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 journalArticlepeer-review

56 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 languageEnglish
Pages (from-to)851-862
Number of pages12
JournalThe Lancet Respiratory Medicine
Volume9
Issue number8
DOIs
Publication statusPublished - Aug 2021

Scopus Subject Areas

  • Pulmonary and Respiratory Medicine

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