tetano
Editor, Senior Moderator
Thorac Cardiovasc Surg
. 2023 May 5.
doi: 10.1055/s-0043-57032. Online ahead of print. Changes in Therapy and Outcome of Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19
Moritz Benjamin Immohr[SUP] 1 [/SUP], Vincent Hendrik Hettlich[SUP] 1 [/SUP], Detlef Kindgen-Milles[SUP] 2 [/SUP], Timo Brandenburger[SUP] 2 [/SUP], Torsten Feldt[SUP] 3 [/SUP], Hug Aubin[SUP] 1 [/SUP], Igor Tudorache[SUP] 1 [/SUP], Payam Akhyari[SUP] 1 [/SUP], Artur Lichtenberg[SUP] 1 [/SUP], Hannan Dalyanoglu[SUP] 1 [/SUP], Udo Boeken[SUP] 1 [/SUP]
Affiliations
Background: Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation (vv-ECMO) is related with poor outcome, especially in Germany. We aimed to analyze whether changes in vv-ECMO therapy during the pandemic were observed and lead to changes in the outcome of vv-ECMO patients.
Methods: All patients undergoing vv-ECMO support for COVID-19 between 2020 and 2021 in a single center (n = 75) were retrospectively analyzed. Weaning from vv-ECMO and in-hospital mortality were defined as primary and peri-interventional adverse events as secondary endpoints of the study.
Results: During the study period, four infective waves were observed in Germany. Patients were assigned correspondingly to four study groups: ECMO implantation between March 2020 and September 2020: first wave (n = 11); October 2020 to February 2021: second wave (n = 23); March 2021 to July 2021: third wave (n = 25); and August 2021 to December 2021: fourth wave (n = 20). Preferred cannulation technique changed within the second wave from femoro-femoral to femoro-jugular access (p < 0.01) and awake ECMO was implemented. Mean ECMO run time increased by more than 300% from 10.9 ± 9.6 (first wave) to 44.9 ± 47.0 days (fourth wave). Weaning of patients was achieved in less than 20% in the first wave but increased to approximately 40% since the second one. Furthermore, we observed a continuous numerically decrease of in-hospital mortality from 81.8 to 57.9% (p = 0.61).
Conclusion: Preference for femoro-jugular cannulation and awake ECMO combined with preexisting expertise and patient selection are considered to be associated with increased duration of ECMO support and numerically improved ECMO weaning and in-hospital mortality.
. 2023 May 5.
doi: 10.1055/s-0043-57032. Online ahead of print. Changes in Therapy and Outcome of Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19
Moritz Benjamin Immohr[SUP] 1 [/SUP], Vincent Hendrik Hettlich[SUP] 1 [/SUP], Detlef Kindgen-Milles[SUP] 2 [/SUP], Timo Brandenburger[SUP] 2 [/SUP], Torsten Feldt[SUP] 3 [/SUP], Hug Aubin[SUP] 1 [/SUP], Igor Tudorache[SUP] 1 [/SUP], Payam Akhyari[SUP] 1 [/SUP], Artur Lichtenberg[SUP] 1 [/SUP], Hannan Dalyanoglu[SUP] 1 [/SUP], Udo Boeken[SUP] 1 [/SUP]
Affiliations
- PMID: 37146634
- DOI: 10.1055/s-0043-57032
Background: Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation (vv-ECMO) is related with poor outcome, especially in Germany. We aimed to analyze whether changes in vv-ECMO therapy during the pandemic were observed and lead to changes in the outcome of vv-ECMO patients.
Methods: All patients undergoing vv-ECMO support for COVID-19 between 2020 and 2021 in a single center (n = 75) were retrospectively analyzed. Weaning from vv-ECMO and in-hospital mortality were defined as primary and peri-interventional adverse events as secondary endpoints of the study.
Results: During the study period, four infective waves were observed in Germany. Patients were assigned correspondingly to four study groups: ECMO implantation between March 2020 and September 2020: first wave (n = 11); October 2020 to February 2021: second wave (n = 23); March 2021 to July 2021: third wave (n = 25); and August 2021 to December 2021: fourth wave (n = 20). Preferred cannulation technique changed within the second wave from femoro-femoral to femoro-jugular access (p < 0.01) and awake ECMO was implemented. Mean ECMO run time increased by more than 300% from 10.9 ± 9.6 (first wave) to 44.9 ± 47.0 days (fourth wave). Weaning of patients was achieved in less than 20% in the first wave but increased to approximately 40% since the second one. Furthermore, we observed a continuous numerically decrease of in-hospital mortality from 81.8 to 57.9% (p = 0.61).
Conclusion: Preference for femoro-jugular cannulation and awake ECMO combined with preexisting expertise and patient selection are considered to be associated with increased duration of ECMO support and numerically improved ECMO weaning and in-hospital mortality.