• Minerva cardioangiologica · Oct 2020

    Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019: an updated perspective of the European experience.

    • Antonino G Marullo, Elena Cavarretta, Biondi Zoccai Giuseppe G Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - giuseppe.biondizoccai@uniroma1.it. , Massimo Mancone, Mariangela Peruzzi, Fernando Piscioneri, Patrizio Sartini, Francesco Versaci, Andrea Morelli, Fabio Miraldi, and Giacomo Frati.
    • Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.
    • Minerva Cardioangiol. 2020 Oct 1; 68 (5): 368-372.

    BackgroundInfection due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), i.e. coronavirus-associated disease 2019 (COVID-2019), may occasionally lead to acute respiratory distress syndrome (ARDS), requiring in the most severe cases extracorporeal membrane oxygenation (ECMO). Yet, limited data, if any, are currently available on the role of ECMO in critically ill patients with COVID-19. We aimed at providing a snapshot analysis of ECMO for COVID-19 in Europe.MethodsFreely available data on ECMO in COVID-19 patients reported by the European Extracorporeal Life Support Organization (EuroELSO) were extracted and analyzed after conversion into long format. The primary outcome was the incidence of death during ECMO. Bootstrapping and logistic regression were used for inferential estimates.ResultsDetails from a total of 333 patients treated in 90 institutions spanning 17 countries were obtained, with 22% women and mean age of 52 years. Death rate was 17.1% (95% confidence interval: 13.1% to 21.1%), even if significant between-center differences were found, with some institutions reporting 100% case fatality. Exploratory inferential analysis showed no nominally statistically significant association between death and gender (P=0.788), but a significant association was found with age, mainly due to increased case fatality in subjects >60 years (odds ratio: 4.80 [95% confidence interval 1.64 to 14.04], P=0.004).ConclusionsECMO may play an important role in critically ill patients with COVID-19 refractory to less invasive treatments. The increased risk of early death in older patients may be used to prioritize ECMO indication in resource-conscious settings, if confirmed externally.

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