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Marullo AG, Cavarretta E, Biondi Zoccai G, Mancone M, Peruzzi M, Piscioneri F, Sartini P, Versaci F, Morelli A, Miraldi F, Frati G. Extracorporeal membrane oxygenation for critically ill patients with coronavirus-associated disease 2019: an updated perspective of the European experience. Minerva Cardioangiol 2020; 68:368-372. [PMID: 32336080 DOI: 10.23736/s0026-4725.20.05328-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Infection 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. METHODS Freely 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. RESULTS Details 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). CONCLUSIONS ECMO 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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Affiliation(s)
- Antonino G Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy - .,Mediterranea Cardiocentro, Naples, Italy
| | - Massimo Mancone
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Latina, Italy
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Fernando Piscioneri
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Latina, Italy
| | - Patrizio Sartini
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Latina, Italy
| | | | - Andrea Morelli
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Latina, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University, Latina, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy.,IRCCS NEUROMED, Pozzilli, Isernia, Italy
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