Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study
Matthieu Schmidt
(1, 2, 3)
,
David Hajage
(4)
,
Guillaume Lebreton
(1, 2, 3)
,
Antoine Monsel
(3, 3, 5)
,
Guillaume Voiriot
(6, 7)
,
David Levy
(2, 3)
,
Elodie Baron
(3, 5)
,
Alexandra Beurton
(8, 3)
,
Juliette Chommeloux
(1, 2, 3)
,
Paris Meng
(6, 8)
,
Safaa Nemlaghi
(8, 3)
,
Pierre Bay
(2, 3)
,
Pascal Leprince
(1, 3)
,
Alexandre Demoule
(9, 3)
,
Bertrand Guidet
(10, 8)
,
Jean Michel Constantin
(3, 8)
,
Muriel Fartoukh
(6, 8)
,
Martin Dres
(9, 3)
,
Alain Combes
(1, 2, 3)
,
Charles-Edouard Luyt
,
Guillaume Hekimian
,
Nicolas Brechot
,
Marc Pineton de Chambrun
,
Cyrielle Desnos
,
Jeremy Arzoine
,
Emmanuelle Guerin
,
Thibaut Schoell
,
Pierre Demondion
,
Charles Juvin
,
Nathalie Nardonne
,
Sofica Marin
,
Cossimo d'Alessandro
,
Bao-Long Nguyen
,
Cyril Quemeneur
,
Arthur James
,
Mona Assefi
,
Victoria Lepere
,
Guillaume Savary
,
Aude Gibelin
,
Matthieu Turpin
,
Alexandre Elabbadi
,
Enora Berti
,
Corinne Vezinet
,
Harold Bonvallot
,
Pierre-Romain Delmotte
,
Martin de Sarcus
,
Charlotte Du Fayet de La Tour
,
Samia Abbas
,
Eric Maury
,
Jean-Luc Baudel
,
Jean-Remi Lavillegrand
,
Hafid Ait Oufella
,
Abdelmalek Abdelkrim
,
Thomas Urbina
,
Sara Virolle
,
Robin Deleris
,
Vincent Bonny
,
Julien Le Marec
,
Julien Mayaux
,
Elise Morawiec
1
ICAN -
Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
2 Institut de cardiologie [CHU Pitié-Salpêtrière]
3 CHU Pitié-Salpêtrière [AP-HP]
4 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
5 I3 - Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière]
6 CHU Tenon [AP-HP]
7 IMRB - Institut Mondor de Recherche Biomédicale
8 SU FM - Sorbonne Université - Faculté de Médecine
9 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
10 CHU Saint-Antoine [AP-HP]
2 Institut de cardiologie [CHU Pitié-Salpêtrière]
3 CHU Pitié-Salpêtrière [AP-HP]
4 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
5 I3 - Immunologie - Immunopathologie - Immunothérapie [CHU Pitié Salpêtrière]
6 CHU Tenon [AP-HP]
7 IMRB - Institut Mondor de Recherche Biomédicale
8 SU FM - Sorbonne Université - Faculté de Médecine
9 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
10 CHU Saint-Antoine [AP-HP]
Matthieu Schmidt
- Function : Author
- PersonId : 773508
- ORCID : 0000-0002-2931-4412
- IdRef : 183767357
David Hajage
- Function : Author
- PersonId : 1003880
- IdHAL : david-hajage
- ORCID : 0000-0002-8475-4090
- IdRef : 144117959
Guillaume Lebreton
- Function : Author
- PersonId : 776954
- ORCID : 0000-0003-4308-506X
Antoine Monsel
- Function : Author
- PersonId : 777906
- ORCID : 0000-0002-9647-7043
- IdRef : 13924669X
Bertrand Guidet
- Function : Author
- PersonId : 988017
- IdHAL : bertrand-guidet
- ORCID : 0000-0002-7643-6770
- IdRef : 076134350
Jean Michel Constantin
- Function : Author
- PersonId : 768718
- ORCID : 0000-0001-7634-5898
- IdRef : 070279918
Martin Dres
- Function : Author
- PersonId : 1000579
- IdHAL : martindres
- ORCID : 0000-0001-9191-6089
Alain Combes
- Function : Author
- PersonId : 999809
- ORCID : 0000-0002-6030-3957
- IdRef : 033468192
Charles-Edouard Luyt
- Function : Author
- PersonId : 768391
- ORCID : 0000-0001-7424-2705
Guillaume Hekimian
- Function : Author
Nicolas Brechot
- Function : Author
Marc Pineton de Chambrun
- Function : Author
Cyrielle Desnos
- Function : Author
Jeremy Arzoine
- Function : Author
Emmanuelle Guerin
