Summary
Currently, little in-depth evidence is known about the application of extracorporeal membrane oxygenation (ECMO) therapy in coronavirus disease 2019 (COVID-19) patients. This retrospective multicenter cohort study included patients with COVID-19 at 7 designated hospitals in Wuhan, China. The patients were followed up until June 30, 2020. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning. Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation (IMV)-only therapy. Of 88 patients receiving ECMO therapy, 27 and 61 patients were and were not successfully weaned from ECMO, respectively. Additionally, 15, 15, and 65 patients were further weaned from IMV, discharged from hospital, or died during hospitalization, respectively. In the multivariate logistic regression analysis, a lymphocyte count ≤0.5×109/L and D-dimer concentration >4× the upper limit of normal level at ICU admission, a peak PaCO2 >60 mmHg at 24 h before ECMO initiation, and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning. In the propensity score-matched analysis, a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group. The presence of lymphocytopenia, higher D-dimer concentrations at ICU admission and hypercapnia before ECMO initiation could help to identify patients with a poor prognosis. Tracheotomy could facilitate weaning from ECMO. ECMO relative to IMV-only therapy was associated with improved outcomes in critically ill COVID-19 patients.
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Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area. JAMA, 2020,323(20):2052–2059
Davies A, Jones D, Bailey M, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA, 2009, 302(17):1888–1895
Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA, 2011,306(15):1659–1668
Li X, Guo Z, Li B, et al. Extracorporeal membrane oxygenation for coronavirus disease 2019 in Shanghai, China. ASAIO J, 2020,66(5):475–481
Henry BM, Lippi G. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): Pooled analysis of early reports. J CRIT CARE, 2020,58:27–28
Lango R, Szkulmowski Z, Maciejewski D, et al. Revised protocol of extracorporeal membrane oxygenation (ECMO) therapy in severe ARDS. Recommendations of the veno-venous ECMO expert panel appointed in February 2016 by the national consultant on anesthesiology and intensive care. Anaesthesiol Intensive Ther, 2017,49(2):88–99
Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl, 2012, 2(1):1–138
Lei F, Liu YM, Zhou F, et al. Longitudinal association between markers of liver injury and mortality in COVID-19 in China. Hepatology, 2020,72(2):389–398
Gando S, Wada H, Thachil J. Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS). J Thromb Haemost, 2013,11(5):826–835
Waljee AK, Mukherjee A, Singal AG, et al. Comparison of imputation methods for missing laboratory data in medicine. BMJ OPEN, 2013,3(8):e2847
Combes A, Hajage D, Capellier G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. New Engl J Med, 2018,378(21):1965–1975
Alshahrani MS, Sindi A, Alshamsi F, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care, 2018,8(1):3
Pan A, Liu L, Wang C, et al. Association of public health interventions with the epidemiology of the COVID-19 outbreak in Wuhan, China. JAMA, 2020,323(19):1–9
Brogan TV, Thiagarajan RR, Rycus PT, et al. Extracorporeal membrane oxygenation in adults with severe respiratory failure: a multi-center database. Intens Care Med, 2009,35(12):2105–2114
Delmas C, Zapetskaia T, Conil JM, et al. 3-month prognostic impact of severe acute renal failure under veno-venous ECMO support: Importance of time of onset. J Crit Care, 2018,44:63–71
Schmidt M, Bailey M, Sheldrake J, et al. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score. Am J Resp Crit Care, 2014, 189(11):1374–1382
Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med, 2002,346(17):1281–1286
Menter T, Haslbauer JD, Nienhold R, et al. Post-mortem examination of COVID19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings of lungs and other organs suggesting vascular dysfunction. Histopathology, 2020,77(2):198–209
Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost, 2020,18(6):1324–1329
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020,395(10229):1054–1062
Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost, 2020,18(5):1094–1099
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA, 2020, 323(11):1061–1069
Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest, 2020,130(5):2620–2629
Henry BM. COVID-19, ECMO, and lymphopenia: a word of caution. Lancet Respir Med, 2020,8(4):e24
Peek GJ, Mugford M, Tiruvoipati R, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet, 2009, 374(9698):1351–1363
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This work was supported by grants from Emergent Key Projects for COVID-19 (No. 2020kfyXGYJ091), the National Natural Science Foundation of China (Nos. 81800256, 81873458, 81670050), and National Key Research and Development Program of China (No. 2019YFC0121600).
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All authors declare no conflict of interest relevant to this study.
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Fang, J., Li, R., Chen, Y. et al. Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan, China: A Retrospective Multicenter Cohort Study. CURR MED SCI 41, 1–13 (2021). https://doi.org/10.1007/s11596-021-2311-8
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DOI: https://doi.org/10.1007/s11596-021-2311-8