Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study

Guillaume Lebreton; Matthieu Schmidt; Maharajah Ponnaiah; Thierry Folliguet; Marylou Para; Julien Guihaire; Emmanuel Lansac; Edouard Sage; Bernard Cholley; Bruno Mégarbane; Pierrick Cronier; Jonathan Zarka; Daniel Da Silva; Sebastien Besset; Tristan Morichau-Beauchant; Igor Lacombat; Nicolas Mongardon; Christian Richard; Jacques Duranteau; Charles Cerf; Gabriel Saiydoun; Romain Sonneville; Jean Daniel Chiche; Patrick Nataf; Dan Longrois; Alain Combes; Pascal Leprince; Paris ECMO-COVID-19 investigators; Charles Juvin; Thibault Schoell; Cosimo D'Alessandro; Sofica Marin; Nathalie Nardone; Pierre Demondion; Horacio Meyer; Karl Bounader; Alexander Moiroux; Ali Akamkam; Guillaume Fadel; Erwan Randrianalisoa; Sébastien Cusquel; Patrice Le Gloahec; Elisabeth Hirschauer; Fabrice Musquet; Pierre Marie Jego; Hélène Guedes; Théophile Roy; Lina Mercereau; Emmanuel Corvol; Anne Laboure; Flore Vilanove; Marco Peperoni; Dariène Machado; Aly Sely; Marion Fortanier; Séverine Gantois; Emilie Tran; Elisabeth Bosq; Aurélie Fontanier; Alice Morin; Jocelyne Cousin; Stéphanie Bovagnet; Charles Edouard Luyt; Guillaume Hekimian; Nicolas Brechot; Marc Pineton de Chambrun; Cyrielle Desnos; Juliette Chomeloux; Jeremy Arzoine; Emmanuelle Guerin; Antoine Monsel; Guillaume Voiriot; David Levy; Elodie Baron; Alexandra Beurton; Juliette Chommeloux; Meng Paris; Safaa Nemlaghi; Pierre Bay; Alexandre Demoule; Bertrand Guidet; Jean Michel Constantin; Muriel Fartoukh; Martin Dres; Patrick Nataf; Guillaume Franchineau; Lucie Le Fevre; Richard Raffoul; Soleiman Alkhoder; Walid Ghodbane; Angelo Pisani; Wael Braham; Ali Bessem Gara; Pierre Mordant; Yves-Hervé Castier; Etienne de Montmollin; Lila Bouadma; Jean-François Timsit; Olivier Langeron; Quentin de Roux; Claire Alessandri; Margot Arminot-Frémaux; Simon Clariot; Thomas Dessalle; Agathe Kudela; André Ly; Arnaud Meffert; Elena Skripkina; Antonio Fiore; Costin Radu; Eleonora Dupuy-Montbrun; Christian Latremouille; Olaf Mercier; Philippe Deleuze; François Stephan; Jacques Duranteau; Christian Richard; Marie Werner; Jean-Louis Teboul; Xavier Monnet; Hassan Debbagh; Alain Chapelier; Julien De Wolf; Matthieu Glorion; Ciprian Pricopi; Francesco Cassiano; Sébastien Jacquemin; Guillaume Tachon; François Parquin; Benjamin Zuber; Alain Carriou; Jean-Paul Mira; Julien Charpentier; Frederic Pene; Lee Nguyen; Sébastian Voicu; Nicolas Deye; Isabelle Malissin; Laetitia Sutterlin; Giulia Naim; Adrien Pépin-Lehalleur; Aymen Mrad; Jean-Michel Ekhérian; Philippe Nguyen; Georgios Sidéris; Dominique Vodovar; Caroline Grant; Mattéo Arcelli; Alban Copie; Zaccaria Errabih; Antoine Gonde; Adèle Magalhaes; Edouard Meurisse; Kiyoko Nitenberg; Arthur Perault; Lucile Perrin; Maxime Renaux; Sophie Marqué; Luis Ensenyat-Martin; Eric Delpierre; Matthieu Duprey; Daniel Da Silva; Bruno Verdière; Julien Amour; Marina Clément; Yves Ollivier; Tristan Morichau-Beauchant; Fabrice Daviaud; Camille Le Breton; Santiago Freita-Ramos; Marc Amouretti; Pierre Antoine Billiet; Myriam Dao; Louis Marie Dumont; Laura Federici; Baptiste Gaborieau; Pierre Postel-Vinay; Constance Vuillard; Noémie Zucman; Didier Dreyfuss; Jean Damien Ricard; Damien Roux

