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Thorac Cardiovasc Surg
DOI: 10.1055/s-0043-57032
Original Thoracic

Changes in Therapy and Outcome of Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19

Moritz Benjamin Immohr 
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Vincent Hendrik Hettlich
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Detlef Kindgen-Milles
2   Department of Anesthesiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Timo Brandenburger
2   Department of Anesthesiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Torsten Feldt
3   Department of Hepatology and Infectiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Hug Aubin 
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Igor Tudorache
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Payam Akhyari 
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Artur Lichtenberg
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Hannan Dalyanoglu
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
,
Udo Boeken
1   Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
› Author Affiliations Funding The authors did not receive any funding for this study.
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Abstract

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.

Keywords

SARS-CoV-2 - COVID-19 - respiratory distress syndrome - extracorporeal - membrane oxygenation - respiratory failure

Ethics

The study followed the principles of the Declaration of Helsinki and was approved by the local university ethics committee.


Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.


Authors' Contributions

M.B.I.: Conceptualization, data curation, formal analysis, investigation, methodology, validation, visualization, writing – original draft, writing – review and editing.


V.H.: Data curation, methodology, investigation, validation, writing – review and editing.


D.K.M.: Data curation, resources, investigation, validation, writing – review and editing.


T.B.: Data curation, resources, investigation, validation, writing – review and editing.


T.F.: Data curation, investigation, validation, writing – review and editing.


H.A.: Data curation, resources, investigation, validation, writing – review and editing.


I.T.: Data curation, investigation, validation, writing – review and editing.


P.A.: Data curation, investigation, validation, writing – review and editing.


A.L.: Data curation, methodology, project administration, resources, supervision, validation, writing – review and editing.


H.D.: Conceptualization, data curation, investigation, methodology, project administration, resources, supervision, validation, writing – review and editing.


U.B.: Conceptualization, data curation, investigation, methodology, project administration, resources, supervision, validation, writing – review and editing.


Note

Presented at the 42nd Annual Meeting of the International Society for Heart and Lung Transplantation,27-30 April 2022, Boston, MA, USA.


Supplementary Material



Publication History

Received: 11 February 2023

Accepted: 16 March 2023

Article published online:
05 May 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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