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Wiest, Clemens; Philipp, Alois; Foltan, Maik; Geismann, Florian; Schneckenpointer, Roland; Baumgartner, Simon; Sticht, Florian; Hitzenbichler, Florian; Arzt, Michael; Fisser, Christoph; Stadlbauer, Andrea; Dienemann, Thomas; Maier, Lars Siegfried; Lunz, Dirk; Mueller, Thomas; Lubnow, Matthias

Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience

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  • Media type: E-Article
  • Title: Refractory circulatory failure in COVID-19 patients treated with veno-arterial ECMO a retrospective single-center experience
  • Contributor: Wiest, Clemens; Philipp, Alois; Foltan, Maik; Geismann, Florian; Schneckenpointer, Roland; Baumgartner, Simon; Sticht, Florian; Hitzenbichler, Florian; Arzt, Michael; Fisser, Christoph; Stadlbauer, Andrea; Dienemann, Thomas; Maier, Lars Siegfried; Lunz, Dirk; Mueller, Thomas; Lubnow, Matthias
  • Published: Public Library of Science (PLoS), 2024
  • Published in: PLOS ONE, 19 (2024) 4, Seite e0298342
  • Language: English
  • DOI: 10.1371/journal.pone.0298342
  • ISSN: 1932-6203
  • Origination:
  • Footnote:
  • Description: ObjectiveIn this retrospective case series, survival rates in different indications for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and differential diagnoses of COVID-19 associated refractory circulatory failure are investigated.MethodsRetrospective analysis of 28 consecutive COVID-19 patients requiring VA-ECMO. All VA-ECMO’s were cannulated peripherally, using a femoro-femoral cannulation.ResultsAt VA-ECMO initiation, median age was 57 years (IQR: 51–62), SOFA score 16 (IQR: 13–17) and norepinephrine dosing 0.53μg/kg/min (IQR: 0.35–0.87). Virus-variants were: 61% wild-type, 14% Alpha, 18% Delta and 7% Omicron. Indications for VA-ECMO support were pulmonary embolism (PE) (n = 5, survival 80%), right heart failure due to secondary pulmonary hypertension (n = 5, survival 20%), cardiac arrest (n = 4, survival 25%), acute heart failure (AHF) (n = 10, survival 40%) and refractory vasoplegia (n = 4, survival 0%). Among the patients with AHF, 4 patients suffered from COVID-19 associated heart failure (CovHF) (survival 100%) and 6 patients from sepsis associated heart failure (SHF) (survival 0%). Main Complications were acute kidney injury (AKI) 93%, renal replacement therapy was needed in 79%, intracranial hemorrhage occurred in 18%. Overall survival to hospital discharge was 39%.ConclusionSurvival on VA-ECMO in COVID-19 depends on VA-ECMO indication, which should be considered in further studies and clinical decision making. A subgroup of patients suffers from acute heart failure due to inflammation, which has to be differentiated into septic or COVID-19 associated. Novel biomarkers are required to ensure reliable differentiation between these entities; a candidate might be soluble interleukin 2 receptor.
  • Access State: Open Access