Increased duration and similar outcomes of V‐V ECLS in patients with COVID‐19 ARDS compared to non‐COVID ARDS: Single center experience
Background Veno‐venous extracorporeal life support (V‐V ECLS or V‐V ECMO) has been adopted as a rescue support in severe cases of COVID‐19 ARDS. Initial reports on the use of V‐V ECLS in COVID‐19 patients reported very high mortality rates (57%–94%), but subsequent studies showed much lower rates (3...
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| Veröffentlicht in: | Artificial organs 2023-04, Vol.47 (4), p.731-739 |
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| creator | Benedetto, Maria Piccone, Giulia Baiocchi, Massimo Cerchierini, Elisa Adversi, Marco Rossi, Agostino Dell'Olio, Alessio Di Luca, Daniela Castelli, Andrea Ranieri, V. Marco Tonetti, Tommaso |
| description | Background
Veno‐venous extracorporeal life support (V‐V ECLS or V‐V ECMO) has been adopted as a rescue support in severe cases of COVID‐19 ARDS. Initial reports on the use of V‐V ECLS in COVID‐19 patients reported very high mortality rates (57%–94%), but subsequent studies showed much lower rates (30%–40%). The aim of this study is to analyze demographic features, clinical course and outcomes of COVID‐19 treated with V‐V ECLS during the Italian ‘third wave’, in which the alpha variant was prevalent in the country.
Methods
Single‐center, retrospective observational study conducted at the ECLS referral center of a teaching hospital in Italy from January 1st, 2021 and October 31st, 2021.
Results
Between January and October 2021, 18 consecutive adult patients who underwent V‐V ECLS for severe ARDS due to COVID‐19 were enrolled. Thirteen patients (72.2%) were male, and their median age was 50 years; the median P/F ratio before V‐V ECLS initiation was 43 mm Hg (IQR, 40; 56), and the median RESP score was 0.5 (IQR, −2.25; 1.0). The mortality rate at 90 days was 55.6, compared to 55.7% in non‐COVID patients in our center (p > 0.05); the median duration of ECLS was 29 days (IQR, 11; 32), compared to 10 days (IQR, 8; 15), in non‐COVID patients (p = 0.004). Incidence of complications was high.
Conclusions
In patients with COVID‐19 ARDS receiving V‐V ECLS, unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while the duration of ECLS was almost three times longer and with frequent complications. This could be partly explained by the selection of very sick patients at the baseline that evolved to multiorgan failure during the course of ECLS.
Veno‐venous extracorporeal life support (V‐V ECLS) has been adopted as a rescue treatment in severe cases of COVID‐19 ARDS.
We collected data from 18 patients, treated consecutively with V‐V ECLS for severe COVID‐19 ARDS in our center, and compared them to 26 ARDS patients treated with V‐V ECLS before the COVID‐19 pandemic.
Unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while duration of ECLS was almost three times longer and with frequent complications |
| doi_str_mv | 10.1111/aor.14463 |
| format | Article |
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Veno‐venous extracorporeal life support (V‐V ECLS or V‐V ECMO) has been adopted as a rescue support in severe cases of COVID‐19 ARDS. Initial reports on the use of V‐V ECLS in COVID‐19 patients reported very high mortality rates (57%–94%), but subsequent studies showed much lower rates (30%–40%). The aim of this study is to analyze demographic features, clinical course and outcomes of COVID‐19 treated with V‐V ECLS during the Italian ‘third wave’, in which the alpha variant was prevalent in the country.
Methods
Single‐center, retrospective observational study conducted at the ECLS referral center of a teaching hospital in Italy from January 1st, 2021 and October 31st, 2021.
Results
Between January and October 2021, 18 consecutive adult patients who underwent V‐V ECLS for severe ARDS due to COVID‐19 were enrolled. Thirteen patients (72.2%) were male, and their median age was 50 years; the median P/F ratio before V‐V ECLS initiation was 43 mm Hg (IQR, 40; 56), and the median RESP score was 0.5 (IQR, −2.25; 1.0). The mortality rate at 90 days was 55.6, compared to 55.7% in non‐COVID patients in our center (p > 0.05); the median duration of ECLS was 29 days (IQR, 11; 32), compared to 10 days (IQR, 8; 15), in non‐COVID patients (p = 0.004). Incidence of complications was high.
