Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis

Teresa Autschbach; Nima Hatam; Koray Durak; Oliver Grottke; Michael Dreher; Katharina Nubbemeyer; Rolf Rossaint; Gernot Marx; Nikolaus Marx; Jan Spillner; Rashad Zayat; Sebastian Kalverkamp; Alex Kersten

doi:10.3390/jcm10122547

Journal of Clinical Medicine (Jun 2021)

Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis

Teresa Autschbach,
Nima Hatam,
Koray Durak,
Oliver Grottke,
Michael Dreher,
Katharina Nubbemeyer,
Rolf Rossaint,
Gernot Marx,
Nikolaus Marx,
Jan Spillner,
Rashad Zayat,
Sebastian Kalverkamp,
Alex Kersten

Affiliations

Teresa Autschbach: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Nima Hatam: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Koray Durak: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Oliver Grottke: Department of Anesthesiology, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Michael Dreher: Department of Pneumology and Intensive Care Medicine, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Katharina Nubbemeyer: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Rolf Rossaint: Department of Anesthesiology, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Gernot Marx: Department of Intensive Care and Intermediate Care Medicine, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Nikolaus Marx: Department of Cardiology, Angiology and Intensive Care, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Jan Spillner: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Rashad Zayat: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Sebastian Kalverkamp: Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
Alex Kersten: Department of Cardiology, Angiology and Intensive Care, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany

DOI: https://doi.org/10.3390/jcm10122547
Journal volume & issue: Vol. 10, no. 12
p. 2547

Abstract

Read online

It remains unclear to what extent the outcomes and complications of extracorporeal membrane oxygenation (ECMO) therapy in COVID-19 patients with acute respiratory distress syndrome (ARDS) differ from non-COVID-19 ARDS patients. In an observational, propensity-matched study, outcomes after ECMO support were compared between 19 COVID-19 patients suffering from ARDS (COVID group) and 34 matched non-COVID-19 ARDS patients (NCOVID group) from our historical cohort. A 1:2 propensity matching was performed based on respiratory ECMO survival prediction (RESP) score, age, gender, bilirubin, and creatinine levels. Patients’ characteristics, laboratory parameters, adverse events, and 90-day survival were analyzed. Patients’ characteristics in COVID and NCOVID groups were similar. Before ECMO initiation, fibrinogen levels were significantly higher in the COVID group (median: 493 vs. 364 mg/dL, p 0.001). Median ECMO support duration was similar (16 vs. 13 days, p = 0.714, respectively). During ECMO therapy, patients in the COVID group developed significantly more thromboembolic events (TEE) than did those in the NCOVID group (42% vs. 12%, p = 0.031), which were mainly pulmonary artery embolism (PAE) (26% vs. 0%, p = 0.008). The rate of major bleeding events (42% vs. 62%, p = 0.263) was similar. Fibrinogen decreased significantly more in the COVID group than in the NCOVID group (p 0.001), whereas D-dimer increased in the COVID group (p = 0.011). Additionally, 90-day mortality did not differ (47% vs. 74%; p = 0.064) between COVID and NCOVID groups. Compared with that in non-COVID-19 ARDS patients, ECMO support in COVID-19 patients was associated with comparable in-hospital mortality and similar bleeding rates but a higher incidence of TEE, especially PAE. In contrast, coagulation parameters differed between COVID and NCOVID patients.

Published in Journal of Clinical Medicine

ISSN: 2077-0383 (Online)
Publisher: MDPI AG
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.mdpi.com/journal/jcm

About the journal

Abstract

Keywords