schmidt
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen
Richard K. Ellerkmann
Department of Anesthesiology and Intensive Care Medicine, Klinikum Dortmund, Klinikum University Witten/Herdecke
Daniel Oswald
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Clinic Centre Westfalen
Gösta Lotz
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University Frankfurt
Viviane Zotzmann
Department of Cardiology and Angiology I (Heart Center Freiburg - Bad Krozingen), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg
Onnen Moerer
Department of Anesthesiology, University Medical Center Göttingen
Christian Kühn
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School
Matthias Kochanek
Department of Internal Medicine, Division I (Hematology/Oncology), University Hospital of Cologne
Ralf Muellenbach
Department of Anesthesiology and Critical Care Medicine, ARDS/ECMO-Center, Campus Kassel of the University of Southampton
Matthias Gaertner
Department of Anaesthesia, Perioperative Medicine and Interdisciplinary Intensive Care Medicine, ECLS/ECMO-Center, Asklepios Klinik Langen
Falk Fichtner
Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Center
Florian Brettner
ARDS- und ECMO Zentrum München-Nymphenburg, Barmherzige Brüder Krankenhaus München
Michael Findeisen
Klinik für Pneumologie, Internistische Intensiv- und Beatmungsmedizin, München Klinik Harlaching
Markus Heim
Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine
Tobias Lahmer
School of Medicine, University Hospital Rechts Der Isar, Department of Internal Medicine II, University of Munich
Felix Rosenow
Department of Cardiology I – Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster
Nils Haake
Department of Intensive Care Medicine, Imland Klinik Rendsburg
Philipp M. Lepper
Department of Internal Medicine V- Pneumology, Allergology and Critical Care Medicine, Saarland University
Peter Rosenberger
Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen
Stephan Braune
Department of Medical Intensive Care and Emergency Medicine, St. Franziskus-Hospital Muenster
Mirjam Kohls
Institute of Clinical Epidemiology and Biometry, University of Würzburg
Peter Heuschmann
Institute of Clinical Epidemiology and Biometry, University of Würzburg
Patrick Meybohm
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg
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/FiO2 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. 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 . Graphical abstract