Extracorporeal Membrane Oxygenation for Respiratory Failure Related to COVID-19

Table 1.  Patient Characteristics before Hospitalization

Characteristics	No.	Full Cohort (n = 429)	Vital Status		P Value
			Nonsurvivors (n = 219)	Survivors (n = 210)
Age	428	54 (46–60)	56 (49–62)	51 (43–58)	< 0.001
< 40 yr		56 (13)	19 of 218 (9)	37 of 210 (18)
40–49 yr		96 (22)	38 of 218 (17)	58 of 210 (28)
50–59 yr		160 (37)	85 of 218 (39)	75 of 210 (36)
60–69 yr		103 (24)	66 of 218 (30)	37 of 210 (18)
> 70 yr		13 (3)	10 of 218 (5)	3 of 210 (1)
Sex	429				0.046
Female		91 (21)	38 of 219 (17)	53 of 210 (25)
Male		338 (79)	181 of 219 (83)	157 of 210 (75)
Body mass index	413	30 (27–34)	29 (27–34)	31 (28–35)	0.132
< 25 kg of m2		53 (13)	28 of 206 (14)	25 of 207 (12)
25–30 kg of m2		147 (36)	79 of 206 (38)	68 of 207 (33)
30–35 kg of m2		121 (29)	61 of 206 (30)	60 of 207 (29)
35–40 kg of m2		56 (14)	20 of 206 (10)	36 of 207 (17)
> 40 kg of m2		36 (9)	18 of 206 (9)	18 of 207 (9)
Comorbidities
Hypertension	429	165 (38)	83 of 219 (38)	82 of 210 (39)	0.807
Diabetes	425	127 (30)	70 of 218 (32)	57 of 207 (28)	0.303
Chronic obstructive pulmonary disease	429	14 (3)	8 of 219 (4)	6 of 210 (3)	0.643
Chronic respiratory failure	429	13 (3)	7 of 219 (3)	6 of 210 (3)	0.838
Congestive heart failure	308	3 (1)	1 of 169 (1)	2 of 169 (1)	0.591
Coronary artery disease	429	21 (5)	10 of 219 (5)	11 of 139 (8)	0.747
Chronic kidney disease	309	11 (4)	7 of 171 (4)	4 of 138 (3)	0.760
Malignancy
Cancer	306	6 (2)	6 of 168 (4)	0 of 138 (0)	0.034
Hematological malignancy	306	3 (1)	1 of 168 (1)	2 of 138 (1)	0.591
Active smoker	423	17 (4)	10 of 216 (5)	7 of 207 (3)	0.514
Alcohol abuse	301	8 (3)	3 of 166 (2)	5 of 135 (4)	0.474
History of venous thromboembolism	306	11 (4)	7 of 168 (4)	4 of 138 (3)	0.760
Pre-ECMO medications
Steroids (corticotherapy)	307	17 (6)	10 of 169 (6)	7 of 138 (5)	0.748
Nonsteroidal anti-inflammatory drugs	307	7 (2)	4 of 167 (2)	3 of 140 (2)	> 0.999
Angiotensin-converting enzyme inhibitors	305	29 (10)	14 of 167 (8)	15 of 138 (11)	0.461
Angiotensin receptor blockers	306	44 (14)	23 of 168 (14)	21 of 138 (15)	0.705

The results are presented as n (%) or median (interquartile range).
ECMO, extracorporeal membrane oxygenation.

