Opportunities and limitations of ECMO therapy for severe Covid-19

ECMO as the “last resort” of intensive therapy

During the corona pandemic, ECMO therapy was often considered a “last resort” for intensive care treatment for people with severe Covid-19 disease and respiratory insufficiency. A machine with an “artificial lung” (oxygenator) takes over the function of the diseased organ by enriching the incoming venous blood with oxygen, removing carbon dioxide and returning the blood to the affected person's circulation. In order to better assess and qualify the benefits of this procedure for the care of Covid-19 sufferers, the research group has retrospectively compiled case data from the central Ruhr area. These related to the period from March 1, 2020 to August 31, 2021, in which the first three waves of the pandemic manifested themselves. All 149 people (63.8 % male, mean age 67 years) required invasive mechanical ventilation during their inpatient care, 50 of whom also received so-called veno-venous ECMO therapy, which supports lung function.

Comparison of Germany and Europe: More maximum therapy despite old age

The result was a high mortality rate in the patient population considered (total: 72.5 %, ECMO: 80.0 %). “Our findings are consistent with other registry data collected in Germany,” explains study leader Dr. Assem Aweimer, senior physician at the Clinic for Cardiology and Angiology at Bergmannsheil. “In addition, they prove the well-known finding that in Germany a higher mortality rate is observed for ventilated Covid-19 patients with and without ECMO than in various other European countries.” A key reason for this can be assumed to be that in this country, too, comparatively Many elderly patients are treated with invasive ventilation and ECMO therapy.

Almost half (49 %) of all patients considered in the study were 70 years of age and older; the mortality rate in this age group was 89 %. The use of ECMO therapy in Germany is not restricted by older age due to its widespread availability - unlike in other European countries, says Dr. Aweimer: “In our study, the average age at ECMO use was 58 years, which is significantly higher than in other European countries, where it is between 49 and 52 years.”

Rapid hospitalization after the onset of symptoms appears to be an important factor

Another notable finding: in patients who died, the period from the onset of symptoms to admission to the clinic was on average 2 days longer than in survivors. This applied regardless of whether the patients were also treated with ECMO or not. Rapid inpatient treatment could have had a positive impact on the chances of recovery, according to the research team. It also points to the very high consumption of resources, such as platelet concentrates, which was associated with carrying out ECMO therapy in the study population.

First study of its kind for the central Ruhr area

“Our study specifically focuses on the Ruhr metropolitan area and is therefore the first of its kind for this region. As a result, it provides important impetus for developing treatment standards and sharpening the parameters that suggest the use of highly complex ECMO therapy,” says Prof. Dr Andreas Mügge, Director of the Medical Clinic II at Bergmannsheil and St. Josef Hospital. “The scientific discussion must be continued so that we can use and implement this important treatment option for people with life-threatening illnesses in the best possible way.”

Four clinics involved

As part of the study, case data from four university hospitals at the Ruhr University Bochum were compiled by Lea Petschulat as part of a doctoral thesis. In addition to Bergmannsheil, study leader Dr. Assem Aweimer the St. Josef Hospital (Prof. Dr. Andreas Mügge), the Miners' Hospital Bochum (Prof. Dr. Michael Adamzik) and the Marien Hospital Herne (Prof. Dr. Ulrich Frey).