Abstract
(1) Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. (2) Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (ECMO-after group) and before the end of the 10-day dexamethasone course (ECMO-before group). (3) Results: Forty patients (28M/12F; age, 57 years (51–62) (median (25th–75th percentiles)) were included, 28 (70%) in the ECMO-before and 12 (30%) in the ECMO-after group. In the ECMO-before group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the ECMO-after group (p < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the ECMO-before group tended to be younger (57 years (51–59) versus 62 years (57–67), p = 0.053). In the ECMO-after group, no patient (0%) survived while 12 patients (43%) survived in the ECMO-before group (p = 0.007). (4) Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.
Highlights
Clinical trials supporting the benefit of corticosteroids included only a minority of COVID-19 patients treated with extracorporeal membrane oxygenation (ECMO) early in the clinical course
intensive care unit (ICU) including 47 patients treated with ECMO
We identified a COVID-19 population with an extremely high risk of death despite management based on current knowledge on acute respiratory distress syndrome (ARDS) treatment including ECMO rescue therapy; we could not determine the exact causes of severity and the optimal therapeutic strategies to improve survival
Summary
Treatment of acute respiratory distress syndrome (ARDS) induced by coronavirus disease-2019 (COVID-19) relies on supportive intensive care, optimized mechanical ventilation and immunomodulatory treatments including a 10-day course of corticosteroids (based on the RECOVERY study) [1] and/or other immune modulators such as tocilizumab [2]. In a large multicenter cohort study, survival of ECMO-treated COVID-19 patients was found to be ~46% [4]; but less than 30% of the selected patients received corticosteroids. In other large published cohorts, corticosteroids were not even accounted for. Clinical trials supporting the benefit of corticosteroids included only a minority of COVID-19 patients treated with ECMO early in the clinical course. In the RECOVERY study, only 16% of the patients were mechanically ventilated and/or treated with ECMO at randomization [1]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
