Extracorporeal Membrane Oxygenation for Patients with Severe COVID-19-Related ARDS: A European Multicenter Analysis

Objectives: With the occurrence of the COVID-19 pandemic in the year of 2020 the number of patients in need of intensive care medicine increased dramatically in many countries. Several of them developed an acute respiratory distress syndrome (ARDS) linked to the COVID-19 infection and many required the use of extracorporeal membrane oxygenation (ECMO).

Methods: We are retrospectively reviewing 141 patients who underwent ECMO for severe COVID-19-related ARDS in a multicenter study at 10 European ECMO centers.

Result: A total of 141 patients (67.4% male, median age was 55.4 years (interquartile range [IQR]: 44–67.5) were treated with ECMO for confirmed (132) or suspected (9) severe COVID-19-related ARDS. Before ECMO, the median Sequential Organ Failure Assessment (SOFA) score was 9.0 (IQR: 7.0–11.5), median pH was 7.25 (IQR: 7.20–7.30), and median PaO₂/FiO₂ ratio was 70 mm Hg (IQR: 60–77).

Venovenous ECMO was provided in 130 patients (92%) and venoarterial ECMO in 11 patients (8%) The median duration of ECMO treatment by now was 11 days, IQR: 7–17). At the time of reporting, 71 confirmed COVID-19 patients (53.8%) are alive, of whom 33 (43.4%) are still in the intensive care unit (9 on ECMO, 24 weaned from ECMO and extubated). Overall mortality so far occurred in 62 patients (46.2%).

By now advanced age, low arterial pH, and low platelet count before ECMO were independent risk factors for increased mortality during the intensive care treatment.

Conclusion: Despite a substantial overall mortality of over 40%, approximately half of the patients with severe COVID-19-related ARDS, refractory to conventional treatment, may be successfully managed with ECMO therapy.

Publication History

Article published online:
19 February 2021