Table 2.  Clinical Condition and Management before ECMO

Condition/Management	No.	Full Cohort (n = 429)	Vital Status		P Value
			Nonsurvivors (n = 219)	Survivors (n = 210)
Delay from hospitalization to ICU admission	428	0 (0–0)	0 (0–0)	0 (0–0)	0.622
< 24 h		329 (77)	169 of 218 (78)	160 of 210 (76)
24–48 h		52 (12)	30 of 218 (14)	22 of 210 (10)
> 72 h		47 (11)	19 of 218 (9)	28 of 210 (13)
ECMO cannulation	426				0.141
Referral center		234 (55)	128 of 216 (59)	106 of 210 (50)
Mobile ECMO unit, no transfer		41 (10)	21 of 216 (10)	20 of 210 (10)
Mobile ECMO unit, transfer to referral center		151 (35)	67 of 216 (31)	84 of 210 (40)
ARDS (Berlin criteria) at cannulation	421	417 (99)	210 of 213 (99)	207 of 208 (100)	0.623
Noninvasive ventilation	426	104 (24)	64 of 217 (29)	40 of 209 (19)	0.013
High-flow oxygen therapy	307	125 (41)	74 of 168 (44)	51 of 139 (37)	0.192
Ventilation duration before ECMO	428	5 (3–8)	6 (3–8)	5 (3–7)	0.057
< 2 days		94 (22)	43 of 218 (20)	51 of 210 (24)
2–7 days		221 (52)	105 of 218 (48)	116 of 210 (55)
> 7 days		113 (26)	70 of 218 (32)	43 of 210 (20)
pH at cannulation	408	7.33 (7.25–7.39)	7.31 (7.22–7.37)	7.35 (7.29–7.41)	< 0.001
Paco2 at cannulation, mmHg	406	55 (46–65)	57 (48–68)	54 (45–62)	0.005
PAO2 of FIO2 ratio at cannulation, mmHg	404	67 (57–82)	67 (58–84)	67 (57–81)	0.625
PEEP at cannulation, cm H2O	385	12 (10–14)	12 (10–14)	12 (10–14)	0.747
VT at cannulation	353	5.9 (5.2–6.3)	5.8 (5.1–6.2)	5.9 (5.3–6.3)	0.244
< 6 ml/kg ideal body weight		216 (61)	113 of 178 (63)	103 of 175 (59)
6–8 ml/kg ideal body weight		132 (37)	63 of 178 (35)	69 of 175 (39)
> 8 ml/kg ideal body weight		5 (1)	2 of 178 (1)	3 of 175 (2)
Respiratory rate at cannulation, breaths/min	348	28 (20–30)	28 (22–30)	28 (20–30)	0.321
Ventilatory ratio*	315	2.2 (1.5–3.0)	2.4 (1.7–3.1)	2.1 (1.5–2.9)	< 0.001
Plateau pressure at cannulation, cm H2O	331	30 (27–32)	30 (26–33)	30 (27–32)	0.414
Driving pressure at cannulation, cm H2O	327	17 (14–20)	17 (13–21)	17 (14–20)	0.297
Neuromuscular blocking agents	427	419 (98)	213 of 218 (98)	206 of 209 (99)	0.725
Prone position	429	411 (96)	207 of 219 (95)	204 of 210 (97)	0.176
Inhaled NO	401	161 (40)	90 of 206 (44)	71 of 195 (36)	0.137
Renal replacement therapy	423	51 (12)	34 of 213 (16)	17 of 210 (8)	0.013
Antiviral therapy	305	179 (59)	96 of 168 (57)	83 of 137 (61)	0.544
Remdesivir		7 (2)	4 of 168 (2)	4 of 137 (3)	> 0.999
Lopinavir/ritonavir		58 (19)	36 of 168 (21)	36 of 137 (26)	0.130
Hydroxychloroquine		102 (33)	52 of 168 (31)	52 of 137 (38)	0.360
Interferon-β		4 (1)	4 of 168 (2)	4 of 137 (3)	0.125
Others		59 (19)	34 of 168 (20)	34 of 137 (25)	0.486
Antibiotic therapy	305	296 (97)	162 of 168 (96)	134 of 137 (98)	0.522
Anticoagulation	294				0.033
No		19 (6)	5 of 161 (3)	14 of 133 (11)
Curative		139 (47)	77 of 161 (48)	62 of 133 (47)
Prophylactic		136 (46)	79 of 161 (49)	57 of 133 (43)
Selective digestive decontamination	304	13 (4)	10 of 166 (6)	3 of 138 (2)	0.099
SOFA score at cannulation	395	9 (8–12)	11 (8–13)	9 (8–12)	0.004
Septic shock	312	35 (11)	25 of 172 (15)	10 of 140 (7)	0.040
Cardiovascular SOFA ≥ 3 at cannulation	422	216 (51)	126 of 215 (59)	90 of 207 (43)	0.002
Left ventricular ejection fraction, %	191	60 (60–65)	60 (55–60)	60 (60–65)	0.722
Vasoactive/inotropic drugs
Norepinephrine	306	176 (58)	103 of 168 (61)	73 of 138 (53)	0.139
Epinephrine	304	10 (3)	8 of 166 (5)	2 of 138 (1)	0.119
Dobutamine	304	8 (3)	5 of 166 (3)	3 of 137 (2)	0.732
Lactatemia at cannulation, mmol/l	366	1.7 (1.2–2.3)	1.7 (1.3–2.4)	1.6 (1.2–2.1)	0.012
Total bilirubin at cannulation	409				0.023
< 1.2 mg/dl		291 (71)	147 of 207 (71)	144 of 202 (71)
1.2–1.9 mg/dl		50 (12)	20 of 207 (10)	30 of 202 (15)
2.0–5.9 mg/dl		57 (14)	30 of 207 (14)	27 of 202 (13)
≥ 6.0 mg/dl		11 (3)	10 of 207 (5)	1 of 202 (0)

