Veno-arterial extracorporeal membrane oxygenation for circulatory failure in COVID-19 patients: insights from the ECMOSARS registry
Author:
Anselmi Amedeo1ORCID, Mansour Alexandre234, Para Marylou56, Mongardon Nicolas789, Porto Alizée10, Guihaire Julien11, Morgant Marie-Catherine12, Pozzi Matteo1314ORCID, Cholley Bernard1516, Falcoz Pierre-Emmanuel171819ORCID, Gaudard Philippe20ORCID, Lebreton Guillaume2122ORCID, Labaste François2324, Barbanti Claudio25, Fouquet Olivier2627ORCID, Chocron Sidney28, Mottard Nicolas29, Esvan Maxime3, Fougerou-Leurent Claire3, Flecher Erwan1, Vincentelli André30, Nesseler Nicolas3231, Pierrot Marc, Flicoteaux Guillaume, Mauriat Philippe, Ouattara Alexandre, Roze Hadrien, Huet Olivier, Fischer Marc-Olivier, Alessandri Claire, Bellaïche Raphel, Constant Ophélie, De 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, Pozzi Matteo, 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, Zreibi Charles Al, 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, De Chambrun Marc Pineton, 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 T,
Affiliation:
1. Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory (LTSI), Inserm U1099 , Rennes, France 2. Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes , France 3. Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes) , Rennes, France 4. Univ Rennes, CHU de Rennes, Inra , France 5. Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP , Paris, France 6. University of Paris, UMR 1148, Laboratory of Vascular Translational Science , Paris, France 7. Service d’anesthésie-réanimation, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor , Créteil, France 8. Univ Paris Est Créteil, Faculté de Santé , Créteil, France 9. U955-IMRB, Equipe 03 “Pharmacologie et Technologies pour les Maladies Cardiovasculaires (PROTECT)”, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA) , Maisons-Alfort, France 10. Department of Cardiac Surgery, Timone Hospital, APHM , Marseille, France 11. Department of Cardiac Surgery, Inserm UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie-Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, University of Paris-Saclay School of Medicine , Le Plessis-Robinson, France 12. Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital , Dijon, France 13. Department of Cardiac Surgery, “Louis Pradel” Cardiologic Hospital , Lyon, France 14. Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1 , Lyon, France 15. AP-HP, Hôpital Européen Georges Pompidou , Paris, France 16. Université de Paris, INSERM UMR_S 1140 “Innovations Thérapeutiques en Hémostase” , Paris, France 17. INSERM, UMR 1260, Regenerative Nanomedicine (RNM), FMTS , Strasbourg, France 18. Université de Strasbourg, Faculté de médecine et pharmacie , Strasbourg, France 19. Hôpitaux Universitaire de Strasbourg, Service de chirurgie thoracique—Nouvel Hôpital Civil , Strasbourg, France 20. Department of Anesthesia and Critical Care, PhyMedExp, Montpellier University, INSERM, CNRS, CHU Montpellier , Montpellier, France 21. Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition , Paris, France 22. Service de Chirurgie Thoracique et Cardiovasculaire, Institut de Cardiologie, APHP, Sorbonne Université, Hôpital Pitié–Salpêtrière , Paris, France 23. Anesthesiology and Intensive Care Department, CHU Toulouse , Toulouse, France 24. Institut des Maladies Métaboliques et Cardiovasculaires, INSERM U1048, Université de Toulouse, Université Paul Sabatier , Toulouse, France 25. APHP Necker, Paris University Hospital , Paris, France 26. Department of Thoracic and Cardiovascular Surgery, University Hospital , Angers, France 27. MITOVASC Institute CNRS UMR 6214, INSERM U1083, University of Angers , Angers, France 28. Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte , Besancon, France 29. Department of Anesthesiology and Critical Care, Clinique de la Sauvegarde, RAMSAY Santé , Lyon, France 30. Department of Cardiac Surgery, University Hospital of Lille , Lille, France 31. Univ Rennes, CHU de Rennes, Inra, Inserm, Institut NUMECAN—UMR_A 1341, UMR_S 1241 , Rennes, France
Abstract
Abstract
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.
Funder
French society of thoracic and cardiovascular surgery
Publisher
Oxford University Press (OUP)
Subject
Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery
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