In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study
Articolo
Data di Pubblicazione:
2023
Citazione:
In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study / Lorusso, R., De Piero, M.E., Mariani, S., Di Mauro, M., Folliguet, T., Taccone, F.S., Camporota, L., Swol, J., Wiedemann, D., Belliato, M., Broman, L.M., Vuylsteke, A., Kassif, Y., Scandroglio, A.M., Fanelli, V., Gaudard, P., Ledot, S., Barker, J., Boeken, U., Maier, S., et al.. - In: THE LANCET RESPIRATORY MEDICINE. - ISSN 2213-2600. - 11:2(2023), pp. 151-162. [10.1016/S2213-2600(22)00403-9]
Abstract:
Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. Methods: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic—from March 1 to Sept 13, 2020—at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. Findings: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46–60]) were included in the study. Median ECMO duration was 15 days (IQR 8–27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. Interpretation: Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. Funding: None.
Tipologia CRIS:
1.1 Articolo in rivista
Elenco autori:
Lorusso, R.; De Piero, M. E.; Mariani, S.; Di Mauro, M.; Folliguet, T.; Taccone, F. S.; Camporota, L.; Swol, J.; Wiedemann, D.; Belliato, M.; Broman, L. M.; Vuylsteke, A.; Kassif, Y.; Scandroglio, A. M.; Fanelli, V.; Gaudard, P.; Ledot, S.; Barker, J.; Boeken, U.; Maier, S.; Kersten, A.; Meyns, B.; Pozzi, M.; Pedersen, F. M.; Schellongowski, P.; Kirali, K.; Barrett, N.; Riera, J.; Mueller, T.; Belohlavek, J.; Lo Coco, V.; Van Der Horst, I. C. C.; Van Bussel, B. C. T.; Schnabel, R. M.; Delnoij, T.; Bolotin, G.; Lorini, L.; Schmiady, M. O.; Schibilsky, D.; Kowalewski, M.; Pinto, L. F.; Silva, P. E.; Kornilov, I.; Blandino Ortiz, A.; Vercaemst, L.; Finney, S.; Roeleveld, P. P.; Di Nardo, M.; Hennig, F.; Antonini, M. V.; Davidson, M.; Jones, T. J.; Staudinger, T.; Mair, P.; Kilo, J.; Krapf, C.; Erbert, K.; Peer, A.; Bonaros, N.; Kotheletner, F.; Krenner Mag, N.; Shestakova, L.; Hermans, G.; Dauwe, D.; Meersseman, P.; Stockman, B.; Nobile, L.; Lhereux, O.; Nrasseurs, A.; Creuter, J.; De Backer, D.; Giglioli, S.; Michiels, G.; Foulon, P.; Raes, M.; Rodrigus, I.; Allegaert, M.; Jorens, P.; Debeucklare, G.; Piagnerelli, M.; Biston, P.; Peperstraete, H.; Vandewiele, K.; Germay, O.; Vandeweghe, D.; Havrin, S.; Bourgeois, M.; Lagny, M. -G.; Alois, G.; Lavios, N.; Misset, B.; Courcelle, R.; Timmermans, P. J.; Yilmaz, A.; Vantomout, M.; Lehaen, J.; Jassen, A.; Guterman, H.; Strauven, M.; Lormans, P.; Verhamme, B.; Vandewaeter, C.; Bonte, F.; Vionne, D.; Balik, M.; Blaha, J.; Lips, M.; Othal, M.; Bursa, F.; Spacek, R.; Christensen, S.; Jorgensen, V.; Sorensen, M.; Madsen, S. A.; Puss, S.; Beljantsev, A.; Saiydoun, G.; Fiore, A.; Colson, P.; Bazalgette, F.; Capdevila, X.; Kollen, S.; Muller, L.; Obadia, J. -F.; Dubien, P. -Y.; Ajrhourh, L.; Guinot, P. G.; Zarka, J.; Besserve, P.; Malfertheiner, M. V.; Dreier, E.; Heinze, B.; Akhyari, P.; Lichtenberg, A.; Aubin, H.; Assman, A.; Saeed, D.; Thiele, H.; Baumgaertel, M.; Schmitto, J. D.; Ruslan, N.; Haverich, A.; Thielmann, M.; Brenner, T.; Ruhpawar, A.; Benk, C.; Czerny, M.; Staudacher, D. L.; Beyersdorf, F.; Kalbhenn, J.; Henn, P.; Popov, A. -F.; Iuliu, T.; Muellenbach, R.; Reyher, C.; Rolfes, C.; Lotz, G.; Sonntagbauer, M.; Winkels, H.; Fichte, J.; Stohr, R.; Kalverkamp, S.; Karagiannidis, C.; Schafer, S.; Svetlitchny, A.; Hopf, H. -B.; Jarczak, D.; Groesdonk, H.; Rommer, M.; Hirsch, J.; Kaehny, C.; Soufleris, D.; Gavriilidis, G.; Pontikis, K.; Kyriakopoulou, M.; Kyriakoudi, A.; O'Brien, S.; Conrick-Martin, I.; Carton, E.; Makhoul, M.; Ben-Ari, J.; Hadash, A.; Kogan, A.; Kassif Lerner, R.; Abu-Shakra, A.; Matan, M.; Balawona, A.; Kachel, E.; Altshuler, R.; Galante, O.; Fuchs, L.; Almog, Y.; Ishay, Y. S.; Lichter, Y.; Gal-oz, A.; Carmi, U.; Nini, A.; Soroksky, A.; Dekel, H.; Rozman, Z.; Tayem, E.; Ilgiyaev, E.; Hochman, Y.; Miltau, D.; Rapoport, A.; Eden, A.; Kompanietz, D.; Yousif, M.; Golos, M.; Grazioli, L.; Ghitti, D.; Loforte, A.; Di Luca, D.; Baiocchi, M.; Pacini, D.; Cappai, A.; Meani, P.; Mondino, M.; Russo, C. F.; Ranucci, M.; Fina, D.; Cotza, M.; Ballotta, A.; Landoni, G.; Nardelli, P.; Fominski, E. V.; Brazzi, L.; Montrucchio, G.; Sales, G.; Simonetti, U.; Livigni, S.; Silengo, D.; Arena, G.; Sovatzis, S. S.; Degani, A.; Riccardi, M.; Milanesi, E.; Raffa, G.; Martucci, G.; Arcadipane, A.; Panarello, G.; Chiarini, G.; Cattaneo, S.; Puglia, C.; Benussi, S.; Foti, G.; Giani, M.; Bombino, M.; Costa, M. C.; Rona, R.; Avalli, L.; Donati, A.; Carozza, R.; Gasparri, F.; Carsetti, A.; Piciche, M.; Marinello, A.; Danzi, V.; Zanin, A.; Condello, I.; Fiore, F.; Moscarelli, M.; Nasso, G.; Speziale, G.; Sandrelli, L.; Montalto, A.; Musumeci, F.; Circelli, A.; Russo, E.; Agnoletti, V.; Rociola, R.; Milano, A. D.; Pilato, E.; Comentale, G.; Montisci, A.; Alessandri, F.; Tosi, A.; Pugliese, F.; Giordano, G.; Carelli, S.; Grieco, D. L.; Dell'Anna, A. M.; Antonelli, M.; Ramoni, E.; Zulueta, J.; Del Giglio, M.; Petracca, S.; Bertini, P.; Guarracino, F.; De Simone, L.; Angeletti, P. M.; Forfori, F.; Tara
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