The results are presented as n (%) or median (interquartile range).
*The ventilatory ratio is defined as [minute ventilation (ml/min) × Paco2 (mmHg)]/(predicted body weight × 100 × 37.5).
ARDS, acute respiratory distress syndrome; ECMO, extracorporeal membrane oxygenation; FIO₂, fractional inspired oxygen tension; ICU, intensive care unit; PEEP, positive end-expiratory pressure; SOFA, Sequential Organ Failure Assessment; V_T, tidal volume.

Table 3.  Blood Gases and Ventilator Settings Pre-ECMO the Day of Implantation and the Day after Cannulation

Blood Gases/Settings	Nonsurvivors (n = 219)					Survivors (n = 210)
	Pre-ECMO Day of Cannulation		Post-ECMO Day 1		P Value	Pre-ECMO Day of Cannulation		Post-ECMO Day 1		P Value
	No.	Median (Interquartile Range)	No.	Median (Interquartile Range)		No.	Median (Interquartile Range)	No.	Median (Interquartile Range)
pH	207	7.31 (7.22–7.37)	209	7.40 (7.34–7.45)	0.010	201	7.35 (7.29–7.41)	206	7.42 (7.37–7.47)	< 0.001
PAO2, mmHg	208	64 (57–77)	209	79 (65–101)	0.001	199	65 (54–73)	206	83 (70–106)	< 0.001
Paco2, mmHg	206	57 (48–68)	206	44 (40–50)	< 0.001	200	54 (45–62)	206	45 (39–50)	< 0.001
FIO2, %	210	100 (100–100)	210	70 (50–100)	< 0.001	201	100 (100–100)	206	60 (50–80)	< 0.001
PAO2/FIO2 ratio, mmHg	208	67 (58–84)	209	116 (90–160)	< 0.001	196	67 (57–81)	204	134 (104–208)	< 0.001
PEEP, cm H2O	201	12 (10–14)	199	12 (10–14)	0.134	184	12 (10–14)	182	12 (10–14)	0.176
VT, ml/kg ideal body weight	178	5.8 (5.1–6.2)	178	3.2 (2.2–4.5)	< 0.001	175	5.9 (5.3–6.3)	185	3.5 (2.6–4.5)	< 0.001
Respiratory Rate, breaths/min	183	28 (22–30)	190	16 (12–20)	< 0.001	165	28 (20–30)	184	18 (12–20)	< 0.001
Plateau pressure, cm H2O	173	30 (26–33)	171	26 (24–28)	< 0.001	158	30 (27–32)	166	25 (23–28)	< 0.001
Driving pressure, cm H2O	171	17 (13–21)	168	14 (11–16)	< 0.001	156	17 (14–20)	159	12 (11–15)	< 0.001

The results are presented as median (interquartile range). The P values are for bivariate analysis between pre- and post-ECMO.
ECMO, extracorporeal membrane oxygenation; FIO₂, fractional inspired oxygen tension; PEEP, positive end-expiratory pressure; VT, tidal volume.

