Abstract 1167 Excess mortality rates in the Middle Ruhr Region of Germany in severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Excess mortality rates in the Middle Ruhr Region of Germany in severe COVID-19-related respiratory failure with and without extracorporeal membrane oxygenation - an observational study
A. Aweimer¹, L. Petschulat¹, B. Jettkant², R. Köditz³, J. Finkeldei³, J. Dietrich⁴, T. Breuer⁴, C. Draese⁵, U. Frey⁵, T. Rahmel⁶, M. Adamzik⁶, D. Buchwald⁷, D. Useini⁷, T. Brechmann³, I. Hosbach², J. Bünger², A. Ewers¹, A. Mügge¹, I. El-Battrawy¹
¹Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil, Bochum; ²Institut für Prävention und Arbeitsmedizin, Bochum; ³Allgemeine Innere Medizin, Intensivmedizin, Endokrinologie und Diabetologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum; ⁴Endokrinologie und Diabetologie, St. Josef Hospital Bochum, Bochum; ⁵Klinik für Anästhesiologie, Operative Intensivmedizin, Schmerz- und Palliativmedizin, Marien Hospital Herne, Herne; ⁶Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie,, Knappschaftskrankenhaus Bochum, Bochum; ⁷Herz- und Thoraxchirurgie, Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil, Bochum;
Background: The use of extracorporeal membrane oxygenation (ECMO) is discussed to improve patients’ outcome in severe COVID-19 with respiratory failure, but data on ECMO remains controversial. The aim of the study was to determine the characteristics of patients under invasive mechanical ventilation (IMV) with or without veno-venous ECMO support and to evaluate outcome parameters. Methods: Ventilated patients with COVID-19 with and without additional ECMO support were analyzed in a retrospective multicenter study regarding clinical characteristics, respiratory and laboratory parameters in day-to-day follow-up. Recruitment of patients was conducted during the first three COVID-19 waves at four German university hospitals of the Ruhr University Bochum, located in the Middle Ruhr Region. Results: From March 1, 2020 to August 31, 2021, the charts of 149 patients who were ventilated for COVID-19 infection, were included (63,8% male, median age 67 years). Fifty patients (33,6%) received additional ECMO support. On average, ECMO therapy was initiated 15.6±9.4 days after symptom onset, 10.6±7.1 days after hospital admission, and 4.8±6.4 days after the start of IMV. Male sex and higher SOFA and RESP scores were observed significantly more often in the high-volume ECMO center. Pre-medication with antidepressants was more often detected in survivors (22.0% vs. 6.5%; p=0,006). ECMO patients were 14 years younger and presented a lower rate of concomitant cardiovascular diseases (18.0% vs. 47.5%; p=0,0004). Additionally, cytokine-adsorption (46.0% vs. 13.1%; p<0,0001) and renal replacement therapy (76.0% vs. 43.4%; p=0,0001) were carried out more frequently; in ECMO patients thrombocytes were transfused 12-fold more often related to more than 4-fold higher bleeding complications. Undulating C-reactive protein (CRP) and massive increase in bilirubin levels (at terminal stage) could be observed in deceased ECMO patients. In-hospital mortality was high (Overall: 72.5%, ECMO: 80.0%, ns). Regardless of ECMO therapy half of the study population deceased within 30 days after hospital admission. Conclusion: Despite being younger and with less comorbidities ECMO therapy did not improve survival in severely ill COVID-19 patients. Undulating CRP levels, a massive increase of bilirubin level and a high use of cytokine-adsorption were associated with worse outcomes. In conclusion, ECMO support might be helpful in selected severe cases of COVID-19.
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