ECMO for COVID-19 patients in Europe and Israel

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) .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 PaO2 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. . 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

Conditions affecting the capacity for cardioprotection by preconditioning (IPreC) obtained by substracting the LDH values of the I/R alone group from the IPreC group for each individual patients and then compared with the mean value of the remainder study population.

<p>Conditions affecting the capacity for cardioprotection by preconditioning (IPreC) obtained by substracting the LDH values of the I/R alone group from the IPreC group for each individual patients and then compared with the mean value of the remainder study population.</p

Indexes of basal redox status in human right atrial tissue (n = 90) from patients with conditions that affect myocardial susceptibilility to I/R-induced injury and the capacity for IPreC-mediated protection.

<p>Indexes of basal redox status in human right atrial tissue (n = 90) from patients with conditions that affect myocardial susceptibilility to I/R-induced injury and the capacity for IPreC-mediated protection.</p

Lactate dehydrogenase (LDH) leakage (A1) and 3-(4,5-dimethyl thiazol-2-yl)-2,5diphenyl tetrazolium bromide (MTT) reduction (B1) and the correlation between IPreC and I/R alone for LDH release (A2) and MTT reduction (B2) of human myocardium muscles (n = 300 per group) subjected to 250 min of aerobic condictions (AC), 90 min of ischemia followed by 120 min of reoxygenation (I/R alone), or ischemic preconditioning (IPreC) induced by 5 min of ischemia followed by 5 min of reoxygenation prior to the 90 min of ischemia.

<p>The mean values are shown. *<i>p</i> < 0.05 vs AC group and †<i>p</i> < 0.05 vs I/R alone group.</p

Conditions affecting the susceptibility to ischemia/reoxygenation (I/R)-induced injury obtained by substracting the LDH values of the AC group from the I/R alone group for each individual patients and then compared with the mean value of the remainder study population.

<p>Conditions affecting the susceptibility to ischemia/reoxygenation (I/R)-induced injury obtained by substracting the LDH values of the AC group from the I/R alone group for each individual patients and then compared with the mean value of the remainder study population.</p

Demographic data of study patients.

<p>Demographic data of study patients.</p

Experimental protocol.

<p>Tissues in all groups were equilibrated for 30–40 min at 37°C in aerobic conditions. Muscle tissues were either maintained under aerobic conditions (AC) for the entire experimental period or subjected to 90 min of ischemia followed by 120 min of ischemia/reoxygenation (I/R alone) or preconditioned (IPreC) with 5 min of ischemia and 5 min of reoxygenation.</p