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Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic

PURPOSE: Since the beginning of the current pandemic in late 2019, three accumulations of severe COVID-19 infections (so-called infective waves) caused a fulminant increase in hospitalization. In therapy-refractory patients, veno-venous extracorporeal membrane oxygenation (vv-ECMO) was used since th...

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Autores principales: Immohr, M.B., Hettlich, V., Aubin, H., Dalyanoglu, H., Kindgen-Milles, D., Tudorache, I., Akhyari, P., Lichtenberg, A., Boeken, U.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Published by Elsevier Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988617/
http://dx.doi.org/10.1016/j.healun.2022.01.1327
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author Immohr, M.B.
Hettlich, V.
Aubin, H.
Dalyanoglu, H.
Kindgen-Milles, D.
Tudorache, I.
Akhyari, P.
Lichtenberg, A.
Boeken, U.
author_facet Immohr, M.B.
Hettlich, V.
Aubin, H.
Dalyanoglu, H.
Kindgen-Milles, D.
Tudorache, I.
Akhyari, P.
Lichtenberg, A.
Boeken, U.
author_sort Immohr, M.B.
collection PubMed
description PURPOSE: Since the beginning of the current pandemic in late 2019, three accumulations of severe COVID-19 infections (so-called infective waves) caused a fulminant increase in hospitalization. In therapy-refractory patients, veno-venous extracorporeal membrane oxygenation (vv-ECMO) was used since the early beginning. However, potential developments in vv-EMCO therapy still need to be proven. METHODS: Between 2020 and 2021 a total of n=60 patients were treated with vv-ECMO for severe COVID-19 related acute respiratory distress syndrome in our department. The patients were prospectively enrolled into an institutional database, followed-up and subsequent retrospectively reviewed. Patients were divided concerning the date of vv-ECMO onset into three groups (03/2020-09/2020: 1. wave, n=11; 10/2020-02/2021: 2. wave, n=23; 03/2021-08/2021: 3. wave, n=26). RESULTS: From the first to the third wave, patients seemed to be younger, more likely to be female as well as more likely obese. While patients of the first wave regularly developed acute kidney failure (81.3 %), these adverse event was seldom in the second (21.7) and third wave (15.4 5)(p=0.01). In contrast to that, other device-related complications such as stroke, bleeding or visceral ischemia did not differ between the three waves. Most apparent changes during the pandemic were prolonged ECMO support duration (1. wave: 8.5 ± 2.1, 2. wave: 54.0 ± 122.7, 3. wave: 28.0 ± 18.6), ECMO weaning rate (1. wave: 18.2 %, 2. wave: 39.1, 3. wave: 44.0 %) and in-hospital mortality (1. wave: 81.8 %, 2. wave: 69.6, 3. wave: 56.0 %), although none of these effects reached statistical significance. CONCLUSION: Although our data cover only a small study population, we observed clear trends towards younger and heavier patients during the pandemic. Most likely, due to a learning effect, support duration of ECMO patients distinctly increased during the pandemic. Subsequently, weaning and survival also increased. However, differences in patient selection could act as a major confounder for these results.
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spelling pubmed-89886172022-04-11 Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic Immohr, M.B. Hettlich, V. Aubin, H. Dalyanoglu, H. Kindgen-Milles, D. Tudorache, I. Akhyari, P. Lichtenberg, A. Boeken, U. J Heart Lung Transplant (1306) PURPOSE: Since the beginning of the current pandemic in late 2019, three accumulations of severe COVID-19 infections (so-called infective waves) caused a fulminant increase in hospitalization. In therapy-refractory patients, veno-venous extracorporeal membrane oxygenation (vv-ECMO) was used since the early beginning. However, potential developments in vv-EMCO therapy still need to be proven. METHODS: Between 2020 and 2021 a total of n=60 patients were treated with vv-ECMO for severe COVID-19 related acute respiratory distress syndrome in our department. The patients were prospectively enrolled into an institutional database, followed-up and subsequent retrospectively reviewed. Patients were divided concerning the date of vv-ECMO onset into three groups (03/2020-09/2020: 1. wave, n=11; 10/2020-02/2021: 2. wave, n=23; 03/2021-08/2021: 3. wave, n=26). RESULTS: From the first to the third wave, patients seemed to be younger, more likely to be female as well as more likely obese. While patients of the first wave regularly developed acute kidney failure (81.3 %), these adverse event was seldom in the second (21.7) and third wave (15.4 5)(p=0.01). In contrast to that, other device-related complications such as stroke, bleeding or visceral ischemia did not differ between the three waves. Most apparent changes during the pandemic were prolonged ECMO support duration (1. wave: 8.5 ± 2.1, 2. wave: 54.0 ± 122.7, 3. wave: 28.0 ± 18.6), ECMO weaning rate (1. wave: 18.2 %, 2. wave: 39.1, 3. wave: 44.0 %) and in-hospital mortality (1. wave: 81.8 %, 2. wave: 69.6, 3. wave: 56.0 %), although none of these effects reached statistical significance. CONCLUSION: Although our data cover only a small study population, we observed clear trends towards younger and heavier patients during the pandemic. Most likely, due to a learning effect, support duration of ECMO patients distinctly increased during the pandemic. Subsequently, weaning and survival also increased. However, differences in patient selection could act as a major confounder for these results. Published by Elsevier Inc. 2022-04 2022-04-07 /pmc/articles/PMC8988617/ http://dx.doi.org/10.1016/j.healun.2022.01.1327 Text en Copyright © 2022 Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle (1306)
Immohr, M.B.
Hettlich, V.
Aubin, H.
Dalyanoglu, H.
Kindgen-Milles, D.
Tudorache, I.
Akhyari, P.
Lichtenberg, A.
Boeken, U.
Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic
title Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic
title_full Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic
title_fullStr Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic
title_full_unstemmed Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic
title_short Changes in Therapy Outcome of Veno-Venous Extracorporeal Membrane Oxygenation for Therapy-Refractory COVID-19 Infections Throughout the Pandemic
title_sort changes in therapy outcome of veno-venous extracorporeal membrane oxygenation for therapy-refractory covid-19 infections throughout the pandemic
topic (1306)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988617/
http://dx.doi.org/10.1016/j.healun.2022.01.1327
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