Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study
Alexander Supady,
Jeff DellaVolpe,
Fabio Silvio Taccone,
Dominik Scharpf,
Matthias Ulmer,
Philipp M. Lepper,
Maximilian Halbe,
Stephan Ziegeler,
Alexander Vogt,
Raj Ramanan,
David Boldt,
Stephanie-Susanne Stecher,
Andrea Montisci,
Tobias Spangenberg,
Olivier Marggraf,
Chandra Kunavarapu,
Lorenzo Peluso,
Sebastian Muenz,
Monica Buerle,
Naveen G. Nagaraj,
Sebastian Nuding,
Catalin Toma,
Vadim Gudzenko,
Hans Joachim Stemmler,
Federico Pappalardo,
Georg Trummer,
Christoph Benk,
Guido Michels,
Daniel Duerschmied,
Constantin von zur Muehlen,
Christoph Bode,
Klaus Kaier,
Daniel Brodie,
Tobias Wengenmayer,
Dawid L. Staudacher
Affiliations
Alexander Supady
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
Jeff DellaVolpe
Methodist Hospital, San Antonio, TX 78229, USA
Fabio Silvio Taccone
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium
Department of Internal Medicine V—Pneumology, Allergology and Critical Care Medicine, Saarland University Medical Center and University of Saarland, D-66421 Homburg, Germany
Maximilian Halbe
Heart Center, University Hospital Zurich, 8006 Zurich, Switzerland
Stephan Ziegeler
Department of Anesthesiology, Intensive Care Medicine and Pain Management, Hospital Ibbenbueren, 49477 Ibbenbueren, Germany
Alexander Vogt
Department of Medicine III, University Clinic Halle (Saale), 06097 Halle (Saale), Germany
Raj Ramanan
University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA
David Boldt
UCLA Healthcare System, Los Angeles, CA 90095, USA
Stephanie-Susanne Stecher
Medical Department II, LMU Hospital Munich, 80331 Munich, Germany
Andrea Montisci
Istituto Clinico Sant’Ambrogio, University of Milan, 20149 Milan, Italy
Tobias Spangenberg
Department of Cardiology, Angiology and Intensive Care, Marien Hospital Hamburg, 22087 Hamburg, Germany
Olivier Marggraf
Asklepios Clinic North, 22417 Hamburg, Germany
Chandra Kunavarapu
Methodist Hospital, San Antonio, TX 78229, USA
Lorenzo Peluso
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1070 Brussels, Belgium
Heart Center, University Hospital Zurich, 8006 Zurich, Switzerland
Sebastian Nuding
Department of Medicine III, University Clinic Halle (Saale), 06097 Halle (Saale), Germany
Catalin Toma
University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA
Vadim Gudzenko
UCLA Healthcare System, Los Angeles, CA 90095, USA
Hans Joachim Stemmler
Medical Department III, LMU Hospital Munich, 80331 Munich, Germany
Federico Pappalardo
Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, 90127 Palermo, Italy
Georg Trummer
Department of Cardiovascular Surgery, Heart Center, University of Freiburg, 79106 Freiburg, Germany
Christoph Benk
Department of Cardiovascular Surgery, Heart Center, University of Freiburg, 79106 Freiburg, Germany
Guido Michels
Department of Acute and Emergency Care, St. Antonius Hospital Eschweiler, 52249 Eschweiler, Germany
Daniel Duerschmied
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
Constantin von zur Muehlen
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
Christoph Bode
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
Klaus Kaier
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany
Daniel Brodie
Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY 10032, USA
Tobias Wengenmayer
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
Dawid L. Staudacher
Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V-V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.