Complete countrywide mortality in COVID patients receiving ECMO in Germany throughout the first three waves of the pandemic

Extracorporeal membrane-oxygenation (ECMO) has been widely used for COVID-19-related acute respiratory distress syndrome (ARDS), with a mortality rate of 37.1% based on the largest published series [1]. This rate is comparable to ECMO-supported patients with non-COVID-19-related ARDS [1]. However, some reports suggest that the real-life mortality is higher than that reported above [2], including a cohort of 768 COVID-19 patients in Germany with an in-hospital mortality rate of 73% [3], and a surprising finding is given that health care resources in Germany were not notably under strain during the pandemic. To better characterize this discrepancy, we evaluated in-hospital mortality for all COVID-19 patients in Germany supported with venovenous ECMO (VV-ECMO).