Table 4.  Outcomes and Complications on ECMO

Outcomes and Complications	No.	Full Cohort (n = 429)	Vital Status		P Value
			Nonsurvivors (n = 219)	Survivors (n = 210)
Total ECMO duration, days		12 (8–21)	11 (6–21)	13 (8–21)	0.751
ECMO-free days at day 28, days	414	0 (0–14)	0 (0–0)	14 (6–19)	< 0.001
Conversion to venoarterial-venous ECMO	429	9 (2)	8 of 219 (4)	1 of 210 (0)	0.038
Cannulation mode	425				0.823
Femoro-jugular		388 (91)	196 of 217 (90)	192 of 208 (92)
Femoro-femoral		27 (6)	16 of 217 (7)	11 of 208 (5)
Bicaval dual lumen		6 (1)	2 of 217 (1)	4 of 208 (2)
Not specified		4 (1)	3 of 217 (1)	1 of 208 (0)
Total ventilation duration, days	390	27 (16–41)	18 (12–34)	31 (24–46)	< 0.001
Ventilator-free days at day 28, days	425	0 (0–0)	0 (0–0)	0 (0–4)	< 0.001
Tracheostomy	424	90 (21)	11 of 217 (5)	79 of 207 (38)	< 0.001
Prone position	425	301 (71)	145 of 216 (67)	156 of 209 (75)	0.089
Respiratory ECMO Survival Prediction score	240	1 (0–3)	1 (0–3)	2 (0–4)	< 0.001
Vasoactive/inotropic drugs
Norepinephrine	304	255 (84)	154 of 167 (92)	101 of 137 (74)	< 0.001
Epinephrine	305	15 (5)	13 of 168 (8)	2 of 137 (1)	0.012
Dobutamine	304	16 (5)	11 of 167 (7)	5 of 137 (4)	0.254
Hemorrhagic complications	426	169 (40)	107 of 217 (49)	62 of 209 (30)	< 0.001
Cannula site bleeding		77 (18)	54 of 107 (50)	23 of 62 (37)
Gastrointestinal bleeding		26 (6)	20 of 107 (19)	6 of 62 (10)
Pulmonary hemorrhage		37 (9)	27 of 107 (25)	10 of 62 (16)
Retroperitoneal bleeding		4 (1)	3 of 107 (3)	1 of 62 (2)
Massive hemorrhage		20 (5)	15 of 107 (14)	5 of 62 (8)
Number of packed red blood cells transfused	300	4 (2–8)	6 (3–10)	3 (0–6)	< 0.001
Thrombotic complications	427	159 (37)	84 of 217 (39)	75 of 210 (36)	0.522
Deep vein thrombosis		33 (8)	9 of 84 (11)	24 of 75 (32)
Pulmonary embolism		48 (11)	28 of 84 (33)	20 of 75 (27)
Circuit clot		66 (15)	32 of 84 (38)	34 of 75 (45)
Circuit change		56 (13)	32 of 84 (38)	24 of 75 (32)
Membrane lung failure		35 (8)	25 of 84 (30)	10 of 75 (13)
Neurologic complications	425	47 (11)	41 of 216 (19)	6 of 209 (3)	< 0.001
Seizures		2 (0)	2 of 41 (5)	0 of 6 (0)
Ischemic stroke		5 (1)	3 of 41 (7)	2 of 6 (33)
Hemorrhagic stroke		38 (9)	35 of 41 (85)	3 of 6 (50)
Acute limb ischemia	424	4	4 (100)	0 (0)	0.124
Acute mesenteric ischemia	427	4	4 (100)	0 (0)	0.123
Acute kidney injury on ECMO	424	192 (45)	134 of 216 (62)	58 of 208 (28)	< 0.001
Renal replacement therapy		149 (35)	104 of 134 (78)	45 of 58 (78)
Extracorporeal blood purification device	326	50 (15)	34 of 178 (19)	16 of 148 (11)	0.039
Ventilator-associated pneumonia	426	277 (65)	137 of 219 (63)	140 of 210 (67)	0.405
Timing of ventilator-associated pneumonia	169				0.235
Before ECMO		83 (49)	50 of 94 (53)	33 of 75 (44)
After ECMO		86 (51)	44 of 94 (47)	42 of 75 (56)
Infectious complications	428	235 (55)	112 of 218 (51)	123 of 210 (59)	0.135
Bacteremia		176 (41)	87 of 112 (78)	89 of 123 (72)
Cannula site infection		36 (8)	16 of 112 (14)	20 of 123 (16)
Infection under ECMO-free days, days*	323	9 (3–21)	7 (2–12)	13 (5–28)	< 0.001
ICU duration, days	411	35 (17–54)	18 (10–34)	34 (26–54)	< 0.001
ICU-free days at day 28, days	412	0 (0–0)	0 (0–0)	0 (0–2)	< 0.001
Hospitalization duration, days	395	35 (17–54)	21 (12–36)	52 (37–71)	< 0.001

