Extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome: a multicenter retrospective cohort study
Vito Fanelli,
Marco Giani,
Giacomo Grasselli,
Francesco Mojoli,
Gennaro Martucci,
Lorenzo Grazioli,
Francesco Alessandri,
Silvia Mongodi,
Gabriele Sales,
Giorgia Montrucchio,
Costanza Pizzi,
Lorenzo Richiardi,
Luca Lorini,
Antonio Arcadipane,
Antonio Pesenti,
Giuseppe Foti,
Nicolò Patroniti,
Luca Brazzi,
VMarco Ranieri
Affiliations
Vito Fanelli
Department of Surgical Sciences, University of Turin
Marco Giani
Department of Emergency and Intensive Care, School of Medicine and Surgery, ASST Monza, University of Milano-Bicocca
Giacomo Grasselli
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Francesco Mojoli
Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Università Degli Studi Di Pavia
Gennaro Martucci
Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione)
Lorenzo Grazioli
Department Emergency and Critical Area, ASST Papa Giovanni XXIII
Francesco Alessandri
Department of Anesthesia and Intensive Care Medicine, Sapienza” University of Rome, Policlinico Umberto I
Silvia Mongodi
Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Università Degli Studi Di Pavia
Gabriele Sales
Department of Surgical Sciences, University of Turin
Giorgia Montrucchio
Department of Surgical Sciences, University of Turin
Costanza Pizzi
Department of Medical Sciences, University of Turin
Lorenzo Richiardi
Department of Medical Sciences, University of Turin
Luca Lorini
Department Emergency and Critical Area, ASST Papa Giovanni XXIII
Antonio Arcadipane
Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo Per I Trapianti E Terapie Ad Alta Specializzazione)
Antonio Pesenti
Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Giuseppe Foti
Department of Emergency and Intensive Care, School of Medicine and Surgery, ASST Monza, University of Milano-Bicocca
Nicolò Patroniti
Anesthesia and Intensive Care,, San Martino Policlinico Hospital - IRCCS for Oncology and Neurosciences
Luca Brazzi
Department of Surgical Sciences, University of Turin
VMarco Ranieri
Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche (DIMEC), Anesthesia and Intensive Care Medicine, Università Di Bologna, IRCCS Policlinico Di Sant’Orsola
Abstract Background Extracorporeal membrane oxygenation (ECMO) has become an established rescue therapy for severe acute respiratory distress syndrome (ARDS) in several etiologies including influenza A H1N1 pneumonia. The benefit of receiving ECMO in coronavirus disease 2019 (COVID-19) is still uncertain. The aim of this analysis was to compare the outcome of patients who received veno-venous ECMO for COVID-19 and Influenza A H1N1 associated ARDS. Methods This was a multicenter retrospective cohort study including adults with ARDS, receiving ECMO for COVID-19 and influenza A H1N1 pneumonia between 2009 and 2021 in seven Italian ICU. The primary outcome was any-cause mortality at 60 days after ECMO initiation. We used a multivariable Cox model to estimate the difference in mortality accounting for patients’ characteristics and treatment factors before ECMO was started. Secondary outcomes were mortality at 90 days, ICU and hospital length of stay and ECMO associated complications. Results Data from 308 patients with COVID-19 (N = 146) and H1N1 (N = 162) associated ARDS who had received ECMO support were included. The estimated cumulative mortality at 60 days after initiating ECMO was higher in COVID-19 (46%) than H1N1 (27%) patients (hazard ratio 1.76, 95% CI 1.17–2.46). When adjusting for confounders, specifically age and hospital length of stay before ECMO support, the hazard ratio decreased to 1.39, 95% CI 0.78–2.47. ICU and hospital length of stay, duration of ECMO and invasive mechanical ventilation and ECMO-associated hemorrhagic complications were higher in COVID-19 than H1N1 patients. Conclusion In patients with ARDS who received ECMO, the observed unadjusted 60-day mortality was higher in cases of COVID-19 than H1N1 pneumonia. This difference in mortality was not significant after multivariable adjustment; older age and longer hospital length of stay before ECMO emerged as important covariates that could explain the observed difference. Trial registration number: NCT05080933 , retrospectively registered.
