Friedrichson Benjamin, Kloka Jan A, Neef Vanessa, Mutlak Haitham, Old Oliver, Zacharowski Kai, Piekarski Florian
From the Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt (BF, JAK, VN, OO, KZ) and Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, SANA Klinikum, Germany (HM).
Eur J Anaesthesiol. 2022 May 1;39(5):445-451. doi: 10.1097/EJA.0000000000001670. Epub 2022 Feb 17.
In the context of the coronavirus disease 2019 (COVID-19) pandemic, many retrospective single-centre or specialised centre reports have shown promising mortality rates with the use of extracorporeal membrane oxygenation (ECMO) therapy. However, the mortality rate of an entire country throughout the COVID-19 pandemic remains unknown.
The primary objective is to determine the hospital mortality in COVID-19 patients receiving venovenous ECMO (VV-ECMO) and veno-arterial ECMO (VA-ECMO) therapy. Secondary objectives are the chronological development of mortality during the pandemic, the analysis of comorbidities, age and complications.
Cohort study.
Inpatient data from January 2020 to September 2021 of all hospitals in Germany were analysed.
All COVID-19-positive patients who received ECMO therapy were analysed according to the appropriate international statistical classification of diseases and related health problem codes (ICDs) and process key codes (OPSs).
The primary outcome was the hospital mortality.
In total, 4279 COVID-19-positive patients who received ECMO therapy were analysed. Among 404 patients treated with VA-ECMO and 3875 treated with VV-ECMO, the hospital mortality was high: 72% (n = 291) for VA-ECMO and 65.9% (n = 2552) for VV-ECMO. A total of 43.2% (n = 1848) of all patients were older than 60 years with a hospital mortality rate of 72.7% (n = 172) for VA-ECMO and 77.6% (n = 1301) for VV-ECMO. CPR was performed in 44.1% (n = 178) of patients with VA-ECMO and 16.4% (n = 637) of patients with VV-ECMO. The mortality rates widely varied from 48.1 to 84.4% in individual months and worsened from March 2020 (59.2%) to September 2021 (78.4%).
In Germany, a large proportion of elderly patients with COVID-19 were treated with ECMO, with an unacceptably high hospital mortality. Considering these data, the unconditional use of ECMO therapy in COVID-19 must be carefully considered and advanced age should be considered as a relative contraindication.
在2019年冠状病毒病（COVID-19）大流行的背景下，许多回顾性单中心或专科中心报告显示，使用体外膜肺氧合（ECMO）治疗的死亡率颇具前景。然而，整个COVID-19大流行期间一个国家的死亡率仍不为人知。
主要目的是确定接受静脉-静脉ECMO（VV-ECMO）和静脉-动脉ECMO（VA-ECMO）治疗的COVID-19患者的医院死亡率。次要目的是大流行期间死亡率的时间发展、合并症、年龄和并发症分析。
队列研究。
分析了德国所有医院2020年1月至2021年9月的住院患者数据。
所有接受ECMO治疗的COVID-19阳性患者均根据适当的国际疾病和相关健康问题统计分类代码（ICD）和流程关键代码（OPS）进行分析。
主要结局为医院死亡率。
总共分析了4279例接受ECMO治疗的COVID-19阳性患者。在404例接受VA-ECMO治疗的患者和3875例接受VV-ECMO治疗的患者中，医院死亡率很高：VA-ECMO为72%（n = 291），VV-ECMO为65.9%（n = 2552）。所有患者中共有43.2%（n = 1848）年龄超过60岁，VA-ECMO的医院死亡率为72.7%（n = 172），VV-ECMO为77.6%（n = 1301）。44.1%（n = 178）接受VA-ECMO治疗的患者和16.4%（n = 637）接受VV-ECMO治疗的患者进行了心肺复苏。各月份的死亡率在48.1%至84.4%之间广泛波动，且从2020年3月（59.2%）到2021年9月（78.4%）有所恶化。
在德国，很大一部分COVID-19老年患者接受了ECMO治疗，医院死亡率高得令人无法接受。考虑到这些数据，必须谨慎考虑在COVID-19中无条件使用ECMO治疗，且高龄应被视为相对禁忌证。