doi:10.1016/S2213-2600(21)00096-5

Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study

Guillaume Lebreton^*, Matthieu Schmidt, Maharajah Ponnaiah, Thierry Folliguet, Marylou Para, Julien Guihaire, Emmanuel Lansac, Edouard Sage, Bernard Cholley, Bruno Mégarbane, Pierrick Cronier, Jonathan Zarka, Daniel Da Silva, Sebastien Besset, Tristan Morichau-Beauchant, Igor Lacombat, Nicolas Mongardon, Christian Richard, Jacques Duranteau, Charles CerfGabriel Saiydoun, Romain Sonneville, Jean Daniel Chiche, Patrick Nataf, Dan Longrois, Alain Combes, Pascal Leprince, Paris ECMO-COVID-19 investigators, Charles Juvin, Thibault Schoell, Cosimo D'Alessandro, Sofica Marin, Nathalie Nardone, Pierre Demondion, Horacio Meyer, Karl Bounader, Alexander Moiroux, Ali Akamkam, Guillaume Fadel, Erwan Randrianalisoa, Sébastien Cusquel, Patrice Le Gloahec, Elisabeth Hirschauer, Fabrice Musquet, Pierre Marie Jego, Hélène Guedes, Théophile Roy, Lina Mercereau, Emmanuel Corvol, Anne Laboure, Flore Vilanove, Marco Peperoni, Dariène Machado, Aly Sely, Marion Fortanier, Séverine Gantois, Emilie Tran, Elisabeth Bosq, Aurélie Fontanier, Alice Morin, Jocelyne Cousin, Stéphanie Bovagnet, Charles Edouard Luyt, Guillaume Hekimian, Nicolas Brechot, Marc Pineton de Chambrun, Cyrielle Desnos, Juliette Chomeloux, Jeremy Arzoine, Emmanuelle Guerin, Antoine Monsel, Guillaume Voiriot, David Levy, Elodie Baron, Alexandra Beurton, Juliette Chommeloux, Meng Paris, Safaa Nemlaghi, Pierre Bay, Alexandre Demoule, Bertrand Guidet, Jean Michel Constantin, Muriel Fartoukh, Martin Dres, Patrick Nataf, Guillaume Franchineau, Lucie Le Fevre, Richard Raffoul, Soleiman Alkhoder, Walid Ghodbane, Angelo Pisani, Wael Braham, Ali Bessem Gara, Pierre Mordant, Yves-Hervé Castier, Etienne de Montmollin, Lila Bouadma, Jean-François Timsit, Olivier Langeron, Quentin de Roux, Claire Alessandri, Margot Arminot-Frémaux, Simon Clariot, Thomas Dessalle, Agathe Kudela, André Ly, Arnaud Meffert, Elena Skripkina, Antonio Fiore, Costin Radu, Eleonora Dupuy-Montbrun, Christian Latremouille, Olaf Mercier, Philippe Deleuze, François Stephan, Jacques Duranteau, Christian Richard, Marie Werner, Jean-Louis Teboul, Xavier Monnet, Hassan Debbagh, Alain Chapelier, Julien De Wolf, Matthieu Glorion, Ciprian Pricopi, Francesco Cassiano, Sébastien Jacquemin, Guillaume Tachon, François Parquin, Benjamin Zuber, Alain Carriou, Jean-Paul Mira, Julien Charpentier, Frederic Pene, Lee Nguyen, Sébastian Voicu, Nicolas Deye, Isabelle Malissin, Laetitia Sutterlin, Giulia Naim, Adrien Pépin-Lehalleur, Aymen Mrad, Jean-Michel Ekhérian, Philippe Nguyen, Georgios Sidéris, Dominique Vodovar, Caroline Grant, Mattéo Arcelli, Alban Copie, Zaccaria Errabih, Antoine Gonde, Adèle Magalhaes, Edouard Meurisse, Kiyoko Nitenberg, Arthur Perault, Lucile Perrin, Maxime Renaux, Sophie Marqué, Luis Ensenyat-Martin, Eric Delpierre, Matthieu Duprey, Daniel Da Silva, Bruno Verdière, Julien Amour, Marina Clément, Yves Ollivier, Tristan Morichau-Beauchant, Fabrice Daviaud, Camille Le Breton, Santiago Freita-Ramos, Marc Amouretti, Pierre Antoine Billiet, Myriam Dao, Louis Marie Dumont, Laura Federici, Baptiste Gaborieau, Pierre Postel-Vinay, Constance Vuillard, Noémie Zucman, Didier Dreyfuss, Jean Damien Ricard, Damien Roux

^*Corresponding author for this work

Research output: Contribution to journal › Journal article › peer-review

159 Citations (Scopus)

Abstract

Background: In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic.

