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. 2021 Feb 13;41(1):1–13. doi: 10.1007/s11596-021-2311-8

Extracorporeal Membrane Oxygenation Therapy for Critically Ill Coronavirus Disease 2019 Patients in Wuhan, China: A Retrospective Multicenter Cohort Study

Jing Fang 1,2,3,4,5,#, Rui Li 1,2,3,4,5,#, Yue Chen 1,#, Juan-juan Qin 6,7,#, Ming Hu 8,#, Chao-lin Huang 9,#, Lin Cheng 1, Yi He 1, Yi Li 1, Qiang Zhou 10, Dai-xing Zhou 11, Fei Huang 1, Fang Lei 7,12, Bo Yang 13, Jun Chen 1,2,3,4,5,✉, Hong-ping Deng 14,✉, Yu-feng Yuan 15,✉, Jia-hong Xia 16,✉, Song Wan 17,✉, Hong-liang Li 6,7,✉, Xiang Wei 1,2,3,4,5,✉
PMCID: PMC7881911  PMID: 33582899

Summary

Currently, little in-depth evidence is known about the application of extracorporeal membrane oxygenation (ECMO) therapy in coronavirus disease 2019 (COVID-19) patients. This retrospective multicenter cohort study included patients with COVID-19 at 7 designated hospitals in Wuhan, China. The patients were followed up until June 30, 2020. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with unsuccessful ECMO weaning. Propensity score matching was used to match patients who received veno-venous ECMO with those who received invasive mechanical ventilation (IMV)-only therapy. Of 88 patients receiving ECMO therapy, 27 and 61 patients were and were not successfully weaned from ECMO, respectively. Additionally, 15, 15, and 65 patients were further weaned from IMV, discharged from hospital, or died during hospitalization, respectively. In the multivariate logistic regression analysis, a lymphocyte count ≤0.5×109/L and D-dimer concentration >4× the upper limit of normal level at ICU admission, a peak PaCO2 >60 mmHg at 24 h before ECMO initiation, and no tracheotomy performed during the ICU stay were independently associated with lower odds of ECMO weaning. In the propensity score-matched analysis, a mixed-effect Cox model detected a lower hazard ratio for 120-day all-cause mortality after ICU admission during hospitalization in the ECMO group. The presence of lymphocytopenia, higher D-dimer concentrations at ICU admission and hypercapnia before ECMO initiation could help to identify patients with a poor prognosis. Tracheotomy could facilitate weaning from ECMO. ECMO relative to IMV-only therapy was associated with improved outcomes in critically ill COVID-19 patients.

Key words: coronavirus disease 2019, extracorporeal membrane oxygenation, mechanical ventilation, acute respiratory distress syndrome, viral pneumonia

Footnotes

This work was supported by grants from Emergent Key Projects for COVID-19 (No. 2020kfyXGYJ091), the National Natural Science Foundation of China (Nos. 81800256, 81873458, 81670050), and National Key Research and Development Program of China (No. 2019YFC0121600).

Conflict of Interest Statement

All authors declare no conflict of interest relevant to this study.

The authors contributed equally to this work.

Contributor Information

Jing Fang, Email: jingfang@hust.edu.cn.

Rui Li, Email: ruilee_tj@126.com.

Yue Chen, Email: chen_yue@hust.edu.cn.

Juan-juan Qin, Email: qinjuanjuan@whu.edu.cn.

Ming Hu, Email: huming74@163.com.

Chao-lin Huang, Email: 88071718@qq.com.

Jun Chen, Email: chjunmage@hotmail.com.

Hong-ping Deng, Email: hpdeng@whu.edu.cn.

Yu-feng Yuan, Email: yuanyf1971@whu.edu.cn.

Jia-hong Xia, Email: jiahong.xia@hust.edu.cn.

Song Wan, Email: swan@surgery.cuhk.edu.hk.

Hong-liang Li, Email: lihl@whu.edu.cn.

Xiang Wei, Email: xiangwei@tjh.tjmu.edu.cn.

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