Conclusions
In patients with COVID‐19 ARDS receiving V‐V ECLS, unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while the duration of ECLS was almost three times longer and with frequent complications. This could be partly explained by the selection of very sick patients at the baseline that evolved to multiorgan failure during the course of ECLS.
Veno‐venous extracorporeal life support (V‐V ECLS) has been adopted as a rescue treatment in severe cases of COVID‐19 ARDS.
We collected data from 18 patients, treated consecutively with V‐V ECLS for severe COVID‐19 ARDS in our center, and compared them to 26 ARDS patients treated with V‐V ECLS before the COVID‐19 pandemic.
Unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while duration of ECLS was almost three times longer and with frequent complications</description><identifier>ISSN: 0160-564X</identifier><identifier>EISSN: 1525-1594</identifier><identifier>DOI: 10.1111/aor.14463</identifier><identifier>PMID: 36394379</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>acute respiratory distress syndrome ; Adult ; Complications ; coronavirus disease‐19 ; COVID-19 ; COVID-19 - complications ; COVID-19 - therapy ; extracorporeal life support ; Extracorporeal Membrane Oxygenation ; Female ; Humans ; Male ; Middle Aged ; Mortality ; Pandemics ; Patients ; Respiratory Distress Syndrome ; Retrospective Studies ; SARS-CoV-2</subject><ispartof>Artificial organs, 2023-04, Vol.47 (4), p.731-739</ispartof><rights>2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.</rights><rights>Copyright © 2023 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3533-5c76c8727d7192de22b06ce3e3e1f685bfd6b159462b67fd74f3cf54472978183</citedby><cites>FETCH-LOGICAL-c3533-5c76c8727d7192de22b06ce3e3e1f685bfd6b159462b67fd74f3cf54472978183</cites><orcidid>0000-0002-7357-7180 ; 0000-0001-9676-3595 ; 0000-0001-7909-6399</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faor.14463$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faor.14463$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36394379$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Benedetto, Maria</creatorcontrib><creatorcontrib>Piccone, Giulia</creatorcontrib><creatorcontrib>Baiocchi, Massimo</creatorcontrib><creatorcontrib>Cerchierini, Elisa</creatorcontrib><creatorcontrib>Adversi, Marco</creatorcontrib><creatorcontrib>Rossi, Agostino</creatorcontrib><creatorcontrib>Dell'Olio, Alessio</creatorcontrib><creatorcontrib>Di Luca, Daniela</creatorcontrib><creatorcontrib>Castelli, Andrea</creatorcontrib><creatorcontrib>Ranieri, V. Marco</creatorcontrib><creatorcontrib>Tonetti, Tommaso</creatorcontrib><title>Increased duration and similar outcomes of V‐V ECLS in patients with COVID‐19 ARDS compared to non‐COVID ARDS: Single center experience</title><title>Artificial organs</title><addtitle>Artif Organs</addtitle><description>Background
Veno‐venous extracorporeal life support (V‐V ECLS or V‐V ECMO) has been adopted as a rescue support in severe cases of COVID‐19 ARDS. Initial reports on the use of V‐V ECLS in COVID‐19 patients reported very high mortality rates (57%–94%), but subsequent studies showed much lower rates (30%–40%). The aim of this study is to analyze demographic features, clinical course and outcomes of COVID‐19 treated with V‐V ECLS during the Italian ‘third wave’, in which the alpha variant was prevalent in the country.
Methods
Single‐center, retrospective observational study conducted at the ECLS referral center of a teaching hospital in Italy from January 1st, 2021 and October 31st, 2021.
Results
Between January and October 2021, 18 consecutive adult patients who underwent V‐V ECLS for severe ARDS due to COVID‐19 were enrolled. Thirteen patients (72.2%) were male, and their median age was 50 years; the median P/F ratio before V‐V ECLS initiation was 43 mm Hg (IQR, 40; 56), and the median RESP score was 0.5 (IQR, −2.25; 1.0). The mortality rate at 90 days was 55.6, compared to 55.7% in non‐COVID patients in our center (p > 0.05); the median duration of ECLS was 29 days (IQR, 11; 32), compared to 10 days (IQR, 8; 15), in non‐COVID patients (p = 0.004). Incidence of complications was high.