Methods: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO.

Findings: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45−58) and Simplified Acute Physiology Score-II of 40 (31−56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H₂O (14−21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54−70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84−0·99] per day decrease), younger age (2·89 [1·41−5·93] for ≤48 years and 2·01 [1·01−3·99] for 49–56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55−0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46–6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation.

Interpretation: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources.

Original language	English
Pages (from-to)	851-862
Number of pages	12
Journal	The Lancet Respiratory Medicine
Volume	9
Issue number	8
DOIs	https://doi.org/10.1016/S2213-2600(21)00096-5
Publication status	Published - Aug 2021

Scopus Subject Areas

Pulmonary and Respiratory Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/S2213-2600(21)00096-5

Cite this

Lebreton, G., Schmidt, M., Ponnaiah, M., Folliguet, T., Para, M., Guihaire, J., Lansac, E., Sage, E., Cholley, B., Mégarbane, B., Cronier, P., Zarka, J., Da Silva, D., Besset, S., Morichau-Beauchant, T., Lacombat, I., Mongardon, N., Richard, C., Duranteau, J., ... Roux, D. (2021). Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study. The Lancet Respiratory Medicine, 9(8), 851-862. https://doi.org/10.1016/S2213-2600(21)00096-5

@article{6ccd096add6441878103262e8fe50583,

title = "Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study",

abstract = "Background: In the {\^I}le-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic. Methods: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO. Findings: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45−58) and Simplified Acute Physiology Score-II of 40 (31−56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14−21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54−70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84−0·99] per day decrease), younger age (2·89 [1·41−5·93] for ≤48 years and 2·01 [1·01−3·99] for 49–56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55−0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46–6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation. Interpretation: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources.",

