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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