1. Extracorporeal membrane oxigenation in COVID-19 patients: Results of the ECMO-COVID Registry of the Spanish Society of Cardiovascular and Endovascular Surgery
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Castano, Mario, Sbraga, Fabrizio, Perez de la Sota, Enrique, Arribas, Jose M., Luisa Camara, M., Voces, Roberto, Donado, Alicia, Sandoval, Elena, Morales, Carlos A., Gonzalez-Santos, Jose M., Barquero-Aleman, Miguel, Fletcher-San Feliu, Delfina, Rodriguez-Roda, Jorge, Molina, Daniel, Bellido, Andre, Vigil-Escalera, Carlota, Tena, M. Angeles, Reyes, Guillermo, Gomez, Felix, Rivas, Jorge, Guevara, Audelio, Tauron, Manel, Miguel Borrego, Jose, Castillo, Laura, Miralles, Albert, Canovas, Sergio, Berastegui, Elisabet, Aramendi, Jose, I, Aldamiz, Gonzalo, Pruna, Robert, Silva, Jacobo, Saez de Ibarra, Jose I., Legarra, Juan J., Ballester, Carlos, Rodriguez-Lecoq, Rafael, Daroca, Tomas, Paredes, Federico, [Castano, Mario] Hosp Univ Leon, Serv Cirugia Cardiaca, Leon, Spain, [Castillo, Laura] Hosp Univ Leon, Serv Cirugia Cardiaca, Leon, Spain, [Sbraga, Fabrizio] Hosp Univ Bellvitge, Serv Cirugia Cardiaca, Lhospitalet De Llobregat, Spain, [Miralles, Albert] Hosp Univ Bellvitge, Serv Cirugia Cardiaca, Lhospitalet De Llobregat, Spain, [Perez de la Sota, Enrique] Hosp Univ 12 Octubre, Serv Cirugia Cardiaca, Madrid, Spain, [Arribas, Jose M.] Hosp Clin Univ Virgen de la Arrixaca, Serv Cirugia Cardiovasc, Murcia, Spain, [Canovas, Sergio] Hosp Clin Univ Virgen de la Arrixaca, Serv Cirugia Cardiovasc, Murcia, Spain, [Luisa Camara, M.] Hosp Badalona Germans Trias & Pujol, Serv Cirugia Cardiaca, Badalona, Spain, [Berastegui, Elisabet] Hosp Badalona Germans Trias & Pujol, Serv Cirugia Cardiaca, Badalona, Spain, [Voces, Roberto] Hosp Cruces, Serv Cirugia Cardiaca, Baracaldo, Spain, [Aramendi, Jose, I] Hosp Cruces, Serv Cirugia Cardiaca, Baracaldo, Spain, [Donado, Alicia] Fdn Jimenez Diaz, Serv Cirugia Cardiaca, Madrid, Spain, [Aldamiz, Gonzalo] Fdn Jimenez Diaz, Serv Cirugia Cardiaca, Madrid, Spain, [Donado, Alicia] Hosp Univ Rey Juan Carlos, Serv Cirugia Cardiaca, Mostoles, Spain, [Aldamiz, Gonzalo] Hosp Univ Rey Juan Carlos, Serv Cirugia Cardiaca, Mostoles, Spain, [Sandoval, Elena] Hosp Univ Clin Barcelona, Serv Cirugia Cardiovasc, Barcelona, Spain, [Morales, Carlos A.] Hosp Univ Cent Asturias, Serv Cirugia Cardiaca, Area Gest Clin Corazon, Oviedo, Spain, [Pruna, Robert] Hosp Univ Cent Asturias, Serv Cirugia Cardiaca, Area Gest Clin Corazon, Oviedo, Spain, [Silva, Jacobo] Hosp Univ Cent Asturias, Serv Cirugia Cardiaca, Area Gest Clin Corazon, Oviedo, Spain, [Gonzalez-Santos, Jose M.] Complejo Asistencial Univ Salamanca, Serv Cirugia Cardiaca, Salamanca, Spain, [Barquero-Aleman, Miguel] Hosp Univ Virgen Macarena, Serv Cirugia Cardiovasc, Seville, Spain, [Fletcher-San Feliu, Delfina] Hosp Univ Son Espases, Serv Cirugia Cardiaca, Palma De Mallorca, Spain, [Saez de Ibarra, Jose I.] Hosp Univ Son Espases, Serv Cirugia Cardiaca, Palma De Mallorca, Spain, [Rodriguez-Roda, Jorge] Hosp Univ Ramon y Cajal, Serv Cirugia Cardiaca, Madrid, Spain, [Molina, Daniel] Hosp Alvaro Cunqueiro, Serv Cirugia Cardiaca, Vigo, Spain, [Legarra, Juan J.] Hosp Alvaro Cunqueiro, Serv Cirugia Cardiaca, Vigo, Spain, [Bellido, Andre] Hosp Univ Miguel Servet, Serv Cirugia Cardiaca, Zaragoza, Spain, [Ballester, Carlos] Hosp Univ Miguel Servet, Serv Cirugia Cardiaca, Zaragoza, Spain, [Vigil-Escalera, Carlota] Hosp Univ Vall Hebron, Serv Cirugia Cardiaca, Barcelona, Spain, [Rodriguez-Lecoq, Rafael] Hosp Univ Vall Hebron, Serv Cirugia Cardiaca, Barcelona, Spain, [Tena, M. Angeles] Hosp Dr Negrin, Serv Cirugia Cardiaca, Las Palmas Gran