TY - JOUR
T1 - Extracorporeal life support in COVID-19-related acute respiratory distress syndrome
T2 - A EuroELSO international survey
AU - for the COVEC-Study Group
AU - Mang, Sebastian
AU - Kalenka, Armin
AU - Broman, Lars Mikael
AU - Supady, Alexander
AU - Swol, Justyna
AU - Danziger, Guy
AU - Becker, André
AU - Hörsch, Sabrina I.
AU - Mertke, Thilo
AU - Kaiser, Ralf
AU - Bracht, Hendrik
AU - Zotzmann, Viviane
AU - Seiler, Frederik
AU - Bals, Robert
AU - Taccone, Fabio Silvio
AU - Moerer, Onnen
AU - Lorusso, Roberto
AU - Bělohlávek, Jan
AU - Muellenbach, Ralf M.
AU - Lepper, Philipp M.
AU - Barrett, Nicholas
AU - Duerschmied, Daniel
AU - Fan, Eddy
AU - Fichtner, Falk
AU - Haake, Hendrik
AU - Langer, Frank
AU - Mutlak, Haitham
AU - Kredel, Markus
AU - Müller, Thomas
AU - Protti, Alessandro
AU - Raddatz, Alexander
AU - Spangenberg, Tobias
AU - Staudacher, Dawid
AU - Wehrfritz, Holger
AU - Wengenmayer, Tobias
AU - Westheider, Arne
AU - Dang Van, Simon
AU - Daubin, Cedric
AU - Gaudard, Philippe
AU - Godet, Thomas
AU - Guinot, Pierre Grégoire
AU - Le Guennec, Loïc
AU - Megarbane, Bruno
AU - Mercat, Alain
AU - Sonneville, Romain
AU - Zogheib, Elie
AU - Pham, Tai
AU - Winiszewski, Hadrien
AU - Schellongowski, Peter
AU - Yannopoulos, Demetris
N1 - Publisher Copyright:
© 2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.
PY - 2021/5
Y1 - 2021/5
N2 - Extracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID-19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID-19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID-19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient’s recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID-19-induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID-19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID-19 benefitted from ECLS.
AB - Extracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID-19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID-19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID-19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient’s recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID-19-induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID-19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID-19 benefitted from ECLS.
KW - COVID-19
KW - COVID-19-induced acute respiratory distress syndrome
KW - SARS-CoV-2
KW - extracorporeal life support
KW - extracorporeal membrane oxygenation
KW - survey
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U2 - 10.1111/aor.13940
DO - 10.1111/aor.13940
M3 - Article
C2 - 33590542
AN - SCOPUS:85103276461
SN - 0160-564X
VL - 45
SP - 495
EP - 505
JO - Artificial Organs
JF - Artificial Organs
IS - 5
ER -