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Journal Articles Artificial Organs Year : 2021

Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey

Sebastian Mang , Armin Kalenka , Lars Mikael Broman , Alexander Supady , Justyna Swol , Guy Danziger , André Becker , Sabrina Hörsch , Thilo Mertke , Ralf Kaiser , Hendrik Bracht , Viviane Zotzmann , Frederik Seiler , Robert Bals , Fabio Silvio Taccone , Onnen Moerer , Roberto Lorusso , Jan Bělohlávek , Ralf Muellenbach , Philipp Lepper , Nicholas Barrett , Daniel Duerschmied , Eddy Fan , Falk Fichtner , Hendrik Haake , Frank Langer , Haitham Mutlak , Markus Kredel , Thomas Müller , Alessandro Protti , Alexander Raddatz , Tobias Spangenberg , Dawid Staudacher , Holger Wehrfritz , Tobias Wengenmayer , Arne Westheider , Simon Dang Van , Cedric Daubin , Philippe Gaudard (1, 2) , Thomas Godet , Pierre‐grégoire Guinot , Loïc Le Guennec , Bruno Megarbane (3, 4) , Alain Mercat , Romain Sonneville , Elie Zogheib , Tai Pham , Hadrien Winiszewski , Peter Schellongowski , Thomas Staudinger , Dominik Wiedemann , Corinna Velik‐salchner , Michael Joannidis , Marc Bodenstein , Heinrich Volker Groesdonk , Stefan Guth , Matthias Hecker , Faeq Husain‐syed , Christian Jung , L. Christian Napp , Ruslan Natanov , Georg Trummer , Sascha Treskatsch , Henryk Welp , Leonello Avalli , Lorenzo Ball , Mirko Belliato , Manuela Bonizzoli , Emma Borrelli , Giacomo Cavallaro , Andrea Franci , Silvia Gramaticopolo , Mauro Panigada , Luigi Tritapepe , Salman Abdulaziz , David Bracco , Yiorgos Alexandros , Ari Joffe , A. Dave Nagpal , Ying Sia , Georg Auzinger , Vasileios Zochios , Alejandro Garcia , Katja Gist , Dana Lustbader , Demetris Yannopoulos , R. Scott Stephens , Joseph Tonna , Linda Paxton , Hitoshi Hirose , Bo Kim , Magnus Dalén , Martin Balik , David Janak , Luis Castillo , Alejandro Bruhn , Jorge Luis Alvarado Socarras , Taeyun Kim , Hyoung Soo Kim , Joung Hun Byun , Guilherme Mainardi , Pedro Mendes , Raphaël Giraud , Philip Fortuna , Tatsuma Fukuda , Jacinta Maas , Dariusz Maciejewski , Deblal Pandit , Yosv Psz , Peter Radsel , Gangfeng Yan
Sebastian Mang
  • Function : Author
Armin Kalenka
  • Function : Author
Lars Mikael Broman
  • Function : Author
Alexander Supady
Justyna Swol
  • Function : Author
Guy Danziger
  • Function : Author
André Becker
  • Function : Author
Sabrina Hörsch
  • Function : Author
Thilo Mertke
  • Function : Author
Ralf Kaiser
  • Function : Author
Hendrik Bracht
  • Function : Author
Viviane Zotzmann
  • Function : Author
Frederik Seiler
  • Function : Author
Robert Bals
  • Function : Author
Fabio Silvio Taccone
  • Function : Author
Onnen Moerer
  • Function : Author
Roberto Lorusso
  • Function : Author
Jan Bělohlávek
  • Function : Author
Ralf Muellenbach
  • Function : Author
Philipp Lepper
  • Function : Author
Nicholas Barrett
  • Function : Author
Daniel Duerschmied
  • Function : Author
Eddy Fan
  • Function : Author
Falk Fichtner
  • Function : Author
Hendrik Haake
  • Function : Author
Frank Langer
  • Function : Author
Haitham Mutlak
  • Function : Author
Markus Kredel
  • Function : Author
Thomas Müller
  • Function : Author
Alessandro Protti
  • Function : Author
Alexander Raddatz
  • Function : Author
Tobias Spangenberg
  • Function : Author
Dawid Staudacher
  • Function : Author
Holger Wehrfritz
  • Function : Author
Tobias Wengenmayer
  • Function : Author
Arne Westheider
  • Function : Author
Simon Dang Van
  • Function : Author
Cedric Daubin
  • Function : Author
Thomas Godet
Pierre‐grégoire Guinot
  • Function : Author
Loïc Le Guennec
  • Function : Author
Alain Mercat
  • Function : Author
Romain Sonneville
Elie Zogheib
Tai Pham
  • Function : Author
Hadrien Winiszewski
  • Function : Author
Peter Schellongowski
  • Function : Author
Thomas Staudinger
  • Function : Author
Dominik Wiedemann
  • Function : Author
Corinna Velik‐salchner
  • Function : Author
Michael Joannidis
  • Function : Author
Marc Bodenstein
  • Function : Author
Heinrich Volker Groesdonk
  • Function : Author
Stefan Guth
  • Function : Author
Matthias Hecker
  • Function : Author
Faeq Husain‐syed
  • Function : Author
Christian Jung
L. Christian Napp
Ruslan Natanov
Georg Trummer
  • Function : Author
Sascha Treskatsch
  • Function : Author
Henryk Welp
  • Function : Author
Leonello Avalli
  • Function : Author
Lorenzo Ball
  • Function : Author
Mirko Belliato
  • Function : Author
Manuela Bonizzoli
  • Function : Author
Emma Borrelli
  • Function : Author
Giacomo Cavallaro
  • Function : Author
Andrea Franci
  • Function : Author
Silvia Gramaticopolo
  • Function : Author
Mauro Panigada
  • Function : Author
Luigi Tritapepe
  • Function : Author
Salman Abdulaziz
  • Function : Author
David Bracco
  • Function : Author
Yiorgos Alexandros
  • Function : Author
Ari Joffe
  • Function : Author
A. Dave Nagpal
  • Function : Author
Ying Sia
  • Function : Author
Georg Auzinger
  • Function : Author
Vasileios Zochios
  • Function : Author
Alejandro Garcia
  • Function : Author
Katja Gist
  • Function : Author
Dana Lustbader
  • Function : Author
Demetris Yannopoulos
  • Function : Author
R. Scott Stephens
  • Function : Author
Joseph Tonna
  • Function : Author
Linda Paxton
  • Function : Author
Hitoshi Hirose
  • Function : Author
Bo Kim
  • Function : Author
Magnus Dalén
  • Function : Author
Martin Balik
  • Function : Author
David Janak
  • Function : Author
Luis Castillo
  • Function : Author
Alejandro Bruhn
Jorge Luis Alvarado Socarras
  • Function : Author
Taeyun Kim
  • Function : Author
Hyoung Soo Kim
  • Function : Author
Joung Hun Byun
  • Function : Author
Guilherme Mainardi
  • Function : Author
Pedro Mendes
Raphaël Giraud
  • Function : Author
Philip Fortuna
  • Function : Author
Tatsuma Fukuda
  • Function : Author
Jacinta Maas
  • Function : Author
Dariusz Maciejewski
  • Function : Author
Deblal Pandit
  • Function : Author
Yosv Psz
  • Function : Author
Peter Radsel
  • Function : Author
Gangfeng Yan
  • Function : Author