Canaria, Spain, [Paredes, Federico] Hosp Dr Negrin, Serv Cirugia Cardiaca, Las Palmas Gran Canaria, Spain, [Reyes, Guillermo] Hosp Univ La Princesa, Serv Cirugia Cardiaca, Madrid, Spain, [Gomez, Felix] Complejo Hosp Navarra, Serv Cirugia Cardiaca, Pamplona, Spain, [Rivas, Jorge] Hosp Univ Quironsalud Madrid, Serv Cirugia Cardiaca, Pozuelo De Alarcon, Spain, [Guevara, Audelio] Hosp Univ & Politecn La Fe, Serv Cirugia Cardiaca, Valencia, Spain, [Tauron, Manel] Hosp Santa Creu & Sant Pau, Serv Cirugia Cardiaca, Barcelona, Spain, [Miguel Borrego, Jose] Hosp Univ Puerta Mar, Serv Cirugia Cardiaca, Cadiz, Spain, [Daroca, Tomas] Hosp Univ Puerta Mar, Serv Cirugia Cardiaca, Cadiz, Spain, and [Paredes, Federico] Hosp Univ Virgen del Rocio, Serv Cirugia Cardiaca, Seville, Spain
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Extracorporeal membrane oxygenation ,Oxygenation ,Respiratory-distress-syndrome ,Failure ,COVID-19 ,Heart failure ,ECMO ,Respiratory failure ,Support ,Guidelines ,Trial - Abstract
Background and aim: COVID-19 patients with severe heart or respiratory failure are potential candidates for extracorporeal membrane oxygenation (ECMO). Indications and management of these patients are unclear. Our aim is to describe the results of a prospective registry of COVID-19 patients treated with ECMO.Methods: An anonymous prospective registry of COVID-19 patients treated with veno-arterial (V-A) or veno-venous (V-V) ECMO was created on march 2020. Clinical, analytical and respiratory preimplantation variables, implantation data and post-implantation course data were recorded. The primary endpoint was all cause in-hospital mortality. Secondary events were functional recovery and the combined endpoint of mortality and functional recovery in patients followed at least 3 months after discharge.Results: Three hundred and sixty-six patients from 25 hospitals were analyzed, 347 V-V ECMO and 18 V-A ECMO patients (mean age 52.7 and 49.5 years respectively). Patients with V-V ECMO were more obese, had less frequently organ damage other than respiratory failure and needed less inotropic support; Thirty three percent of V-A ECMO and 34.9% of V-A ECMO were discharged (P = NS). Hospital mortality was non-significantly different, 56.2% versus 50.9% respectively, mainly during ECMO therapy and mostly due to multiorgan failure. Other 51 patients (14%) remained admitted. Mean follow-up was 196 +/- 101.7 days (95%CI: 170.8-221.6). After logistic regression, body weight (OR 0.967, 95%CI: 0.95-0.99, P = 0.004) and ECMO implantation in the own centre (OR 0.48, 95%CI: 0.27-0.88, P = 0.018) were protective for hospital mortality. Age (OR 1.063, 95%CI: 1.005-1.12, P = 0.032), arterial hypertension (3.593, 95%CI: 1.06-12.19, P = 0.04) and global (2.44, 95%CI: 0.27-0.88, P = 0.019), digestive (OR 4,23, 95%CI: 1.27-14.07, P = 0.019) and neurological (OR 4.66, 95%CI: 1.39-15.62, P = 0.013) complications during ECMO therapy were independent predictors of primary endpoint occurrence. Only the post-discharge day at follow-up was independent predictor of both secondary endpoints occurrence.Conclusions: Hospital survival of severely ill COVID-19 patients treated with ECMO is near 50%. Age, arterial hypertension and ECMO complications are predictors of hospital mortality, and body weight and implantation in the own centre are protective. Functional recovery is only predicted by the follow-up time after discharge. A more homogeneous management of these patients is warranted for clinical results and future research optimization. (C) 2022 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.
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- 2022