- Function : Author
Thibaut Schoell
- Function : Author
Pierre Demondion
- Function : Author
Charles Juvin
- Function : Author
Nathalie Nardonne
- Function : Author
Sofica Marin
- Function : Author
Cossimo d'Alessandro
- Function : Author
Bao-Long Nguyen
- Function : Author
Cyril Quemeneur
- Function : Author
Arthur James
- Function : Author
Mona Assefi
- Function : Author
Victoria Lepere
- Function : Author
Guillaume Savary
- Function : Author
Aude Gibelin
- Function : Author
Matthieu Turpin
- Function : Author
Alexandre Elabbadi
- Function : Author
Enora Berti
- Function : Author
Corinne Vezinet
- Function : Author
Harold Bonvallot
- Function : Author
Pierre-Romain Delmotte
- Function : Author
Martin de Sarcus
- Function : Author
Charlotte Du Fayet de La Tour
- Function : Author
Samia Abbas
- Function : Author
Eric Maury
- Function : Author
Jean-Luc Baudel
- Function : Author
Jean-Remi Lavillegrand
- Function : Author
Hafid Ait Oufella
- Function : Author
Abdelmalek Abdelkrim
- Function : Author
Thomas Urbina
- Function : Author
Sara Virolle
- Function : Author
Robin Deleris
- Function : Author
Vincent Bonny
- Function : Author
Julien Le Marec
- Function : Author
Julien Mayaux
- Function : Author
Elise Morawiec
- Function : Author
Abstract
Background
Patients with COVID-19 who develop severe acute respiratory distress syndrome (ARDS) can have symptoms that rapidly evolve to profound hypoxaemia and death. The efficacy of extracorporeal membrane oxygenation (ECMO) for patients with severe ARDS in the context of COVID-19 is unclear. We aimed to establish the clinical characteristics and outcomes of patients with respiratory failure and COVID-19 treated with ECMO.
Methods
This retrospective cohort study was done in the Paris–Sorbonne University Hospital Network, comprising five intensive care units (ICUs) and included patients who received ECMO for COVID-19 associated ARDS. Patient demographics and daily pre-ECMO and on-ECMO data and outcomes were collected. Possible outcomes over time were categorised into four different states (states 1–4): on ECMO, in the ICU and weaned off ECMO, alive and out of ICU, or death. Daily probabilities of occupation in each state and of transitions between these states until day 90 post-ECMO onset were estimated with use of a multi-state Cox model stratified for each possible transition. Follow-up was right-censored on July 10, 2020.
Findings
From March 8 to May 2, 2020, 492 patients with COVID-19 were treated in our ICUs. Complete day-60 follow-up was available for 83 patients (median age 49 [IQR 41–56] years and 61 [73%] men) who received ECMO. Pre-ECMO, 78 (94%) patients had been prone-positioned; their median driving pressure was 18 (IQR 16–21) cm H2O and PaO2/FiO2 was 60 (54–68) mm Hg. At 60 days post-ECMO initiation, the estimated probabilities of occupation in each state were 6% (95% CI 3–14) for state 1, 18% (11–28) for state 2, 45% (35–56) for state 3, and 31% (22–42) for state 4. 35 (42%) patients had major bleeding and four (5%) had a haemorrhagic stroke. 30 patients died.
Interpretation
The estimated 60-day survival of ECMO-rescued patients with COVID-19 was similar to that of studies published in the past 2 years on ECMO for severe ARDS. If another COVID-19 outbreak occurs, ECMO should be considered for patients developing refractory respiratory failure despite optimised care.