Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation-A Retrospective International Multicenter Study

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...

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Published inMembranes (Basel) Vol. 11; no. 3; p. 170
Main Authors Supady, Alexander, DellaVolpe, Jeff, Taccone, Fabio Silvio, Scharpf, Dominik, Ulmer, Matthias, Lepper, Philipp M, Halbe, Maximilian, Ziegeler, Stephan, Vogt, Alexander, Ramanan, Raj, Boldt, David, Stecher, Stephanie-Susanne, Montisci, Andrea, Spangenberg, Tobias, Marggraf, Olivier, Kunavarapu, Chandra, Peluso, Lorenzo, Muenz, Sebastian, Buerle, Monica, Nagaraj, Naveen G, Nuding, Sebastian, Toma, Catalin, Gudzenko, Vadim, Stemmler, Hans Joachim, Pappalardo, Federico, Trummer, Georg, Benk, Christoph, Michels, Guido, Duerschmied, Daniel, von Zur Muehlen, Constantin, Bode, Christoph, Kaier, Klaus, Brodie, Daniel, Wengenmayer, Tobias, Staudacher, Dawid L
Format Journal Article
LanguageEnglish
Published Switzerland MDPI 27.02.2021
MDPI AG
Subjects
acute respiratory distress syndrome
COVID-19
extracorporeal membrane oxygenation
SARS-CoV-2
COVID-19
acute respiratory distress syndrome
SARS-CoV-2
extracorporeal membrane oxygenation
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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. 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. 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. 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.
AbstractList 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.
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. 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. 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. 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.
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. METHODSThis 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. RESULTSIn 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. CONCLUSIONSThe 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.
Author Taccone, Fabio Silvio
DellaVolpe, Jeff
Buerle, Monica
von Zur Muehlen, Constantin
Duerschmied, Daniel
Brodie, Daniel
Nagaraj, Naveen G
Wengenmayer, Tobias
Scharpf, Dominik
Trummer, Georg
Ulmer, Matthias
Muenz, Sebastian
Kaier, Klaus
Marggraf, Olivier
Bode, Christoph
Halbe, Maximilian
Vogt, Alexander
Nuding, Sebastian
Lepper, Philipp M
Ramanan, Raj
Boldt, David
Montisci, Andrea
Peluso, Lorenzo
Spangenberg, Tobias
Pappalardo, Federico
Supady, Alexander
Kunavarapu, Chandra
Stemmler, Hans Joachim
Benk, Christoph
Staudacher, Dawid L
Gudzenko, Vadim
Toma, Catalin
Michels, Guido
Stecher, Stephanie-Susanne
Ziegeler, Stephan
AuthorAffiliation 13 UCLA Healthcare System, Los Angeles, CA 90095, USA; DBoldt@mednet.ucla.edu (D.B.); VGudzenko@mednet.ucla.edu (V.G.)
3 Heidelberg Institute of Global Health, University of Heidelberg, 69120 Heidelberg, Germany
10 Department of Anesthesiology, Intensive Care Medicine and Pain Management, Hospital Ibbenbueren, 49477 Ibbenbueren, Germany; s.ziegeler@klinikum-ibbenbueren.de
12 University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA; Ramananrr@upmc.edu (R.R.); tomacx@UPMC.EDU (C.T.)
11 Department of Medicine III, University Clinic Halle (Saale), 06097 Halle (Saale), Germany; alexander.vogt@uk-halle.de (A.V.); sebastian.nuding@uk-halle.de (S.N.)
19 Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC Italy, 90127 Palermo, Italy; fedepappa.71@gmail.com
2 Department of Cardiology and Angiology I, Heart Center, University of Freiburg, 79106 Freiburg, Germany; klaus.kaier@uniklinik-freiburg.de
4 Methodist Hospital, San Antonio, TX 78229, USA; jeff.dellavolpe@gmail.com (J.
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/33673615$$D View this record in MEDLINE/PubMed
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Issue 3
Keywords COVID-19
acute respiratory distress syndrome
SARS-CoV-2
extracorporeal membrane oxygenation
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Snippet The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under...
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SubjectTerms acute respiratory distress syndrome
COVID-19
extracorporeal membrane oxygenation
SARS-CoV-2
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Title Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation-A Retrospective International Multicenter Study
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