Conclusions
In patients with COVID‐19 ARDS receiving V‐V ECLS, unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while the duration of ECLS was almost three times longer and with frequent complications. This could be partly explained by the selection of very sick patients at the baseline that evolved to multiorgan failure during the course of ECLS.
Veno‐venous extracorporeal life support (V‐V ECLS) has been adopted as a rescue treatment in severe cases of COVID‐19 ARDS.
We collected data from 18 patients, treated consecutively with V‐V ECLS for severe COVID‐19 ARDS in our center, and compared them to 26 ARDS patients treated with V‐V ECLS before the COVID‐19 pandemic.
Unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while duration of ECLS was almost three times longer and with frequent complications</description><subject>acute respiratory distress syndrome</subject><subject>Adult</subject><subject>Complications</subject><subject>coronavirus disease‐19</subject><subject>COVID-19</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - therapy</subject><subject>extracorporeal life support</subject><subject>Extracorporeal Membrane Oxygenation</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Respiratory Distress Syndrome</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><issn>0160-564X</issn><issn>1525-1594</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctq3DAUhkVoSSaXRV6gCLppFk4k6zbubpik7cDAQCYdujOyfNwq2JIr2STZ5QUKfcY-STUzaReFSgst_u98HPQjdE7JJU3nSvtwSTmX7ABNqMhFRkXBX6EJoZJkQvIvR-g4xntCiOJEHqIjJlnBmSom6MfCmQA6Qo3rMejBeoe1q3G0nW11wH4cjO8gYt_gza_nnxt8M1-usXW4TzC4IeIHO3zD89VmcZ1yWuDZ7fUap6Feh2QdPHbepWRH7ML3eG3d1xawSfMQMDz2EJLLwCl63eg2wtnLe4I-f7i5m3_KlquPi_lsmRkmGMuEUdJMVa5qRYu8hjyviDTA0qWNnIqqqWW1_QOZV1I1teINM43gXOWFmtIpO0Hv9t4--O8jxKHsbDTQttqBH2OZK6a4oqzYom__Qe_9GFzaLlEFVUIxShN1sadM8DEGaMo-2E6Hp5KScttRmToqdx0l9s2Lcaw6qP-Sf0pJwNUeeLAtPP3fVM5Wt3vlbyo6m24</recordid><startdate>202304</startdate><enddate>202304</enddate><creator>Benedetto, Maria</creator><creator>Piccone, Giulia</creator><creator>Baiocchi, Massimo</creator><creator>Cerchierini, Elisa</creator><creator>Adversi, Marco</creator><creator>Rossi, Agostino</creator><creator>Dell'Olio, Alessio</creator><creator>Di Luca, Daniela</creator><creator>Castelli, Andrea</creator><creator>Ranieri, V. Marco</creator><creator>Tonetti, Tommaso</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7357-7180</orcidid><orcidid>https://orcid.org/0000-0001-9676-3595</orcidid><orcidid>https://orcid.org/0000-0001-7909-6399</orcidid></search><sort><creationdate>202304</creationdate><title>Increased duration and similar outcomes of V‐V ECLS in patients with COVID‐19 ARDS compared to non‐COVID ARDS: Single center experience</title><author>Benedetto, Maria ; Piccone, Giulia ; Baiocchi, Massimo ; Cerchierini, Elisa ; Adversi, Marco ; Rossi, Agostino ; Dell'Olio, Alessio ; Di Luca, Daniela ; Castelli, Andrea ; Ranieri, V. Marco ; Tonetti, Tommaso</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3533-5c76c8727d7192de22b06ce3e3e1f685bfd6b159462b67fd74f3cf54472978183</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>acute respiratory distress syndrome</topic><topic>Adult</topic><topic>Complications</topic><topic>coronavirus disease‐19</topic><topic>COVID-19</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - therapy</topic><topic>extracorporeal life support</topic><topic>Extracorporeal Membrane Oxygenation</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Respiratory Distress Syndrome</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Benedetto, Maria</creatorcontrib><creatorcontrib>Piccone, Giulia</creatorcontrib><creatorcontrib>Baiocchi, Massimo</creatorcontrib><creatorcontrib>Cerchierini, Elisa</creatorcontrib><creatorcontrib>Adversi, Marco</creatorcontrib><creatorcontrib>Rossi, Agostino</creatorcontrib><creatorcontrib>Dell'Olio, Alessio</creatorcontrib><creatorcontrib>Di