Extracorporeal Membrane Oxygenation in Critically Ill COVID-19 Patients and Predictors of Mortality: The Aachen Experience

Objectives: The role of extracorporeal membrane oxygenation (ECMO) in the management of critically ill COVID-19 patients remains unclear. Our study aims to analyze the outcomes and risk factors from patients treated with ECMO.

Methods: This retrospective, single-center study includes seventeen COVID-19 patients treated with ECMO. Univariate and multivariate parametric survival regression identified predictors of survival.

Result: Nine patients (53%) were successfully weaned from ECMO and discharged. The incidence of in-hospital mortality was 47%. In a univariate analysis, only four out of 83 pre-ECMO variables were significantly different; IL-6, PCT, and NT-proBNP were significantly higher in non-survivors compared with survivors. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score was significantly lower in survivors. After a multivariate parametric survival regression, IL-6, NT-proBNP and RESP scores remained significant independent predictors, with hazard ratios (HR) of 1.069 [95% CI: 0.986–1.160], p = 0.016 1.001 [95% CI: 1.000–1.001], p = 0.012; and 0.843 [95% CI: 0.564–1.260], p = 0.040, respectively. A prediction model consisting of IL-6, NT-proBNP, and RESP score showed an area under the curve (AUC) of 0.87, with a sensitivity of 87.5% and specificity of 77.8%, compared with an AUC of 0.79 for the RESP score alone.

Conclusion: The present study suggests that ECMO is a potentially lifesaving treatment for select critically ill COVID-19 patients. Considering IL-6 and NT-per-BNP, in addition to the RESP score, may enhance outcome predictions.

Publikationsverlauf

Artikel online veröffentlicht:
19. Februar 2021