Six-month Survival after Extracorporeal Membrane Oxygenation for Severe COVID-19

Biancari, Fausto; Mariscalco, Giovanni; Dalén, Magnus; Settembre, Nicla; Welp, Henryk; Perrotti, Andrea; Wiebe, Karsten; Leo, Enrico; Loforte, Antonio; Chocron, Sidney; Pacini, Davide; Juvonen, Tatu; Broman, L. Mikael; Perna, Dario Di; Yusuff, Hakeem; Harvey, Chris; Mongardon, Nicolas; Maureira, Juan P.; Levy, Bruno; Falk, Lars; Ruggieri, Vito G.; Zipfel, Svante; Folliguet, Thierry; Fiore, Antonio

OBJECTIVES: We evaluated the outcome of adult patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) requiring the use of extracorporeal membrane oxygenation (ECMO). DESIGN: Multicenter retrospective, observational study. SETTING: tertiary referral university and community hospitals. PARTICIPANTS: Patients with confirmed severe COVID-19-related ARDS. INTERVENTIONS: Venovenous- or venoarterial-ECMO. MEASUREMENTS AND MAIN RESULTS: 132 patients (mean age 51.1±9.7 years, females 17.4%) were treated with ECMO for confirmed severe COVID-19-related ARDS. Before ECMO, the mean Sequential Organ Failure Assessment (SOFA) score was 10.1±4.4, mean pH was 7.23±0.09 and mean PaO(2)/FiO(2) ratio was 77±50 mmHg. Venovenous-ECMO was adopted in 122 patients (92.4%) and venoarterial-ECMO in 10 patients (7.6%) (mean duration, 14.6±11.0 days). Sixty-three (47.7%) patients died on ECMO and 70 (53.0%) during the index hospitalization. Six-month all-cause mortality was 53.0%. Advanced age (per year, HR 1.026, 95%CI 1.000-1-052) and low pre-ECMO arterial pH (per unit, HR 0.006, 95%CI 0.000-0.083) were the only baseline variables associated with increased risk of 6-month mortality. CONCLUSIONS: The present findings suggest that about half of adult patients with severe COVID-19-related ARDS can be successfully managed with ECMO with sustained results at 6-month. Decreased arterial pH before ECMO was significantly associated with early mortality. Therefore, we hypothesize that initiation of ECMO therapy before severe metabolic derangements subset may significantly improve survival rates in these patients. These results should be viewed in the light of a strict patient selection policy and may not be replicated in patients with advanced age or multiple comorbidities. CLINICAL TRIAL REGISTRATION: Identifier, ____.