Pre-ECMO characteristics, organ dysfunction and exploratory mortality prediction in COVID-19 versus non-COVID-19 ARDS treated with veno-venous ECMO: a retrospective cohort study

BMC Anesthesiology, vol. 26

Abstract

OBJECTIVE: The transferability of pre-ECMO characteristics and established mortality prediction tools across COVID-19 (C-19) and non-COVID-19 (nC-19) acute respiratory distress syndrome (ARDS) remains uncertain. We compared clinical characteristics, organ dysfunction, respiratory support and outcome in a large cohort of patients treated with veno-venous extracorporeal membrane oxygenation (vvECMO), and explored mortality prediction in C-19 ARDS. METHODS: This retrospective single-center cohort study included n = 600 vvECMO patients (C-19: n = 245, nC-19: n = 355) hospitalized at the Charité ARDS ECMO Center from 01/2007 to 12/2018 (nC-19) and 03/2020-01/2022 (C-19). Pre-ECMO clinical and laboratory variables were compared between cohorts and by ICU survival. RESP score performance was assessed, and an exploratory C-19 ECMO mortality prediction (CEMP) score was derived from pre-ECMO variables using an explainable machine-learning workflow with SHapley Additive exPlanations (SHAP). RESULTS: C-19 patients were older (median 57.0 vs. 51.0 years, p < 0.0001), more often male (74.7% vs. 66.8%, p = 0.0337), and had a higher BMI (29.3 vs. 26.0 kg/m², p < 0.0001). nC-19 patients had a higher CCI (3 vs. 2, p = 0.0137) and SOFA score (12 vs. 11, p = 0.0004). Septic shock before vvECMO initiation was more prevalent in nC-19 patients (65.4% vs. 13.9%, p < 0.0001), and nC-19 patients had higher median baseline bilirubin, creatinine, and lactate levels (all p < 0.0001). nC-19 patients had higher median PEEP, pPeak, and plateau pressure than C-19 patients, whereas their PaO₂/FiO₂ ratio was lower (p < 0.0001). Duration of vvECMO support was longer in C-19 patients (26.0 vs. 12.6 days, p < 0.0001); ICU mortality did not differ significantly (55.1% vs. 47.9%, p = 0.0966). RESP showed limited discrimination in C-19 patients, and the CEMP derivation analysis yielded an apparent AUC of 0.757 (95% CI 0.69-0.82). CONCLUSION: This large single-center comparative vvECMO cohort highlights differences between C-19 and nC-19 ARDS in organ dysfunction burden, respiratory characteristics, and treatment duration. ICU mortality did not differ significantly between groups. RESP showed limited discrimination in C-19; CEMP remains exploratory and requires calibration and independent external validation before clinical application.

Authors 23

1. Mirja Mittermaier

   Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin

   Affiliation as printed

   Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

   Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

2. Jan A. Graw

   Friedrich-Alexander-Universität Erlangen-Nürnberg · Universitätsklinikum Erlangen

   Affiliation as printed

   Department of Anaesthesiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, 91054, Erlangen, Germany

3. Alexander H. Thieme

   Humboldt-Universität zu Berlin · Stanford Medicine · Freie Universität Berlin · Charité - Universitätsmedizin Berlin · Stanford University

   Affiliation as printed

   Center for Biomedical Informatics Research (BMIR), Department of Biomedical Data Science, Stanford University, Stanford, CA, USA

   Department of Medicine, Stanford University, Stanford, CA, USA

   Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

4. Johann Lieberwirth

   Humboldt-Universität zu Berlin

   Affiliation as printed

   Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

5. Oliver Hunsicker

   Humboldt-Universität zu Berlin

   Affiliation as printed

   Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, CCM/CVK, Augustenburger Platz 1, 13353, Berlin, Germany

6. Daniel Zickler

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

   Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany

7. Jan Matthias Kruse

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

   Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany

8. Alexander Uhrig

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

   Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

9. Panagiotis Pergantis

   Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

   Affiliation as printed

   ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

   Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

10. Carmen Garcia

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

11. Felix Machleidt

    Humboldt-Universität zu Berlin

    Affiliation as printed

    Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

12. Till Jacobi

    Humboldt-Universität zu Berlin

    Affiliation as printed

    Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

13. Victoria Bünger

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, CCM/CVK, Augustenburger Platz 1, 13353, Berlin, Germany

14. Michaela Ludmilla Merten

    Witten/Herdecke University · Kliniken der Stadt Köln

    Affiliation as printed

    Department of Pneumology and Critical Care Medicine, ARDS and ECMO centre, Cologne- Merheim Hospital, Kliniken der Stadt Köln gGmbH, Cologne, Germany

    Witten/Herdecke University, Witten, Germany

15. Micha Landoll Aachen Department of Cardiovascular Engineering Institute of Applied Medical Engineering Medical Faculty Institute for Computational Biomedicine

    Kliniken der Stadt Köln · RWTH Aachen University

    Affiliation as printed

    Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Aachen, Germany

    Department of Pneumology and Critical Care Medicine, ARDS and ECMO centre, Cologne- Merheim Hospital, Kliniken der Stadt Köln gGmbH, Cologne, Germany

    Institute for Computational Biomedicine, Medical Faculty, RWTH Aachen University, Aachen, Germany

16. Christian Karagiannidis

    Witten/Herdecke University · Kliniken der Stadt Köln

    Affiliation as printed

    Department of Pneumology and Critical Care Medicine, ARDS and ECMO centre, Cologne- Merheim Hospital, Kliniken der Stadt Köln gGmbH, Cologne, Germany

    Witten/Herdecke University, Witten, Germany

17. Leif-Erik Sander

    Humboldt-Universität zu Berlin · Berlin Institute of Health at Charité - Universitätsmedizin Berlin

    Affiliation as printed

    Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

18. Kai-Uwe Eckardt

    Humboldt-Universität zu Berlin

    Affiliation as printed

    Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité-Universitätsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany

19. Claudia Spies

    Humboldt-Universität zu Berlin

    Affiliation as printed

    Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, CCM/CVK, Augustenburger Platz 1, 13353, Berlin, Germany

20. Martin Witzenrath

    Humboldt-Universität zu Berlin · German Center for Lung Research · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

    German Center for Lung Research (DZL), Berlin, Germany

21. Steffen Weber-Carstens

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, CCM/CVK, Augustenburger Platz 1, 13353, Berlin, Germany

22. Mario Menk

    University Hospital Carl Gustav Carus

    Affiliation as printed

    Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany

23. Holger Müller-Redetzky corresponding

    Humboldt-Universität zu Berlin · Charité - Universitätsmedizin Berlin

    Affiliation as printed

    ARDS/ECMO Centrum Charité, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany. holger.mueller-redetzky@charite.de

    Department of Infectious Diseases, Respiratory Medicine and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany. holger.mueller-redetzky@charite.de