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

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

doi:10.1097/CCE.0000000000000770

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

Crit Care Explor. 2022 Oct 7;4(10):e0770. doi: 10.1097/CCE.0000000000000770. eCollection 2022 Oct.

Authors

Senta Jorinde Raasveld¹, Fabio Silvio Taccone², Lars Mikael Broman^{3

4}, Greet Hermans^{5

6}, Philippe Meersseman^{5

6}, Manuel Quintana Diaz⁷, Thijs S R Delnoij^{8

9}, Marcel van de Poll⁹, Elisa Gouvea Bogossian², Floor L F van Baarle¹, Koray Durak¹⁰, Rashad Zayat¹⁰, Annemieke Oude Lansink-Hartgring¹¹, Christiaan L Meuwese¹², Joris J van der Heijden¹³, Erwin de Troy¹⁴, Dieter Dauwe¹⁴, Erik Scholten¹⁵, Franciska van der Velde¹⁶, Jacinta J Maas¹⁶, Dinis Dos Reis Miranda¹², Marijn Kuijpers¹⁷, Judith van den Brule¹⁸, Walter M van den Bergh¹¹, Alexander P J Vlaar¹

Affiliations

¹ Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands.
² Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium.
³ Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
⁴ ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
⁵ Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
⁶ Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
⁷ Department of Intensive Care, Hospital Universitario La Paz, Madrid, Spain.
⁸ Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁹ Department of Intensive Care, Maastricht University Medical Center, Maastricht, the Netherlands.
¹⁰ Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.
¹¹ Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
¹² Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
¹³ Intensive Care Centre, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
¹⁴ Department of Intensive Care Medicine, Surgical Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
¹⁵ Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
¹⁶ Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands.
¹⁷ Department of Intensive Care Medicine, Isala Hospital, Zwolle, The Netherlands.
¹⁸ Department of Intensive Care Medicine, Radboud Hospital, Nijmegen, Tthe Netherlands.

Abstract

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.

Keywords: COVID-19; acute respiratory distress syndrome; extracorporeal membrane oxygenation; mortality; venovenous extracorporeal membrane oxygenation.