author = "Guillaume Lebreton and Matthieu Schmidt and Maharajah Ponnaiah and Thierry Folliguet and Marylou Para and Julien Guihaire and Emmanuel Lansac and Edouard Sage and Bernard Cholley and Bruno M{\'e}garbane and Pierrick Cronier and Jonathan Zarka and {Da Silva}, Daniel and Sebastien Besset and Tristan Morichau-Beauchant and Igor Lacombat and Nicolas Mongardon and Christian Richard and Jacques Duranteau and Charles Cerf and Gabriel Saiydoun and Romain Sonneville and Chiche, {Jean Daniel} and Patrick Nataf and Dan Longrois and Alain Combes and Pascal Leprince and {Paris ECMO-COVID-19 investigators} and Charles Juvin and Thibault Schoell and Cosimo D'Alessandro and Sofica Marin and Nathalie Nardone and Pierre Demondion and Horacio Meyer and Karl Bounader and Alexander Moiroux and Ali Akamkam and Guillaume Fadel and Erwan Randrianalisoa and S{\'e}bastien Cusquel and {Le Gloahec}, Patrice and Elisabeth Hirschauer and Fabrice Musquet and Jego, {Pierre Marie} and H{\'e}l{\`e}ne Guedes and Th{\'e}ophile Roy and Lina Mercereau and Emmanuel Corvol and Anne Laboure and Flore Vilanove and Marco Peperoni and Dari{\`e}ne Machado and Aly Sely and Marion Fortanier and S{\'e}verine Gantois and Emilie Tran and Elisabeth Bosq and Aur{\'e}lie Fontanier and Alice Morin and Jocelyne Cousin and St{\'e}phanie Bovagnet and Luyt, {Charles Edouard} and Guillaume Hekimian and Nicolas Brechot and {de Chambrun}, {Marc Pineton} and Cyrielle Desnos and Juliette Chomeloux and Jeremy Arzoine and Emmanuelle Guerin and Antoine Monsel and Guillaume Voiriot and David Levy and Elodie Baron and Alexandra Beurton and Juliette Chommeloux and Meng Paris and Safaa Nemlaghi and Pierre Bay and Alexandre Demoule and Bertrand Guidet and Constantin, {Jean Michel} and Muriel Fartoukh and Martin Dres and Patrick Nataf and Guillaume Franchineau and Fevre, {Lucie Le} and Richard Raffoul and Soleiman Alkhoder and Walid Ghodbane and Angelo Pisani and Wael Braham and Gara, {Ali Bessem} and Pierre Mordant and Yves-Herv{\'e} Castier and {de Montmollin}, Etienne and Lila Bouadma and Jean-Fran{\c c}ois Timsit and Olivier Langeron and {de Roux}, Quentin and Claire Alessandri and Margot Arminot-Fr{\'e}maux and Simon Clariot and Thomas Dessalle and Agathe Kudela and Andr{\'e} Ly and Arnaud Meffert and Elena Skripkina and Antonio Fiore and Costin Radu and Eleonora Dupuy-Montbrun and Christian Latremouille and Olaf Mercier and Philippe Deleuze and Fran{\c c}ois Stephan and Jacques Duranteau and Christian Richard and Marie Werner and Jean-Louis Teboul and Xavier Monnet and Hassan Debbagh and Alain Chapelier and {De Wolf}, Julien and Matthieu Glorion and Ciprian Pricopi and Francesco Cassiano and S{\'e}bastien Jacquemin and Guillaume Tachon and Fran{\c c}ois Parquin and Benjamin Zuber and Alain Carriou and Jean-Paul Mira and Julien Charpentier and Frederic Pene and Lee Nguyen and S{\'e}bastian Voicu and Nicolas Deye and Isabelle Malissin and Laetitia Sutterlin and Giulia Naim and Adrien P{\'e}pin-Lehalleur and Aymen Mrad and Jean-Michel Ekh{\'e}rian and Philippe Nguyen and Georgios Sid{\'e}ris and Dominique Vodovar and Caroline Grant and Matt{\'e}o Arcelli and Alban Copie and Zaccaria Errabih and Antoine Gonde and Ad{\`e}le Magalhaes and Edouard Meurisse and Kiyoko Nitenberg and Arthur Perault and Lucile Perrin and Maxime Renaux and Sophie Marqu{\'e} and Luis Ensenyat-Martin and Eric Delpierre and Matthieu Duprey and {Da Silva}, Daniel and Bruno Verdi{\`e}re and Julien Amour and Marina Cl{\'e}ment and Yves Ollivier and Tristan Morichau-Beauchant and Fabrice Daviaud and {Le Breton}, Camille and Santiago Freita-Ramos and Marc Amouretti and Billiet, {Pierre Antoine} and Myriam Dao and Dumont, {Louis Marie} and Laura Federici and Baptiste Gaborieau and Pierre Postel-Vinay and Constance Vuillard and No{\'e}mie Zucman and Didier Dreyfuss and Ricard, {Jean Damien} and Damien Roux",

note = "Funding Information: Editorial support, limited to editing, checking content and language, and formatting, was provided by Sophie Rushton-Smith (MedLink Healthcare Communications) and was funded by the authors. Publisher Copyright: {\textcopyright} 2021 Elsevier Ltd",

