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Veno-arterial extracorporeal membrane oxygenation for circulatory failure in COVID-19 patients: insights from the ECMOSARS registry

2023; Oxford University Press; Volume: 64; Issue: 3 Linguagem: Inglês

10.1093/ejcts/ezad229

1873-734X

Amédéo Anselmi, Alexandre Mansour, Marylou Para, Nicolas Mongardon, Alizée Porto, Julien Guihaire, Marie‐Catherine Morgant, Mattéo Pozzi, Bernard Cholley, Pierre‐Emmanuel Falcoz, Philippe Gaudard, Guillaume Lebreton, François Labaste, Claudio Barbanti, Olivier Fouquet, Sidney Chocron, Nicolas Mottard, Maxime Esvan, Claire Fougerou‐Leurent, Erwan Flécher, André Vincentelli, Nicolas Nesseler, Marc Pierrot, Guillaume Flicoteaux, Philippe Mauriat, Alexandre Ouattara, Hadrien Rozé, Olivier Huet, Marc‐Olivier Fischer, Claire Alessandri, Raphel Bellaïche, Ophélie Constant, Quentin de Roux, André Ly, Arnaud Meffert, Jean‐Claude Merle, L Picard, Elena Skripkina, Thierry Folliguet, Antonio Fiore, Nicolas D’Ostrevy, Marie-Catherine Morgan, Pierre-Grégoire Guinot, Maxime Nguyen, Lucie Gaide‐Chevronnay, Nicolas Terzi, Gwenhaël Colin, Olivier Fabre, Arash Astaneh, Justin Issard, Élie Fadel, Dominique Fabre, Antoine Girault, Iolande Ion, Jean-Baptiste Ménager, Délphine Mitilian, Olaf Mercier, François Stéphan, Jacques Thès, Jérôme Jouan, Thibault Duburcq, Valentin Loobuyck, Mouhammed Moussa, A Mugnier, Natacha Rousse, Sabrina Manganiello, Olivier Desebbe, Jean-Luc Fellahi, Roland Hénaine, Matteo Pozzi, Jean‐Christophe Richard, Zakaria Riad, Christophe Guervilly, Sami Hraiech, Laurent Papazian, Matthias Castanier, C. Chanavaz, Cyril Cadoz, Sébastien Gette, Guillaume Louis, Erick Portocarrero, Kais Brini, Nicolas Bischoff, Bruno Lévy, Antoine Kimmoun, Mathieu Mattèi, Pierre Perez, Alexandre Bourdiol, Yannick Hourmant, Pierre-Joachim Mahé, Bertrand Rozec, Mickaël Vourc’h, Stéphane Aubert, Florian Bazalgette, Claire Roger, Pierre Jaquet, Brice Lortat‐Jacob, Pierre Mordant, Patrick Nataf, Juliette Patrier, Sophie Provenchère, Morgan Roué, Romain Sonneville, Alexy Tran‐Dinh, Paul-Henri Wicky, Charles Al Zreibi, Yannis Guyonvarch, Sophie Hamada, Astrid Bertier, Anatole Harrois, Jordi Matiello, Thomas Kerforne, C. Lacroix, Nicolas Bréchot, Alain Combes, Matthieu Schmidt, Juliette Chommeloux, Jean Michel Constantin, Cosimo D’Alessandro, Pierre Demondion, Alexandre Demoule, Martin Dres, Guillaume Fadel, Muriel Fartoukh, Guillaume Hékimian, Charles Juvin, Pascal Leprince, David Levy, Charles Edouard Luyt, Marc Pineton de Chambrun, Thibaut Schoell, Pierre Fillâtre, Nicolas Massart, Roxane Nicolas, Maud Jonas, Charles Vidal, Nicolas Allou, Salvatore Muccio, Dario Di Perna, Vito Giovanni Ruggieri, Bruno Mourvillier, Karl Bounader, Yoann Launey, Thomas Lebouvier, Alessandro Parasido, Florian Reizine, Philippe Séguin, Emmanuel Besnier, Dorothée Carpentier, Thomas Clavier, Anne Olland, Marion Villard, Fanny Vardon‐Bounes, Vincent Minville, Antoine Guillon, Yannick Fédun, James T. Ross,

Cardiac Arrest and Resuscitation

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.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.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).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.