Outcome prediction in patients with severe COVID-19 requiring extracorporeal membrane oxygenation — A retrospective international multicenter study

Alexander Supady, Jeff Dellavolpe, Fabio Silvio Taccone, Dominik Scharpf, Matthias Ulmer, Philipp M. Lepper, Maximilian Halbe, Stephan Ziegeler, Alexander Vogt, Raj Ramanan, David Boldt, Stephanie Susanne Stecher, Andrea Montisci, Tobias Spangenberg, Olivier Marggraf, Chandra Kunavarapu, Lorenzo Peluso, Sebastian Muenz, Monica Buerle, Naveen G. NagarajSebastian Nuding, Catalin Toma, Vadim Gudzenko, Hans Joachim Stemmler, Federico Pappalardo, Georg Trummer, Christoph Benk, Guido Michels, Daniel Duerschmied, Constantin von zur Muehlen, Christoph Bode, Klaus Kaier, Daniel Brodie, Tobias Wengenmayer, Dawid L. Staudacher

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V-V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

Original languageEnglish (US)
Article number170
Pages (from-to)1-13
Number of pages13
JournalMembranes
Volume11
Issue number3
DOIs
StatePublished - Mar 2021
Externally publishedYes

Keywords

  • Acute respiratory distress syndrome
  • COVID19
  • Extracorporeal membrane oxygenation
  • SARS-CoV-2

ASJC Scopus subject areas

  • Chemical Engineering (miscellaneous)
  • Process Chemistry and Technology
  • Filtration and Separation

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