year = "2021",

month = aug,

doi = "10.1016/S2213-2600(21)00096-5",

language = "English",

volume = "9",

pages = "851--862",

journal = "The Lancet Respiratory Medicine",

issn = "2213-2600",

publisher = "Elsevier Ltd.",

number = "8",

}

Lebreton, G, Schmidt, M, Ponnaiah, M, Folliguet, T, Para, M, Guihaire, J, Lansac, E, Sage, E, Cholley, B, Mégarbane, B, Cronier, P, Zarka, J, Da Silva, D, Besset, S, Morichau-Beauchant, T, Lacombat, I, Mongardon, N, Richard, C, Duranteau, J, Cerf, C, Saiydoun, G, Sonneville, R, Chiche, JD, Nataf, P, Longrois, D, Combes, A, Leprince, P, Paris ECMO-COVID-19 investigators, Juvin, C, Schoell, T, D'Alessandro, C, Marin, S, Nardone, N, Demondion, P, Meyer, H, Bounader, K, Moiroux, A, Akamkam, A, Fadel, G, Randrianalisoa, E, Cusquel, S, Le Gloahec, P, Hirschauer, E, Musquet, F, Jego, PM, Guedes, H, Roy, T, Mercereau, L, Corvol, E, Laboure, A, Vilanove, F, Peperoni, M, Machado, D, Sely, A, Fortanier, M, Gantois, S, Tran, E, Bosq, E, Fontanier, A, Morin, A, Cousin, J, Bovagnet, S, Luyt, CE, Hekimian, G, Brechot, N, de Chambrun, MP, Desnos, C, Chomeloux, J, Arzoine, J, Guerin, E, Monsel, A, Voiriot, G, Levy, D, Baron, E, Beurton, A, Chommeloux, J, Paris, M, Nemlaghi, S, Bay, P, Demoule, A, Guidet, B, Constantin, JM, Fartoukh, M, Dres, M, Nataf, P, Franchineau, G, Fevre, LL, Raffoul, R, Alkhoder, S, Ghodbane, W, Pisani, A, Braham, W, Gara, AB, Mordant, P, Castier, Y-H, de Montmollin, E, Bouadma, L, Timsit, J-F, Langeron, O, de Roux, Q, Alessandri, C, Arminot-Frémaux, M, Clariot, S, Dessalle, T, Kudela, A, Ly, A, Meffert, A, Skripkina, E, Fiore, A, Radu, C, Dupuy-Montbrun, E, Latremouille, C, Mercier, O, Deleuze, P, Stephan, F, Duranteau, J, Richard, C, Werner, M, Teboul, J-L, Monnet, X, Debbagh, H, Chapelier, A, De Wolf, J, Glorion, M, Pricopi, C, Cassiano, F, Jacquemin, S, Tachon, G, Parquin, F, Zuber, B, Carriou, A, Mira, J-P, Charpentier, J, Pene, F, Nguyen, L, Voicu, S, Deye, N, Malissin, I, Sutterlin, L, Naim, G, Pépin-Lehalleur, A, Mrad, A, Ekhérian, J-M, Nguyen, P, Sidéris, G, Vodovar, D, Grant, C, Arcelli, M, Copie, A, Errabih, Z, Gonde, A, Magalhaes, A, Meurisse, E, Nitenberg, K, Perault, A, Perrin, L, Renaux, M, Marqué, S, Ensenyat-Martin, L, Delpierre, E, Duprey, M, Da Silva, D, Verdière, B, Amour, J, Clément, M, Ollivier, Y, Morichau-Beauchant, T, Daviaud, F, Le Breton, C, Freita-Ramos, S, Amouretti, M, Billiet, PA, Dao, M, Dumont, LM, Federici, L, Gaborieau, B, Postel-Vinay, P, Vuillard, C, Zucman, N, Dreyfuss, D, Ricard, JD & Roux, D 2021, 'Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study', The Lancet Respiratory Medicine, vol. 9, no. 8, pp. 851-862. https://doi.org/10.1016/S2213-2600(21)00096-5

Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study. / Lebreton, Guillaume; Schmidt, Matthieu; Ponnaiah, Maharajah et al.
In: The Lancet Respiratory Medicine, Vol. 9, No. 8, 08.2021, p. 851-862.

