• Fausto Biancari, Giovanni Mariscalco, Magnus Dalén, Nicla Settembre, Henryk Welp, Andrea Perrotti, Karsten Wiebe, Enrico Leo, Antonio Loforte, Sidney Chocron, Davide Pacini, Tatu Juvonen, L Mikael Broman, Dario Di Perna, Hakeem Yusuff, Chris Harvey, Nicolas Mongardon, Juan P Maureira, Bruno Levy, Lars Falk, Vito G Ruggieri, Svante Zipfel, Thierry Folliguet, and Antonio Fiore.
• Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland; Research Unit of Surgery, Anesthesia and Critical Care, University of Oulu, Oulu, Finland; Department of Surgery, University of Turku, Turku, Finland. Electronic address: faustobiancari@yahoo.it.
• J. Cardiothorac. Vasc. Anesth. 2021 Jul 1; 35 (7): 199920061999-2006.

ObjectivesThe authors evaluated the outcome of adult patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) requiring the use of extracorporeal membrane oxygenation (ECMO).DesignMulticenter retrospective, observational study.SettingTen tertiary referral university and community hospitals.ParticipantsPatients with confirmed severe COVID-19-related ARDS.InterventionsVenovenous or venoarterial ECMO.Measurements And Main ResultsOne hundred thirty-two patients (mean age 51.1 ± 9.7 years, female 17.4%) were treated with ECMO for confirmed severe COVID-19-related ARDS. Before ECMO, the mean Sequential Organ Failure Assessment score was 10.1 ± 4.4, mean pH was 7.23 ± 0.09, and mean PaO2/fraction of inspired oxygen ratio was 77 ± 50 mmHg. Venovenous ECMO was adopted in 122 patients (92.4%) and venoarterial ECMO in ten patients (7.6%) (mean duration, 14.6 ± 11.0 days). Sixty-three (47.7%) patients died on ECMO and 70 (53.0%) during the index hospitalization. Six-month all-cause mortality was 53.0%. Advanced age (per year, hazard ratio [HR] 1.026, 95% CI 1.000-1-052) and low arterial pH (per unit, HR 0.006, 95% CI 0.000-0.083) before ECMO were the only baseline variables associated with increased risk of six-month mortality.ConclusionsThe present findings suggested that about half of adult patients with severe COVID-19-related ARDS can be managed successfully with ECMO with sustained results at six months. Decreased arterial pH before ECMO was associated significantly with early mortality. Therefore, the authors hypothesized that initiation of ECMO therapy before severe metabolic derangements subset may improve survival rates significantly in these patients. These results should be viewed in the light of a strict patient selection policy and may not be replicated in patients with advanced age or multiple comorbidities.Clinical Trial Registrationidentifier, NCT04383678.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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