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Table 2 Characteristics and complications during ECMO according to ICU admission before or after July 1, 2020

From: Evolving outcomes of extracorporeal membrane oxygenation support for severe COVID-19 ARDS in Sorbonne hospitals, Paris

Characteristic

All (N = 159)

ICU admission

p

Before July 1 (n = 88)

After July 1 (n = 71)

ECMO-day 1

    

Type of ECMO support

   

0.846

 Femoral–jugular VV

150 (94)

81 (92)

69 (97)

 

 Femoral–femoral VV

4 (3)

3 (3)

1 (1)

 

Ventilation mode

   

 < 0.001

 APRV/bilevel

144 (91)

75 (85)

69 (97)

 

 Volume-assist control ventilation

13 (8)

13 (15)

0 (0)

 

 High-flow oxygen

2 (1)

0 (0)

2 (3)

 

Ventilation parameters

    

 Minute ventilation, L/min

3.8 (2.4–6.2)

3.5 (2.4–6.1)

4.6 (2.6–6.2)

0.455

 Driving pressure, cmH2O

12 (12–14)

12 (12–14)

12 (12–14)

0.623

 Compliance, mL/cmH2O

13.5 (9.5–22.1)

13.2 (9.0–20.1)

13.9 (10.0–23.3)

0.120

 Mechanical power, J/min

7.2 (4.3–12.1)

6.4 (4.1–11.3)

8.1 (5.1–12.3)

0.220

 Ventilatory ratio

0.76 (0.51–1.14)

0.72 (0.44–1.09)

0.77 (0.56–1.17)

0.183

Laboratory values

    

 Platelet, × 103/mm3

247 (177–317)

237 (177–310)

266 (179–333)

0.320

 Hemoglobin, g/dL

9.4 (8.1–10.7)

9.1 (8.0–10.3)

10.0 (8.5–11.0)

0.023

 Fibrinogen, mg/L

7.1 (5.7–8.2)

6.7 (5.7–8.1)

7.1 (5.6–8.2)

0.711

 d–Dimers, ng/L

4905 (2020–17,340)

5935 (2320–18,710)

2485 (1727–3655)

0.020

 aPTT ratio

1.5 (1.2–1.7)

1.35 (1.16–1.6)

1.4 (1.2–1.6)

0.011

During the ECMO run

    

aPTT ratio ECMO-day 2

1.5 (1.2–1.7)

1.5 (1.3–1.9)

1.4 (1.2–1.6)

0.011

aPTT ratio ECMO-day 3

1.7 (1.3–2.2)

1.8 (1.4–2.5)

1.5 (1.2–2.0)

0.012

Adjuvant therapies on ECMO

    

 Continuous neuromuscular blockers

102 (64)

83 (94)

19 (27)

 < 0.001

 Prone positioning

131 (82)

71 (81)

60 (85)

0.529

  No. of sessions on-ECMO

2 (1–3)

2 (1–3)

2 (1–4)

0.121

 Nitric oxide or prostacyclin

5 (3)

5 (6)

0 (0)

0.066

 High-dose corticosteroids

39 (25)

13 (15)

26 (37)

0.001

Renal replacement therapy

63 (40)

39 (44)

24 (34)

0.178

Tracheostomy

47 (30)

26 (30)

21 (30)

0.996

Received COVID-19 specific treatment

    

 Remdesivir

17 (11)

8 (9)

9 (13)

0.467

 Lopinavir/ritonavir

20 (13)

20 (23)

0 (0)

 < 0.001

 Tocilizumab

9 (6)

8 (9)

1 (1)

0.042

 Dexamethasone, ≤ 6 mg/day 1st 15 days

73 (46)

13 (15)

60 (85)

 < 0.001

ECMO-related complications

    

 Intravascular hemolysis

29 (18)

9 (10)

20 (28)

0.004

 Clogged circuit requiring change

17 (11)

3 (3)

14 (20)

 < 0.001

 Severe thrombocytopenia (< 50 G/L) a

10 (6)

5 (6)

5 (7)

0.754

 ECMO setting/insertion change(s) b

8 (5)

4 (5)

4 (6)

0.051

 Massive hemorrhage

70 (44)

34 (39)

36 (51)

0.127

 Stroke

   

1.000

  Ischemic

2 (1)

1 (1)

1 (1)

 

  Hemorrhagic

8 (5)

4 (5)

4 (6)

 

 Pulmonary embolism

23 (14)

16 (18)

7 (10)

0.138

 Cardiac arrest

17 (11)

9 (10)

8 (11)

0.833

 Pneumothorax

17 (11)

5 (6)

12 (17)

0.03

 Antibiotic-treated VAP

159 (100)

75 (85)

63 (89)

0.516

  ≥ 1 treated bacteremia episode(s)

75 (47)

44 (51)

31 (44)

0.388

  1. Values are expressed as median (interquartile range) or number (%)
  2. APRV airway pressure release ventilation, aPTT activated partial thromboplastin time, ECMO extracorporeal membrane oxygenation, ICU intensive care unit, Fr French, FiO2 the fraction of inspired oxygen, PEEP positive end-expiratory pressure, PaO2 partial pressure of arterial oxygen, PaCO2 partial pressure of arterial carbon dioxide, PAPV positive airway-pressure ventilation, PBW predicted body weight, and SOFA Sequential Organ-Function Assessment, VA venoarterial, VV venovenous, VAP ventilator-associated pneumonia
  3. aDuring the first 3 days
  4. bIncluded ECMO-cannulation switches from VA to VV; VA to venous–arteriovenous (V-AV); and VV to V-AV
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