Research output: Contribution to journal › Journal article › peer-review

TY - JOUR

T1 - Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France

T2 - a multicentre cohort study

AU - Lebreton, Guillaume

AU - Schmidt, Matthieu

AU - Ponnaiah, Maharajah

AU - Folliguet, Thierry

AU - Para, Marylou

AU - Guihaire, Julien

AU - Lansac, Emmanuel

AU - Sage, Edouard

AU - Cholley, Bernard

AU - Mégarbane, Bruno

AU - Cronier, Pierrick

AU - Zarka, Jonathan

AU - Da Silva, Daniel

AU - Besset, Sebastien

AU - Morichau-Beauchant, Tristan

AU - Lacombat, Igor

AU - Mongardon, Nicolas

AU - Richard, Christian

AU - Duranteau, Jacques

AU - Cerf, Charles

AU - Saiydoun, Gabriel

AU - Sonneville, Romain

AU - Chiche, Jean Daniel

AU - Nataf, Patrick

AU - Longrois, Dan

AU - Combes, Alain

AU - Leprince, Pascal

AU - Paris ECMO-COVID-19 investigators

AU - Juvin, Charles

AU - Schoell, Thibault

AU - D'Alessandro, Cosimo

AU - Marin, Sofica

AU - Nardone, Nathalie

AU - Demondion, Pierre

AU - Meyer, Horacio

AU - Bounader, Karl

AU - Moiroux, Alexander

AU - Akamkam, Ali

AU - Fadel, Guillaume

AU - Randrianalisoa, Erwan

AU - Cusquel, Sébastien

AU - Le Gloahec, Patrice

AU - Hirschauer, Elisabeth

AU - Musquet, Fabrice

AU - Jego, Pierre Marie

AU - Guedes, Hélène

AU - Roy, Théophile

AU - Mercereau, Lina

AU - Corvol, Emmanuel

AU - Laboure, Anne

AU - Vilanove, Flore

AU - Peperoni, Marco

AU - Machado, Dariène

AU - Sely, Aly

AU - Fortanier, Marion

AU - Gantois, Séverine

AU - Tran, Emilie

AU - Bosq, Elisabeth

AU - Fontanier, Aurélie

AU - Morin, Alice

AU - Cousin, Jocelyne

AU - Bovagnet, Stéphanie

AU - Luyt, Charles Edouard

AU - Hekimian, Guillaume

AU - Brechot, Nicolas

AU - de Chambrun, Marc Pineton

AU - Desnos, Cyrielle

AU - Chomeloux, Juliette

AU - Arzoine, Jeremy

AU - Guerin, Emmanuelle

AU - Monsel, Antoine

AU - Voiriot, Guillaume

AU - Levy, David

AU - Baron, Elodie

AU - Beurton, Alexandra

AU - Chommeloux, Juliette

AU - Paris, Meng

AU - Nemlaghi, Safaa

AU - Bay, Pierre

AU - Demoule, Alexandre

AU - Guidet, Bertrand

AU - Constantin, Jean Michel

AU - Fartoukh, Muriel

AU - Dres, Martin

AU - Nataf, Patrick

AU - Franchineau, Guillaume

AU - Fevre, Lucie Le

AU - Raffoul, Richard

AU - Alkhoder, Soleiman

AU - Ghodbane, Walid

AU - Pisani, Angelo

AU - Braham, Wael

AU - Gara, Ali Bessem

AU - Mordant, Pierre

AU - Castier, Yves-Hervé

AU - de Montmollin, Etienne

AU - Bouadma, Lila

AU - Timsit, Jean-François

AU - Langeron, Olivier

AU - de Roux, Quentin

AU - Alessandri, Claire

AU - Arminot-Frémaux, Margot

AU - Clariot, Simon

AU - Dessalle, Thomas

AU - Kudela, Agathe

AU - Ly, André

AU - Meffert, Arnaud

AU - Skripkina, Elena

AU - Fiore, Antonio

AU - Radu, Costin

AU - Dupuy-Montbrun, Eleonora

AU - Latremouille, Christian

AU - Mercier, Olaf

AU - Deleuze, Philippe

AU - Stephan, François

AU - Duranteau, Jacques

AU - Richard, Christian

AU - Werner, Marie

AU - Teboul, Jean-Louis

AU - Monnet, Xavier

AU - Debbagh, Hassan

AU - Chapelier, Alain

AU - De Wolf, Julien

AU - Glorion, Matthieu

AU - Pricopi, Ciprian

AU - Cassiano, Francesco

AU - Jacquemin, Sébastien

AU - Tachon, Guillaume

AU - Parquin, François

AU - Zuber, Benjamin

AU - Carriou, Alain

AU - Mira, Jean-Paul

AU - Charpentier, Julien

AU - Pene, Frederic

AU - Nguyen, Lee

AU - Voicu, Sébastian

AU - Deye, Nicolas

AU - Malissin, Isabelle

AU - Sutterlin, Laetitia

AU - Naim, Giulia

AU - Pépin-Lehalleur, Adrien

AU - Mrad, Aymen

AU - Ekhérian, Jean-Michel

AU - Nguyen, Philippe

AU - Sidéris, Georgios

AU - Vodovar, Dominique

AU - Grant, Caroline

AU - Arcelli, Mattéo

AU - Copie, Alban

AU - Errabih, Zaccaria

AU - Gonde, Antoine

AU - Magalhaes, Adèle

AU - Meurisse, Edouard

AU - Nitenberg, Kiyoko

AU - Perault, Arthur

AU - Perrin, Lucile

AU - Renaux, Maxime

AU - Marqué, Sophie

AU - Ensenyat-Martin, Luis

AU - Delpierre, Eric

AU - Duprey, Matthieu

AU - Da Silva, Daniel

AU - Verdière, Bruno

AU - Amour, Julien

AU - Clément, Marina

AU - Ollivier, Yves

AU - Morichau-Beauchant, Tristan

AU - Daviaud, Fabrice

AU - Le Breton, Camille

AU - Freita-Ramos, Santiago

AU - Amouretti, Marc

AU - Billiet, Pierre Antoine

AU - Dao, Myriam

AU - Dumont, Louis Marie

AU - Federici, Laura

AU - Gaborieau, Baptiste

AU - Postel-Vinay, Pierre

AU - Vuillard, Constance

AU - Zucman, Noémie

AU - Dreyfuss, Didier

AU - Ricard, Jean Damien

AU - Roux, Damien