Luca, Daniela</creatorcontrib><creatorcontrib>Castelli, Andrea</creatorcontrib><creatorcontrib>Ranieri, V. Marco</creatorcontrib><creatorcontrib>Tonetti, Tommaso</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Benedetto, Maria</au><au>Piccone, Giulia</au><au>Baiocchi, Massimo</au><au>Cerchierini, Elisa</au><au>Adversi, Marco</au><au>Rossi, Agostino</au><au>Dell'Olio, Alessio</au><au>Di Luca, Daniela</au><au>Castelli, Andrea</au><au>Ranieri, V. Marco</au><au>Tonetti, Tommaso</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased duration and similar outcomes of V‐V ECLS in patients with COVID‐19 ARDS compared to non‐COVID ARDS: Single center experience</atitle><jtitle>Artificial organs</jtitle><addtitle>Artif Organs</addtitle><date>2023-04</date><risdate>2023</risdate><volume>47</volume><issue>4</issue><spage>731</spage><epage>739</epage><pages>731-739</pages><issn>0160-564X</issn><eissn>1525-1594</eissn><abstract>Background
Veno‐venous extracorporeal life support (V‐V ECLS or V‐V ECMO) has been adopted as a rescue support in severe cases of COVID‐19 ARDS. Initial reports on the use of V‐V ECLS in COVID‐19 patients reported very high mortality rates (57%–94%), but subsequent studies showed much lower rates (30%–40%). The aim of this study is to analyze demographic features, clinical course and outcomes of COVID‐19 treated with V‐V ECLS during the Italian ‘third wave’, in which the alpha variant was prevalent in the country.
Methods
Single‐center, retrospective observational study conducted at the ECLS referral center of a teaching hospital in Italy from January 1st, 2021 and October 31st, 2021.
Results
Between January and October 2021, 18 consecutive adult patients who underwent V‐V ECLS for severe ARDS due to COVID‐19 were enrolled. Thirteen patients (72.2%) were male, and their median age was 50 years; the median P/F ratio before V‐V ECLS initiation was 43 mm Hg (IQR, 40; 56), and the median RESP score was 0.5 (IQR, −2.25; 1.0). The mortality rate at 90 days was 55.6, compared to 55.7% in non‐COVID patients in our center (p > 0.05); the median duration of ECLS was 29 days (IQR, 11; 32), compared to 10 days (IQR, 8; 15), in non‐COVID patients (p = 0.004). Incidence of complications was high.
Conclusions
In patients with COVID‐19 ARDS receiving V‐V ECLS, unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while the duration of ECLS was almost three times longer and with frequent complications. This could be partly explained by the selection of very sick patients at the baseline that evolved to multiorgan failure during the course of ECLS.
Veno‐venous extracorporeal life support (V‐V ECLS) has been adopted as a rescue treatment in severe cases of COVID‐19 ARDS.
We collected data from 18 patients, treated consecutively with V‐V ECLS for severe COVID‐19 ARDS in our center, and compared them to 26 ARDS patients treated with V‐V ECLS before the COVID‐19 pandemic.
Unadjusted mortality was similar to pre‐pandemic V‐V ECLS cases, while duration of ECLS was almost three times longer and with frequent complications</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36394379</pmid><doi>10.1111/aor.14463</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7357-7180</orcidid><orcidid>https://orcid.org/0000-0001-9676-3595</orcidid><orcidid>https://orcid.org/0000-0001-7909-6399</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | Artificial organs, 2023-04, Vol.47 (4), p.731-739 |
| issn | 0160-564X 1525-1594 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2737471398 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | acute respiratory distress syndrome Adult Complications coronavirus disease‐19 COVID-19 COVID-19 - complications COVID-19 - therapy extracorporeal life support Extracorporeal Membrane Oxygenation Female Humans Male Middle Aged Mortality Pandemics Patients Respiratory Distress Syndrome Retrospective Studies SARS-CoV-2 |
| title | Increased duration and similar outcomes of V‐V ECLS in patients with COVID‐19 ARDS compared to non‐COVID ARDS: Single center experience |
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