The results are presented as n (%) or median (interquartile range).
*Infection under ECMO includes ventilator-associated pneumonia, bacteremia, and cannula site infection.
ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit.

Table 5.  Pre-ECMO Variables Associated with In-hospital Mortality in Multivariable Analysis

Variables	Hazard Ratio (95% CI)*
Neuromuscular blocking agents†	0.286 (0.101–0.81)
Ventilation duration before ECMO†
< 2 days	1
2–7 days	1.37 (0.89–2.10)
> 7 days	1.74 (1.07–2.83)
Age (10-yr increase)‡	1.27 (1.07–1.50)
Total bilirubin at implantation‡
< 1.2 mg/dl	1
1.2–1.9 mg/dl	0.88 (0.51–1.50)
2.0–5.9 mg/dl	1.16 (0.72–1.86)
≥ 6.0 mg/dl	2.65 (1.09–6.4)

*Hazard ratio with 95% CI, based on multivariable Cox model of exposure variables fully adjusted for all confounders, after multiple imputation (see model 4, Supplemental Digital Content 1, table S2, http://links.lww.com/ALN/C809). †Defined as pre-ECMO modifiable exposure variables in the model (see Supplemental Digital Content 1, Figure S1, http://links.lww.com/ALN/C809). ‡Defined as patient-related confounders and pre-ECMO hospitalization-related confounders in the model (see Supplemental Digital Content 1, Figure S1, http://links.lww.com/ALN/C809).
ECMO, extracorporeal membrane oxygenation.

Authors and Disclosures

Nicolas Nesseler, M.D., Ph.D
Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France; University of Rennes, University Hospital of Rennes, National Research Institute for Agriculture, National Institute of Health and Medical Research, Institute of Nutrition, Metabolism, and Cancer, Mixed Research Unit_1341, Mixed Research Unit_1241, Rennes, France.

Guillaume Fadel, M.D.
Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, Pitié-Salpétriêre Hospital, Paris, France.

Alexandre Mansour, M.D.
Department of Anesthesia and Critical Care, Pontchaillou, University Hospital of Rennes, Rennes, France; University of Rennes, University Hospital of Rennes, National Institute of Health and Medical Research, Center of Clinical Investigation of Rennes 1414, Rennes, France.

Marylou Para, M.D.
Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, Public Assistance-Hospitals of Paris, Paris, France; University of Paris, Mixed Research Unit_1148, Laboratory of Vascular Translational Science, Paris, France.