N1 - Funding Information: Editorial support, limited to editing, checking content and language, and formatting, was provided by Sophie Rushton-Smith (MedLink Healthcare Communications) and was funded by the authors. Publisher Copyright: © 2021 Elsevier Ltd

PY - 2021/8

Y1 - 2021/8

N2 - Background: In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic. Methods: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO. Findings: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45−58) and Simplified Acute Physiology Score-II of 40 (31−56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14−21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54−70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84−0·99] per day decrease), younger age (2·89 [1·41−5·93] for ≤48 years and 2·01 [1·01−3·99] for 49–56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55−0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46–6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation. Interpretation: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources.

AB - Background: In the Île-de-France region (henceforth termed Greater Paris), extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) was considered early in the COVID-19 pandemic. We report ECMO network organisation and outcomes during the first wave of the pandemic. Methods: In this multicentre cohort study, we present an analysis of all adult patients with laboratory-confirmed SARS-CoV-2 infection and severe ARDS requiring ECMO who were admitted to 17 Greater Paris intensive care units between March 8 and June 3, 2020. Central regulation for ECMO indications and pooling of resources were organised for the Greater Paris intensive care units, with six mobile ECMO teams available for the region. Details of complications (including ECMO-related complications, renal replacement therapy, and pulmonary embolism), clinical outcomes, survival status at 90 days after ECMO initiation, and causes of death are reported. Multivariable analysis was used to identify pre-ECMO variables independently associated with 90-day survival after ECMO. Findings: The 302 patients included who underwent ECMO had a median age of 52 years (IQR 45−58) and Simplified Acute Physiology Score-II of 40 (31−56), and 235 (78%) of whom were men. 165 (55%) were transferred after cannulation by a mobile ECMO team. Before ECMO, 285 (94%) patients were prone positioned, median driving pressure was 18 cm H2O (14−21), and median ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen was 61 mm Hg (IQR 54−70). During ECMO, 115 (43%) of 270 patients had a major bleeding event, 27 of whom had intracranial haemorrhage; 130 (43%) of 301 patients received renal replacement therapy; and 53 (18%) of 294 had a pulmonary embolism. 138 (46%) patients were alive 90 days after ECMO. The most common causes of death were multiorgan failure (53 [18%] patients) and septic shock (47 [16%] patients). Shorter time between intubation and ECMO (odds ratio 0·91 [95% CI 0·84−0·99] per day decrease), younger age (2·89 [1·41−5·93] for ≤48 years and 2·01 [1·01−3·99] for 49–56 years vs ≥57 years), lower pre-ECMO renal component of the Sequential Organ Failure Assessment score (0·67, 0·55−0·83 per point increase), and treatment in centres managing at least 30 venovenous ECMO cases annually (2·98 [1·46–6·04]) were independently associated with improved 90-day survival. There was no significant difference in survival between patients who had mobile and on-site ECMO initiation. Interpretation: Beyond associations with similar factors to those reported on ECMO for non-COVID-19 ARDS, 90-day survival among ECMO-assisted patients with COVID-19 was strongly associated with a centre's experience in venovenous ECMO during the previous year. Early ECMO management in centres with a high venovenous ECMO case volume should be advocated, by applying centralisation and regulation of ECMO indications, which should also help to prevent a shortage of resources.

UR - http://www.scopus.com/inward/record.url?scp=85106981695&partnerID=8YFLogxK

U2 - 10.1016/S2213-2600(21)00096-5

DO - 10.1016/S2213-2600(21)00096-5

M3 - Journal article

C2 - 33887246

AN - SCOPUS:85106981695

SN - 2213-2600

VL - 9

SP - 851

EP - 862

JO - The Lancet Respiratory Medicine

JF - The Lancet Respiratory Medicine

IS - 8

ER -

Extracorporeal membrane oxygenation network organisation and clinical outcomes during the COVID-19 pandemic in Greater Paris, France: a multicentre cohort study

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