Table 3.
ECMO management and complications as of July 10, 2020
| All patients (N=83) | |||
|---|---|---|---|
| SOFA score on ECMO day 3* | 11 (8–14) | ||
| SOFA score on ECMO day 7† | 11 (8–13) | ||
| aPTT ratio ECMO day 2 | 1·5 (1·3–2·0) | ||
| aPTT ratio ECMO day 3 | 1·8 (1·4–2·6) | ||
| Adjuvant therapies on ECMO | |||
| Received continuous neuromuscular blockers | 80 (96%) | ||
| Prone-position | 67 (81%) | ||
| Number of sessions on ECMO during the first 7 days | 1 (0–2) | ||
| Nitric oxide or prostacyclin | 5 (6%) | ||
| High-dose corticosteroids | 17 (20%) | ||
| Renal replacement therapy | 38 (46%) | ||
| Received COVID-19 specific treatment | 63 (76%) | ||
| Remdesivir | 8 (10%) | ||
| Lopinavir and ritonavir | 19 (23%) | ||
| Tocilizumab | 8 (10%) | ||
| Hydroxychloroquine | 16 (19%) | ||
| High-dose corticosteroids before ECMO day 8 | 12 (14%) | ||
| Included in a randomised controlled trial on SARS-CoV-2 therapy | 13 (16%) | ||
| ECMO-related complications | |||
| ≥1 ECMO-circuit changes | 22 (27%) | ||
| Intravascular haemolysis | 11 (13%) | ||
| Clogged circuit requiring change | 3 (4%) | ||
| Repeat ECMO needed after decannulation | 1 (1%) | ||
| Severe thrombocytopenia (<50 × 109 cells per L) during the first 3 days‡ | 5 (6%) | ||
| ECMO setting or insertion changes§ | 4 (5%) | ||
| Heparin-induced thrombocytopenia | 2 (2%) | ||
| Massive haemorrhage | 35 (42%) | ||
| Oronasal bleeding | 20 (24%) | ||
| Haemothorax | 7 (8%) | ||
| Cannula | 5 (6%) | ||
| Other site | 13 (16%) | ||
| Blood-product transfusion | |||
| Patients who received ≥1 red blood cell units | 64 (77%) | ||
| Number of red blood cell units per patient | 3 (1–11) | ||
| Patients who received ≥1 platelet units | 11 (13%) | ||
| Patients who received ≥1 fresh-frozen plasma units | 9 (11%) | ||
| Patients who received ≥1 fibrinogen concentrates | 12 (14%) | ||
| Stroke | 5 (6%) | ||
| Ischaemic | 1 (1%) | ||
| Haemorrhagic | 4 (5%) | ||
| Antibiotic-treated cannula infection | 19 (23%) | ||
| Pulmonary embolism | 16 (19%) | ||
| Cardiac arrest | 11 (13%) | ||
| Tracheostomy | 25 (30%) | ||
| Pneumothorax | 9 (11%) | ||
| Antibiotic-treated ventilator-associated pneumonia | 72 (87%) | ||
| Number of episodes | 2 (1–3) | ||
| ≥1 antibiotic-treated bacteraemia episodes | 40 (48%) | ||
| Cause of death¶ | |||
| Septic shock | 10 (33%) | ||
| Multiorgan failure | 7 (23%) | ||
| Stroke | 4 (13%) | ||
| Haemorrhagic shock | 4 (13%) | ||
| Cardiovascular shock | 2 (7%) | ||
| ECMO-device failure | 1 (3%) | ||
| Other | 2 (7%) | ||
Data are median (IQR) or n (%). ECMO=extracorporeal membrane oxygenation. SOFA=Sequential Organ Function Assessment. aPTT=activated partial thromboplastin time. SARS-CoV-2=severe acute respiratory syndrome coronavirus 2.
*
80 patients.
†
72 patients.
‡
81 patients.
§
Included ECMO-cannulation switches from venoarterial to venovenous (n=1); venoarterial to venous–arteriovenous (n=1); and venovenous to venous–arteriovenous (n=2).
¶
30 patients.