Pierre-Emmanuel Falcoz, M.D., Ph.D.
National Institute of Health and Medical Research, Mixed Research Unit_1260, Regenerative Nanomedicine, Translational Medicine Federation, Strasbourg, France; University of Strasbourg, Pharmacy and Medical School, Strasbourg, France; University Hospital of Strasbourg, Thoracic Surgery Department, New Hospital Civil, Strasbourg, France.

Nicolas Mongardon, M.D., Ph.D.
Department of Anesthesia and Critical Care, Medical-University Department, Surgery, Anesthesiology, Surgical Intensive Care Units, University Hospital Department Ageing Thorax-Vessels-Blood, Public Assistance-Hospitals of Paris, Henri Mondor University Hospitals, Créteil, France; University of East Paris Créteil, School of Medicine, Créteil, France; U955-Mondor Institute of Biomedical Research, Equipe 03, Pharmacology and Technologies for Cardiovascular Diseases, National Institute of Health and Medical Research, University of East Paris Créteil, National Veterinary School of Alfort, Maisons-Alfort, France.

Alizée Porto, M.D.
Department of Cardiac Surgery, Timone Hospital, Marseille Public University Hospital System, 13005, Marseille, France.

Astrid Bertier, M.D.
Intensive Care Unit, Bicêtre Hospital, Public Assistance-Hospitals of Paris, Paris, France.

Bruno Levy, M.D., Ph.D.
Intensive Care Unit, CHRU Nancy, Pôle Cardio-Médico-Chirurgical, Vandoeuvre-lès-Nancy, France; National Institute of Health and Medical Research U1116, Faculty of Medicine, Vandoeuvre-lès-Nancy, France; University of Lorraine, Nancy, France.

Cyril Cadoz, M.D.
Polyvalent Intensive Care Unit, Mercy Hospital, Regional Hospital, Metz-Thionville, France.

Pierre-Grégoire Guinot, M.D., Ph.D.
Department of Anesthesiology and Critical Care Medicine, Dijon University Hospital, Dijon, France.

Olivier Fouquet, M.D., Ph.D.
Department of Thoracic and Cardiovascular Surgery, University Hospital, Angers, France; Mitochondrial and Cardiovascular Pathophysiology Institute, French National Centre for Scientific Research, Mixed Research Unit_6214, National Institute of Health and Medical Research U1083, University of Angers, Angers, France.

Jean-Luc Fellahi, M.D., Ph.D.
Department of Anesthesia and Critical Care, Louis Pradel Hospital, University Hospital of Lyon, Lyon, France; CarMeN Laboratory, National Institute of Health and Medical Research, Mixed Research Unit_1060, Claude Bernard Lyon University, Lyon, France.

Alexandre Ouattara, M.D., Ph.D.
University Hospital of Bordeaux, Department of Anesthesia and Critical Care, Magellan Medico-Surgical Center, Bordeaux, France; National Institute of Health and Medical Research, Mixed Research Unit 1034, Biology of Cardiovascular Diseases, Pessac, France.

Julien Guihaire, M.D., Ph.D.
Department of Cardiac Surgery, National Institute of Health and Medical Research, Mixed Research Unit_999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, University of Paris-Saclay School of Medicine, Le Plessis Robinson, France.

Vito-Giovanni Ruggieri, M.D., Ph.D.
Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Reims, France.

Philippe Gaudard, M.D., Ph.D.
Department of Anesthesia and Critical Care, PhyMedExp, Montpellier University, National Institute of Health and Medical Research, French National Centre for Scientific Research, University Hospital of Montpellier, Montpellier, France.

François Labaste, M.D., Ph.D.
Anesthesiology and Intensive Care Department, University Hospital of Toulouse, Toulouse, France; Metabolic and Cardiovascular Diseases Institute, National Institute of Health and Medical Research U1048, University of Toulouse, Paul Sabatier University, Toulouse, France.

Thomas Clavier, M.D.
Department of Anesthesiology, Critical Care and Perioperative Medicine, University Hospital of Rouen, Rouen, France.

