1. Veno-Arterial Extracorporeal Membrane Oxygenation for Circulatory Failure in COVID-19 Patients: Insights from the ECMOSARS Registry
- Author
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Anselmi, Amedeo, Mansour, Alexandre, Para, Marylou, Mongardon, Nicolas, Porto, Alizée, Guihaire, Julien, Morgant, Marie-Catherine, Pozzi, Matteo, Cholley, Bernard, Falcoz, Pierre-Emmanuel, Gaudard, Philippe, Lebreton, Guillaume, Labaste, François, Barbanti, Claudio, Fouquet, Olivier, Chocron, Sidney, Mottard, Nicolas, Esvan, Maxime, Fougerou-Leurent, Claire, Flecher, Erwan, Vincentelli, André, Nesseler, Nicolas, Pierrot, Marc, Flicoteaux, Guillaume, Mauriat, Philippe, Ouattara, Alexandre, Roze, Hadrien, Huet, Olivier, Fischer, Marc-Olivier, Alessandri, Claire, Bellaïche, Raphel, Constant, Ophélie, Roux, Quentin, Ly, André, Meffert, Arnaud, Merle, Jean-Claude, Picard, Lucile, Skripkina, Elena, Folliguet, Thierry, Fiore, Antonio, d'Ostrevy, Nicolas, Morgan, Marie-Catherine, Guinot, Pierre-Grégoire, Nguyen, Maxime, Gaide-Chevronnay, Lucie, Terzi, Nicolas, Colin, Gwenhaël, Fabre, Olivier, Astaneh, Arash, Issard, Justin, Fadel, Elie, Fabre, Dominique, Girault, Antoine, Ion, Iolande, Menager, Jean Baptiste, Mitilian, Delphine, Mercier, Olaf, Stephan, François, Thes, Jacques, Jouan, Jerôme, Duburcq, Thibault, Loobuyck, Valentin, Moussa, Mouhammed, Mugnier, Agnes, Rousse, Natacha, Manganiello, Sabrina, Desebbe, Olivier, Fellahi, Jean-Luc, Henaine, Roland, Richard, Jean-Christophe, Riad, Zakaria, Guervilly, Christophe, Hraiech, Sami, Papazian, Laurent, Castanier, Matthias, Chanavaz, Charles, Cadoz, Cyril, Gette, Sebastien, Louis, Guillaume, Portocarrero, Erick, Brini, Kais, Bischoff, Nicolas, Levy, Bruno, Kimmoun, Antoine, Mattei, Mathieu, Perez, Pierre, Bourdiol, Alexandre, Hourmant, Yannick, Mahé, Pierre-Joachim, Rozec, Bertrand, Vourc’h, Mickaël, Aubert, Stéphane, Bazalgette, Florian, Roger, Claire, Jaquet, Pierre, Lortat-Jacob, Brice, Mordant, Pierre, Nataf, Patrick, Patrier, Juliette, Provenchere, Sophie, Roué, Morgan, Sonneville, Romain, Tran-Dinh, Alexy, Wicky, Paul-Henri, Al Zreibi, Charles, Guyonvarch, Yannis, Hamada, Sophie, Bertier, Astrid, Harrois, Anatole, Matiello, Jordi, Kerforne, Thomas, Lacroix, Corentin, Brechot, Nicolas, Combes, Alain, Schmidt, Matthieu, Chommeloux, Juliette, Constantin, Jean Michel, D’alessandro, Cosimo, Demondion, Pierre, Demoule, Alexandre, Dres, Martin, Fadel, Guillaume, Fartoukh, Muriel, Hekimian, Guillaume, Juvin, Charles, Leprince, Pascal, Levy, David, Luyt, Charles Edouard, Pineton de Chambrun, Marc, Schoell, Thibaut, Fillâtre, Pierre, Massart, Nicolas, Nicolas, Roxane, Jonas, Maud, Vidal, Charles, Allou, Nicolas, Muccio, Salvatore, Di Perna, Dario, Ruggieri, Vito-Giovanni, Mourvillier, Bruno, Bounader, Karl, Launey, Yoann, Lebouvier, Thomas, Parasido, Alessandro, Reizine, Florian, Seguin, Philippe, Besnier, Emmanuel, Carpentier, Dorothée, Clavier, Thomas, Olland, Anne, Villard, Marion, Bounes, Fanny, Minville, Vincent, Guillon, Antoine, Fedun, Yannick, Ross, James, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), IMRB - PROTECT/'Pharmacologie et Technologies pour les Maladies Cardiovasculaires' [Créteil] (U955 Inserm - UPEC), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Pôle des Cardiopathies Congénitales du Nouveau-Né à L'adulte - Centre Constitutif Cardiopathies Congénitales Complexes M3C, Groupe Hospitalier Paris Saint-Joseph, Hôpital Marie-Lannelongue, Inserm U999, Université Paris-Saclay, Research on Healthcare Performance (RESHAPE - Inserm U1290 - UCBL1), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM), Innovations thérapeutiques en hémostase = Innovative Therapies in Haemostasis (IThEM - U1140), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Franco-czech Laboratory for clinical research on obesity, Charles University [Prague] (CU)-Institut National de la Santé et de la Recherche Médicale (INSERM), MitoVasc - Physiopathologie Cardiovasculaire et Mitochondriale (MITOVASC), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Nutrition, Métabolismes et Cancer (NuMeCan), and Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
- Subjects
Heart Failure ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,VA-ECMO ,[SDV.IB]Life Sciences [q-bio]/Bioengineering ,Outcomes ,Covid-19 - Abstract
International audience; Objectives: The clinical profile and outcomes of patients with Covid-19 who require veno-arterial or veno-venous-arterial extracorporeal membrane oxygenation (VA-ECMO - VAV-ECMO) are poorly understood. We aimed to describe the characteristics and outcomes of these patients and to identify predictors of both favorable and unfavorable outcomes.Methods: ECMOSARS is a multicenter, prospective, nationwide French registry enrolling patients who require VV/VA-ECMO in the context of Covid-19 infection (652 patients at 41 centers). We focused on 47 patients supported with VA- or VAV-ECMO for refractory cardiogenic shock.Results: Median age was 49. 14% of patients had a prior diagnosis of heart failure. The most common etiologies of cardiogenic shock were acute pulmonary embolism (30%), myocarditis (28%), and acute coronary syndrome (4%). E-CPR (Extracorporeal Cardiopulmonary Resuscitation) occurred in 38%. In-hospital survival was 28% in the whole cohort, and 43% when E-CPR patients were excluded. ECMO cannulation was associated with significant improvements in pH and FiO2 on day one, but non-survivors showed significantly more severe acidosis and higher FiO2 than survivors at this point (p = 0.030 and p = 0.006). Other factors associated with death were greater age (p = 0.02), higher BMI (p = 0.03), E-CPR (p = 0.001), non-myocarditis etiology (p = 0.02), higher serum lactates (p = 0.004), epinephrine (but not noradrenaline) use before initiation of ECMO (p = 0.003), hemorrhagic complications (p = 0.001), greater transfusion requirements (p = 0.001), and more severe SAVE and SAFE scores (p = 0.01 and p = 0.03).Conclusions: We report the largest focused analysis of VA- and VAV-ECMO recipients in Covid-19. Although relatively rare, the need for temporary mechanical circulatory support in these patients is associated with poor prognosis. However, VA-ECMO remains a viable solution to rescue carefully selected patients. We identified factors associated with poor prognosis and suggest that E-CPR is not a reasonable indication for VA-ECMO in this population.
- Published
- 2023