Abstract

Extracorporeal life support (ECLS) is a means to support patients with acute respiratory failure. Initially, recommendations to treat severe cases of pandemic coronavirus disease 2019 (COVID-19) with ECLS have been restrained. In the meantime, ECLS has been shown to produce similar outcomes in patients with severe COVID-19 compared to existing data on ARDS mortality. We performed an international email survey to assess how ECLS providers worldwide have previously used ECLS during the treatment of critically ill patients with COVID-19. A questionnaire with 45 questions (covering, e.g., indication, technical aspects, benefit, and reasons for treatment discontinuation), mostly multiple choice, was distributed by email to ECLS centers. The survey was approved by the European branch of the Extracorporeal Life Support Organization (ELSO); 276 ECMO professionals from 98 centers in 30 different countries on four continents reported that they employed ECMO for very severe COVID-19 cases, mostly in veno-venous configuration (87%). The most common reason to establish ECLS was isolated hypoxemic respiratory failure (50%), followed by a combination of hypoxemia and hypercapnia (39%). Only a small fraction of patients required veno-arterial cannulation due to heart failure (3%). Time on ECLS varied between less than 2 and more than 4 weeks. The main reason to discontinue ECLS treatment prior to patient's recovery was lack of clinical improvement (53%), followed by major bleeding, mostly intracranially (13%). Only 4% of respondents reported that triage situations, lack of staff or lack of oxygenators, were responsible for discontinuation of ECLS support. Most ECLS physicians (51%, IQR 30%) agreed that patients with COVID-19-induced ARDS (CARDS) benefitted from ECLS. Overall mortality of COVID-19 patients on ECLS was estimated to be about 55%. ECLS has been utilized successfully during the COVID-19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID-19 benefitted from ECLS.
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Dates and versions

hal-03211954 , version 1 (29-04-2021)

Identifiers

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Sebastian Mang, Armin Kalenka, Lars Mikael Broman, Alexander Supady, Justyna Swol, et al.. Extracorporeal life support in COVID‐19‐related acute respiratory distress syndrome: A EuroELSO international survey. Artificial Organs, 2021, 45 (5), pp.495-505. ⟨10.1111/aor.13940⟩. ⟨hal-03211954⟩
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