Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris
Matthieu Schmidt,
Elise Langouet,
David Hajage,
Sarah Aissi James,
Juliette Chommeloux,
Nicolas Bréchot,
Petra Barhoum,
Lucie Lefèvre,
Antoine Troger,
Marc Pineton de Chambrun,
Guillaume Hékimian,
Charles-Edouard Luyt,
Martin Dres,
Jean-Michel Constantin,
Muriel Fartoukh,
Pascal Leprince,
Guillaume Lebreton,
Alain Combes,
for the GRC RESPIRE Sorbonne Université
Affiliations
Matthieu Schmidt
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Elise Langouet
Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié–Salpêtrière
David Hajage
INSERM, Institut Pierre-Louis d’Epidémiologie Et de Santé Publique, APHP, Hôpitaux Universitaires Pitié–Salpêtrière Charles Foix, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Sorbonne Université
Sarah Aissi James
Service de Médecine Intensive-Réanimation, iCAN, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris (APHP), Sorbonne Université Hôpital Pitié–Salpêtrière
Juliette Chommeloux
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Nicolas Bréchot
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Petra Barhoum
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Lucie Lefèvre
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Antoine Troger
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Marc Pineton de Chambrun
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Guillaume Hékimian
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Charles-Edouard Luyt
Inserm, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université
Abstract Background Extracorporeal membrane oxygenation (ECMO) was frequently used to treat patients with severe coronavirus disease-2019 (COVID-19)-associated acute respiratory distress (ARDS) during the initial outbreak. Care of COVID-19 patients evolved markedly during the second part of 2020. Our objective was to compare the characteristics and outcomes of patients who received ECMO for severe COVID-19 ARDS before or after July 1, 2020. Methods We included consecutive adults diagnosed with COVID-19 in Paris–Sorbonne University Hospital Network ICUs, who received ECMO for severe ARDS until January 28, 2021. Characteristics and survival probabilities over time were estimated during the first and second waves. Pre-ECMO risk factors predicting 90-day mortality were assessed using multivariate Cox regression. Results Characteristics of the 88 and 71 patients admitted, respectively, before and after July 1, 2020, were comparable except for older age, more frequent use of dexamethasone (18% vs. 82%), high-flow nasal oxygenation (19% vs. 82%) and/or non-invasive ventilation (7% vs. 37%) after July 1. Respective estimated probabilities (95% confidence intervals) of 90-day mortality were 36% (27–47%) and 48% (37–60%) during the first and the second periods. After adjusting for confounders, probability of 90-day mortality was significantly higher for patients treated after July 1 (HR 2.27, 95% CI 1.02–5.07). ECMO-related complications did not differ between study periods. Conclusions 90-day mortality of ECMO-supported COVID-19–ARDS patients increased significantly after July 1, 2020, and was no longer comparable to that of non-COVID ECMO-treated patients. Failure of prolonged non-invasive oxygenation strategies before intubation and increased lung damage may partly explain this outcome.