Kais Brini, M.D.
Polyvalent and Cardiac Intensive Care Unit, Montsouris Mutualist Institute, Paris, France.

Nicolas Allou, M.D.
Polyvalent Intensive Care Unit, Félix Guyon-Saint-Denis University Hospital, La Réunion, Saint Denis, France.

Corentin Lacroix, M.D.
Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France.

Juliette Chommeloux, M.D.
Sorbonne University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Intensive Care Unit, Cardiology Unit, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.

Guillaume Lebreton, M.D., Ph.D.
Sorbonne Université, University, National Institute of Health and Medical Research, Mixed Research Unit_1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; Department of Thoracic and Cardiovascular Surgery, Cardiology Institute, Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.

Michael A. Matthay, M.D., Ph.D.
Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California.

Sophie Provenchere, M.D., Ph.D.
University of Paris, Department of Anesthesiology and Intensive Care, Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris, France; Clinical Investigation Center 1425, Public Assistance-Hospitals of Paris, National Institute of Health and Medical Research, Paris, France.

Erwan Flécher, M.D., Ph.D.
Department of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, University of Rennes 1, Signal and Image Treatment Laboratory, National Institute of Health and Medical Research U1099, Rennes, France.

André Vincentelli, M.D., Ph.D.
Department of Cardiac Surgery, University Hospital of Lille, Lille, France.

Appendix: Ecmosars Investigators

Marc Pierrot, M.D., University Hospital of Angers, Angers, France, collected data, provided and cared for study patients

Sidney Chocron, M.D., Ph.D., University Hospital of Besançon, Besançon, France, collected data, provided and cared for study patients

Guillaume Flicoteaux, M.D., University Hospital of Besançon, Besançon, France, collected data, provided and cared for study patients

Philippe Mauriat, M.D., University Hospital of Bordeaux, Bordeaux, France, critically reviewed the study proposal

Hadrien Roze, M.D., University Hospital of Bordeaux, Bordeaux, France, collected data, provided and cared for study patients

Olivier Huet, M.D., Ph.D., University Hospital of Brest, Brest, France, collected data, provided and cared for study patients

Marc-Olivier Fischer, M.D., Ph.D., University Hospital of Caen, Caen, France, collected data, provided and cared for study patients

Claire Alessandri, M.D., Public Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Raphel Bellaïche, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Ophélie Constant, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Quentin de Roux, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

André Ly, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Arnaud Meffert, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Jean-Claude Merle, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Lucile Picard, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Elena Skripkina, M.D, Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Thierry Folliguet, M.D., Ph.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Antonio Fiore, M.D., Public Assistance-Hospitals of Paris, University Hospital Henri Mondor, Créteil, France, provided and cared for study patients

Nicolas d'Ostrevy, M.D., University Hospital of Clermont-Ferrand, collected data, provided and cared for study patients

Marie-Catherine Morgan, M.D., University Hospital of Dijon, Dijon, France, collected data, provided and cared for study patients

Maxime Nguyen, M.D., University Hospital of Dijon, Dijon, France, collected data, provided and cared for study patients

Lucie Gaide-Chevronnay, M.D., University Hospital of Grenoble, Grenoble, France, collected data, provided and cared for study patients

Nicolas Terzi, M.D., Ph.D., University Hospital of Grenoble, Grenoble, France, collected data, provided and cared for study patients

Gwenhaël Colin, M.D., Vendée Hospital, La Roche-sur-Yon, France, collected data, provided and cared for study patients

Olivier Fabre,, M.D., Hospital of Lens, Lens, France, collected data, provided and cared for study patients

Arash Astaneh, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Justin Issard, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Elie Fadel, M.D., Ph.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Dominique Fabre, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Antoine Girault, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Iolande Ion, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Jean Baptiste Menager, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Delphine Mitilian, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Olaf Mercier, M.D., Ph.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

François Stephan, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Jacques Thes, M.D., Marie-Lannelongue Hospital, Le Plessis-Robinson, France, collected data, provided and cared for study patients

