Survival and Long-Term Functional Status of COVID-19 Patients Requiring Prolonged Extracorporeal Membrane Oxygenation Support
Martínez-Martínez, María (Universitat Autònoma de Barcelona. Departament de Medicina)
Schmidt, Matthieu (Sorbonne Université)
Broman, Lars Mikael (Karolinska Institutet (Estocolm, Suècia). Department of Physiology and Pharmacology)
Roncon-Albuquerque, Roberto (São João Universitary Hospital Center (Porto, Portugal))
Langouet, Elise (Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France)
Campos, Isabel (São João Universitary Hospital Center (Porto, Portugal))
Argudo, Eduard (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Vila Carabasa, Josep Maria (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Sastre, Sara Martín (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Gallart, Elisabet (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ferrer, Ricard (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Combes, Alain (Sorbonne Université)
Riera, Jordi (Hospital Universitari Vall d'Hebron)

Date:	2024
Abstract:	Severe cases of acute respiratory distress syndrome (ARDS) may require prolonged (>28 d) extracorporeal membrane oxygenation (ECMO). In nonresolving disease, recovery is uncertain, and lung transplant may be proposed. This study aims to identify the variables influencing survival and to describe the functional status of these patients at 6 months. This was a retrospective, multicenter, observational cohort study including patients requiring ECMO support for coronavirus disease (COVID-19)-related ARDS for >28 days. Multivariate analysis was performed using Cox regression in preselected variables and in least absolute shrinkage and selection operator selected variables. In a post hoc analysis to account for confounders and differences in awake strategy use by centers, treatment effects of the awake strategy were estimated using an augmented inverse probability weighting estimator with robust standard errors clustered by center. Between March 15, 2020 and March 15, 2021, 120 patients required ECMO for >28 days. Sixty-four patients (53. 3%) survived decannulation, 62 (51. 7%) were alive at hospital discharge, and 61 (50. 8%) were alive at 6-month follow-up. In the multivariate analysis, age (1. 09; 95% confidence interval [CI], 1. 03-1. 15; P = 0. 002) and an awake ECMO strategy (defined as the patient being awake, cooperative, and performing rehabilitation and physiotherapy with or without invasive mechanical ventilation at any time during the extracorporeal support) (0. 14; 95% CI, 0. 03-0. 47; P = 0. 003) were found to be predictors of hospital survival. At 6 months, 51 (42. 5%) patients were at home, 42 (84. 3%) of them without oxygen therapy. A cutoff point of 47 ECMO days had a 100% (95% CI, 76. 8-100%) sensitivity and 60% (95% CI, 44. 3-73. 6%) specificity for oxygen therapy at 6 months, with 100% specificity being found in 97 days. Patients with COVID-19 who require ECMO for >28 days can survive with nonlimiting lung impairment. Age and an awake ECMO strategy may be associated with survival. Longer duration of support correlates with need for oxygen therapy at 6 months.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute respiratory distress syndrome ; Respiratory failure ; Awake ; Lung transplantation
Published in:	Annals of the American Thoracic Society, Vol. 21 (march 2024) , p. 449-455, ISSN 2325-6621

DOI: 10.1513/AnnalsATS.202306-572OC
PMID: 38134435

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