Veno-Arterial Extracorporeal Membrane Oxygenation for Circulatory Failure in COVID-19 Patients: Insights from the ECMOSARS Registry
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Anselmi, Amedeo | Mansour, Alexandre | Para, Marylou | Mongardon, Nicolas | Porto, Alizée | Guihaire, Julien | Morgant, Marie-Catherine | Pozzi, Matteo | Cholley, Bernard | Falcoz, Pierre-Emmanuel | Gaudard, Philippe | Lebreton, Guillaume | Labaste, François | Barbanti, Claudio | Fouquet, Olivier | Chocron, Sidney | Mottard, Nicolas | Esvan, Maxime | Fougerou-Leurent, Claire | Flecher, Erwan | Vincentelli, André | Nesseler, Nicolas | Pierrot, Marc | Flicoteaux, Guillaume | Mauriat, Philippe | Ouattara, Alexandre | Roze, Hadrien | Huet, Olivier | Fischer, Marc-Olivier | Alessandri, Claire | Bellaïche, Raphel | Constant, Ophélie | Roux, Quentin | Ly, André | Meffert, Arnaud | Merle, Jean-Claude | Picard, Lucile | Skripkina, Elena | Folliguet, Thierry | Fiore, Antonio | d'Ostrevy, Nicolas | Morgan, Marie-Catherine | Guinot, Pierre-Grégoire | Nguyen, Maxime | Gaide-Chevronnay, Lucie | Terzi, Nicolas | Colin, Gwenhaël | Fabre, Olivier | Astaneh, Arash | Issard, Justin | Fadel, Elie | Fabre, Dominique | Girault, Antoine | Ion, Iolande | Menager, Jean Baptiste | Mitilian, Delphine | Mercier, Olaf | Stephan, François | Thes, Jacques | Jouan, Jerôme | Duburcq, Thibault | Loobuyck, Valentin | Moussa, Mouhammed | Mugnier, Agnes | Rousse, Natacha | Manganiello, Sabrina | Desebbe, Olivier | Fellahi, Jean-Luc | Henaine, Roland | Richard, Jean-Christophe | Riad, Zakaria | Guervilly, Christophe | Hraiech, Sami | Papazian, Laurent | Castanier, Matthias | Chanavaz, Charles | Cadoz, Cyril | Gette, Sebastien | Louis, Guillaume | Portocarrero, Erick | Brini, Kais | Bischoff, Nicolas | Levy, Bruno | Kimmoun, Antoine | Mattei, Mathieu | Perez, Pierre | Bourdiol, Alexandre | Hourmant, Yannick | Mahé, Pierre-Joachim | Rozec, Bertrand | Vourc’h, Mickaël | Aubert, Stéphane | Bazalgette, Florian | Roger, Claire | Jaquet, Pierre | Lortat-Jacob, Brice | Mordant, Pierre | Nataf, Patrick | Patrier, Juliette | Provenchere, Sophie | Roué, Morgan | Sonneville, Romain | Tran-Dinh, Alexy | Wicky, Paul-Henri | Al Zreibi, Charles | Guyonvarch, Yannis | Hamada, Sophie | Bertier, Astrid | Harrois, Anatole | Matiello, Jordi | Kerforne, Thomas | Lacroix, Corentin | Brechot, Nicolas | Combes, Alain | Schmidt, Matthieu | Chommeloux, Juliette | Constantin, Jean Michel | D’alessandro, Cosimo | Demondion, Pierre | Demoule, Alexandre | Dres, Martin | Fadel, Guillaume | Fartoukh, Muriel | Hekimian, Guillaume | Juvin, Charles | Leprince, Pascal | Levy, David | Luyt, Charles Edouard | Pineton de Chambrun, Marc | Schoell, Thibaut | Fillâtre, Pierre | Massart, Nicolas | Nicolas, Roxane | Jonas, Maud | Vidal, Charles | Allou, Nicolas | Muccio, Salvatore | Di Perna, Dario | Ruggieri, Vito-Giovanni | Mourvillier, Bruno | Bounader, Karl | Launey, Yoann | Lebouvier, Thomas | Parasido, Alessandro | Reizine, Florian | Seguin, Philippe | Besnier, Emmanuel | Carpentier, Dorothée | Clavier, Thomas | Olland, Anne | Villard, Marion | Bounes, Fanny | Minville, Vincent | Guillon, Antoine | Fedun, Yannick | Ross, James
Edité par
CCSD ; Oxford University Press (OUP) -
International audience.
Objectives - The clinical profile and outcomes of patients with Coronavirus Disease 2019 (COVID-19) who require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or veno-arterial-venous extracorporeal membrane oxygenation (VAV-ECMO) are poorly understood. We aimed to describe the characteristics and outcomes of these patients and to identify predictors of both favourable and unfavourable outcomes. Methods - ECMOSARS is a multicentre, prospective, nationwide French registry enrolling patients who require veno-venous extracorporeal membrane oxygenation (ECMO)/VA-ECMO in the context of COVID-19 infection (652 patients at 41 centres). We focused on 47 patients supported with VA- or VAV-ECMO for refractory cardiogenic shock. Results - The median age was 49. Fourteen percent of patients had a prior diagnosis of heart failure. The most common aetiologies of cardiogenic shock were acute pulmonary embolism (30%), myocarditis (28%) and acute coronary syndrome (4%). Extracorporeal cardiopulmonary resuscitation (E-CPR) occurred in 38%. In-hospital survival was 28% in the whole cohort, and 43% when E-CPR patients were excluded. ECMO cannulation was associated with significant improvements in pH and FiO2 on day 1, but non-survivors showed significantly more severe acidosis and higher FiO2 than survivors at this point (P = 0.030 and P = 0.006). Other factors associated with death were greater age (P = 0.02), higher body mass index (P = 0.03), E-CPR (P = 0.001), non-myocarditis aetiology (P = 0.02), higher serum lactates (P = 0.004), epinephrine (but not noradrenaline) use before initiation of ECMO (P = 0.003), haemorrhagic complications (P = 0.001), greater transfusion requirements (P = 0.001) and more severe Survival after Veno-Arterial ECMO (SAVE) and Sonographic Assessment of Intravascular Fluid Estimate (SAFE) scores (P = 0.01 and P = 0.03). Conclusions - We report the largest focused analysis of VA- and VAV-ECMO recipients in COVID-19. Although relatively rare, the need for temporary mechanical circulatory support in these patients is associated with poor prognosis. However, VA-ECMO remains a viable solution to rescue carefully selected patients. We identified factors associated with poor prognosis and suggest that E-CPR is not a reasonable indication for VA-ECMO in this population.
