Outcomes of Extracorporeal Membrane Oxygenation in COVID-19–Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis

Senta Jorinde Raasveld, MD; Fabio Silvio Taccone, MD, PhD; Lars Mikael Broman, MD, PhD; Greet Hermans, MD, PhD; Philippe Meersseman, MD, PhD; Manuel Quintana Diaz, MD, PhD; Thijs S. R. Delnoij, MD; Marcel van de Poll, MD, PhD; Elisa Gouvea Bogossian, MD; Floor L. F. van Baarle, MD; Koray Durak, BSc; Rashad Zayat, MD, PhD; Annemieke Oude Lansink-Hartgring, MD, PhD; Christiaan L. Meuwese, MD, PhD; Joris J. van der Heijden, MD, PhD; Erwin de Troy, MD, PhD; Dieter Dauwe, MD, PhD; Erik Scholten, MD; Franciska van der Velde, MD; Jacinta J. Maas, MD, PhD; Dinis Dos Reis Miranda, MD, PhD; Marijn Kuijpers, MD; Judith van den Brule, MD, PhD; Walter M. van den Bergh, MD, PhD; Alexander P. J. Vlaar, MD, PhD

doi:10.1097/CCE.0000000000000770

Critical Care Explorations (Oct 2022)

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19–Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis

Senta Jorinde Raasveld, MD,
Fabio Silvio Taccone, MD, PhD,
Lars Mikael Broman, MD, PhD,
Greet Hermans, MD, PhD,
Philippe Meersseman, MD, PhD,
Manuel Quintana Diaz, MD, PhD,
Thijs S. R. Delnoij, MD,
Marcel van de Poll, MD, PhD,
Elisa Gouvea Bogossian, MD,
Floor L. F. van Baarle, MD,
Koray Durak, BSc,
Rashad Zayat, MD, PhD,
Annemieke Oude Lansink-Hartgring, MD, PhD,
Christiaan L. Meuwese, MD, PhD,
Joris J. van der Heijden, MD, PhD,
Erwin de Troy, MD, PhD,
Dieter Dauwe, MD, PhD,
Erik Scholten, MD,
Franciska van der Velde, MD,
Jacinta J. Maas, MD, PhD,
Dinis Dos Reis Miranda, MD, PhD,
Marijn Kuijpers, MD,
Judith van den Brule, MD, PhD,
Walter M. van den Bergh, MD, PhD,
Alexander P. J. Vlaar, MD, PhD

Affiliations

Senta Jorinde Raasveld, MD: 1 Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands.
Fabio Silvio Taccone, MD, PhD: 2 Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
Lars Mikael Broman, MD, PhD: 3 Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Greet Hermans, MD, PhD: 5 Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
Philippe Meersseman, MD, PhD: 5 Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
Manuel Quintana Diaz, MD, PhD: 7 Department of Intensive Care, Hospital Universitario La Paz, Madrid, Spain.
Thijs S. R. Delnoij, MD: 8 Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
Marcel van de Poll, MD, PhD: 9 Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands.
Elisa Gouvea Bogossian, MD: 2 Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
Floor L. F. van Baarle, MD: 1 Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands.
Koray Durak, BSc: 10 Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Rashad Zayat, MD, PhD: 10 Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
Annemieke Oude Lansink-Hartgring, MD, PhD: 11 Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Christiaan L. Meuwese, MD, PhD: 12 Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Joris J. van der Heijden, MD, PhD: 13 Intensive Care Centre, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
Erwin de Troy, MD, PhD: 14 Department of Intensive Care Medicine, Surgical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
Dieter Dauwe, MD, PhD: 14 Department of Intensive Care Medicine, Surgical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
Erik Scholten, MD: 15 Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
Franciska van der Velde, MD: 16 Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Jacinta J. Maas, MD, PhD: 16 Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Dinis Dos Reis Miranda, MD, PhD: 12 Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Marijn Kuijpers, MD: 17 Department of Intensive Care Medicine, Isala Hospital, Zwolle, The Netherlands.
Judith van den Brule, MD, PhD: 18 Department of Intensive Care Medicine, Radboud Hospital, Nijmegen, Tthe Netherlands.
Walter M. van den Bergh, MD, PhD: 11 Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Alexander P. J. Vlaar, MD, PhD: 1 Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands.

DOI: https://doi.org/10.1097/CCE.0000000000000770
Journal volume & issue: Vol. 4, no. 10
p. e0770

Abstract

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IMPORTANCE:. Although venovenous extracorporeal membrane oxygenation (VV ECMO) has been used in case of COVID-19 induced acute respiratory distress syndrome (ARDS), outcomes and criteria for its application should be evaluated. OBJECTIVES:. To describe patient characteristics and outcomes in patients receiving VV ECMO due to COVID-19–induced ARDS and to assess the possible impact of COVID-19 on mortality. DESIGN, SETTING AND PARTICIPANTS:. Multicenter retrospective study in 15 ICUs worldwide. All adult patients (> 18 yr) were included if they received VV ECMO with ARDS as main indication. Two groups were created: a COVID-19 cohort from March 2020 to December 2020 and a “control” non-COVID ARDS cohort from January 2018 to July 2019. MAIN OUTCOMES AND MEASURES:. Collected data consisted of patient demographics, baseline variables, ECMO characteristics, and patient outcomes. The primary outcome was 60-day mortality. Secondary outcomes included patient characteristics, COVID-19–related therapies before and during ECMO and complication rate. To assess the influence of COVID-19 on mortality, inverse probability weighted (IPW) analyses were used to correct for predefined confounding variables. RESULTS:. A total of 193 patients with COVID-19 received VV ECMO. The main indication for VV ECMO consisted of refractory hypoxemia, either isolated or combined with refractory hypercapnia. Complications with the highest occurrence rate included hemorrhage, an additional infectious event or acute kidney injury. Mortality was 35% and 45% at 28 and 60 days, respectively. Those mortality rates did not differ between the first and second waves of COVID-19 in 2020. Furthermore, 60-day mortality was equal between patients with COVID-19 and non-COVID-19–associated ARDS receiving VV ECMO (hazard ratio 60-d mortality, 1.27; 95% CI, 0.82–1.98; p = 0.30). CONCLUSIONS AND RELEVANCE:. Mortality for patients with COVID-19 who received VV ECMO was similar to that reported in other COVID-19 cohorts, although no differences were found between the first and second waves regarding mortality. In addition, after IPW, mortality was independent of the etiology of ARDS.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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