key: cord-1056309-6ocv839l authors: Lorusso, Roberto; Combes, Alain; Coco, Valeria Lo; De Piero, Maria Elena; Belohlavek, Jan title: ECMO for COVID-19 patients in Europe and Israel date: 2021-01-09 journal: Intensive Care Med DOI: 10.1007/s00134-020-06272-3 sha: 7d6b811d74d2f9b46f1d23d77aa7cf9703dfd358 doc_id: 1056309 cord_uid: 6ocv839l nan As of October 17th the novel coronavirus (SARS-CoV-2) caused a pandemic disease (coronavirus disease 2019, COVID-19) 40 million people worldwide, with almost one million deaths [1] . Although most patients have an uncomplicated clinical course, the more severe forms of COVID-19 require hospitalization and intensive care unit admission [2] . Conventional high-flow oxygen therapy, non-invasive and/or invasive mechanical ventilation, often in combination with pronepositioning, have all been reported to be effective in the majority of patients [2] . However, in severe cases, life-threatening, refractory hypoxemia may occur [2] . Secondary infections, myocardial disease involvement and a hypercoaguable state with/without pulmonary embolism may also contribute to the complexity of treating these critically ill patients [3] [4] [5] . In such cases rescue therapy may be required. The World Health Organization (WHO) [6] , the Extracorporeal Life Support Organization (www.elso.org) and others have advocated the use of extracorporeal membrane oxygenation (ECMO) for patients with severe cardiorespiratory failure. Few patients in China received ECMO support in the early phase of the pandemic and the mortality rate among these patients was high [7] . Initial experience with COVID-19 in Europe was similar as the high number of critically ill patients disrupted usual care pathways and stretched hospital resources [2] . There was probably some hesitation to provide a form of support which is considered highly resource consuming. However, despite the rapid growth in the number of critically ill COVID-19 patients in Europe, over time an unexpectedly high number of severely compromised patients were considered eligible for ECMO support. At this time the Steering Committee of the European chapter of the Extracorporeal Life Support Organization (Euro-ELSO) initiated prospective data collection among European and Israeli centres with the intention of providing near real-time information on ECMO use in COVID-19. The study was approved by the Maastricht University Ethical Committee (coordinating center) and is registered under ClinicalTrials.gov identifier: NCT04366921. Data are collected weekly and reported anonymously through the Euro-ELSO website https ://www.euroe lso.net/covid -19/covid -19-surve y/. This voluntary study includes basic data on patients´ age and gender, the details of their ECMO treatment and real-time status (i.e., ongoing, successfully weaned, or died). Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) (See Supplementary Fig. 1) . The mean age of treated patients was 52.6 years (range 16-80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO 2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. (Fig. 1) . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients. We also thank for the contribution of the EuroECMO COVID-19 Working Group members listed below for providing data Intensive Care Dept Merijn Kant (Dept. Cardiothoracic Surgery and Intensive care Unit of Cardiac Surgery Department of Pulmonology Dept. of Anesthesiology and Intensive Care Intensive Care Unit Asklepios Klinik Langen, Dept. of Anesthesia, perioperative Medicine and interdisciplinary Intensive Care Medicine Cardio-Thorac-Vascular Surgery and Intensive Care Unit Dept. of Critical Care and Anesthesia Intensive Care, Pole Hospitalier Jolimont Frederik Bonte EC.C.P (AZ Delta Hospital Intensive care Unit, Vall d´Hebron Hospital Intensive Care Unit Coronary Intensive Care Unit Critical Care Dept Critical Care Dept Cardiovascular Surgery Dept., ICCV, Hospital Clínic Intensive Care Unit Intensive Care Unit Intensive Care Unit Intensive Care Unit, Hospital de Valdecilla Intensive Care Unit, Hospital Puerta del Mar Intensive Care Unit Critical Care Dept., Hospital Universitari i Politècnic La Fe Critical Care Dept Critical Care Department Critical Care Dept Critical Care Dept Critical Care Dept., Hospital Universitario Virgen Macarena Unidad de Gestión Clínica de Medicina Intensiva Critical Care Dept., Hospital Universitari Son Espases Cardiac Surgery Dept Cardio-Thoracic Surgery Intensive Care Unit Dept., Assistance Publique-Hopitaux de Paris Cardiothoracic and Vascular Surgery, Henri Mondor Hospital Cardio-vascular surgery Intensive Care de Marne-la Vallee Hospital Center Department of Intensive Care Unit Dept. of Cardio-thoracic Surgery Cardiac Surgery Unit Intensive Care Cardiothoracic Surgery, Central Clinical Hospital Cardiothoracic Intensive Care Unit, University Hospital Dept. of Anesthesia, Resuscitation and Intensive Care Medicine Intensive Care Unit, Guy's and St. Thomas's Hospital and NHS Foundation Trust Cardiothoracic Critical Care Unit Dept. of Anesthesia and Intensive Care Dept. of Anaesthesia, Royal Infirmary Hospital Botkin Infection Hospital & Almazov Centre, S Intensive Care Unit Krasnodar Regional Hospital Dept. of Anaesthesiology and Intensive Care, The Nikiforov Russian Center of Emergency and Radiation Medicine Kosuyolu High Speciality Education and Research Hospital of Cardiovascular Surgery, Dr. Siyami Ersek Cardiovascular Surgery Research and Training Hospital Cardiothoracic Surgery Anesthesia and Intensive Care Cardiothoracic Intensive Care Unit, Sahlgrenska University Hospital Clinical features of patients infected with 2019 novel coronavirus in Wuhan The prevalence, risk factors and outcome of cardiac dysfunction in hospitalized patients with COVID-19 Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan China CRICS TRIGGERSEP Group (clinical research in intensive care and sepsis trial group for global evaluation and research in sepsis) high risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance Extracorporeal membrane oxygenation for coronavirus disease We thank below Euro-ELSO Steering Committee Members for the approval and a critical review of the study: M. Velia Antonini (Intensive Care Unit, University Hospital of Parma, Parma, Italy); Nicholas A. Barrett Conflicts of interest R.L. declares to be a consultant for Medtronic, LivaNova and Member of the Medical Advisory Board for Eurosets. J.B. declares to be a consultant for Abiomed and Getinge. The other authors declare that they have no conflict of interest. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by-nc/4.0/. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Accepted: 30 September 2020