Extracorporeal Membrane Oxygenation for Patients with Severe COVID-19-Related ARDS: A European Multicenter Analysis

Objectives: With the occurrence of the COVID-19 pandemic in the year of 2020 the number of patients in need ofintensive care medicine increased dramatically in many countries. Several of them developed an acute respiratory distresssyndrome (ARDS) linked to the COVID-19 infection and many required the use of extracorporeal membrane oxygenation(ECMO). Methods: We are retrospectively reviewing 141 patients who underwent ECMO for severe COVID-19-related ARDS in amulticenter study at 10 European ECMO centers. Result: A total of 141 patients (67.4% male, median age was 55.4 years (interquartile range [IQR]: 44-67.5) were treatedwith ECMO for confirmed (132) or suspected (9) severe COVID-19-related ARDS. Before ECMO, the median SequentialOrgan Failure Assessment (SOFA) score was 9.0 (IQR: 7.0-11.5), median pH was 7.25 (IQR: 7.20-7.30), and medianPaO /FiO ratio was 70 mm Hg (IQR: 60-77). Venovenous ECMO was provided in 130 patients (92%) and venoarterial ECMO in 11 patients (8%) The median duration ofECMO treatment by now was 11 days, IQR: 7-17). At the time of reporting, 71 confirmed COVID-19 patients (53.8%) arealive, of whom 33 (43.4%) are still in the intensive care unit (9 on ECMO, 24 weaned from ECMO and extubated). Overallmortality so far occurred in 62 patients (46.2%). By now advanced age, low arterial pH, and low platelet count before ECMO were independent risk factors for increasedmortality during the intensive care treatment. Conclusion: Despite a substantial overall mortality of over 40%, approximately half of the patients with severe COVID-19-related ARDS, refractory to conventional treatment, may be successfully managed with ECMO therapy.