Jerôme Jouan, M.D., University Hospital of Limoges, Limoges, France, collected data, provided and cared for study patients

Thibault Duburcq, M.D., University Hospital of Lille, Lille, France, collected data, provided and cared for study patientsValentin Loobuyck, M.D., University Hospital of Lille, Lille, France, collected data, provided and cared for study patientsSabrina Manganiello, M.D., University Hospital of Lille, Lille, France, collected data, provided and cared for study patients

Mouhammed Moussa, M.D., University Hospital of Lille, Lille, France, collected data, provided and cared for study patients

Agnes Mugnier, M.D., University Hospital of Lille, Lille, France, collected data, provided and cared for study patients

Natacha Rousse, M.D., University Hospital of Lille, Lille, France, collected data, provided and cared for study patients

Olivier Desebbe, M.D., Clinique de la Sauvegarde, Lyon, France, collected data, provided and cared for study patients

Roland Henaine, M.D., Ph.D., Hospices Civils de Lyon, Lyon, France, critically reviewed the study proposal, provided and cared for study patients

Matteo Pozzi, M.D, Hospices Civils de Lyon, Lyon, France, collected data, provided and cared for study patients

Jean-Christophe Richard, M.D., Ph.D., Hospices Civils de Lyon, Lyon, France, collected data, provided and cared for study patients

Zakaria Riad, M.D., Hospices Civils de Lyon, Lyon, France, collected data, provided and cared for study patients

Christophe Guervilly, M.D., North Hospital, Marseille Public University Hospital System, Marseille, France, collected data, provided and cared for study patients

Sami Hraiech, M.D., North Hospital, Marseille Public University Hospital System, Marseille, France, collected data, provided and cared for study patients

Laurent Papazian, M.D., Ph.D., North Hospital, Marseille Public University Hospital System, Marseille, France, collected data, provided and cared for study patients

Matthias Castanier, M.D., European Hospital, Marseille, France, collected data, provided and cared for study patients

Charles Chanavaz, M.D., Clairval Hospital, Marseille, France, collected data, provided and cared for study patients

Sebastien Gette, M.D., Regional Hospital of Metz-Thionville, Metz-Thionville, France, provided and cared for study patients

Guillaume Louis, M.D., Regional Hospital of Metz-Thionville, Metz-Thionville, France, provided and cared for study patients

Erick Portocarrero, M.D., Regional Hospital of Metz-Thionville, Metz-Thionville, France, provided and cared for study patients

Nicolas Bischoff, M.D., Emile Muller Hospital, Mulhouse, France, collected data, provided and cared for study patients

Antoine Kimmoun, M.D., Ph.D., University Hospital of Nancy, Nancy, France, collected data, provided and cared for study patients

Mathieu Mattei, M.D., University Hospital of Nancy, Nancy, France, collected data, provided and cared for study patients

Pierre Perez, M.D., University Hospital of Nancy, Nancy, France, collected data, provided and cared for study patients

Alexandre Bourdiol, M.D., University Hospital of Nantes, Nantes, France, collected data, provided and cared for study patients

Yannick Hourmant, M.D., University Hospital of Nantes, Nantes, France, collected data, provided and cared for study patients

Pierre-Joachim Mahé, M.D., University Hospital of Nantes, Nantes, France, collected data, provided and cared for study patients

Bertrand Rozec, M.D., Ph.D., University Hospital of Nantes, Nantes, France, collected data, provided and cared for study patients

Mickaël Vourc'h, M.D., University Hospital of Nantes, Nantes, France, collected data, provided and cared for study patients

Stéphane Aubert, M.D., Ambroise Paré Hospital, Neuilly-sur-Seine, France, collected data, provided and cared for study patients

Florian Bazalgette, M.D., University Hospital of Nîmes, Nîmes, France, collected data, provided and cared for study patients

Claire Roger, M.D., University Hospital of Nîmes, Nîmes, France, collected data, provided and cared for study patients

Pierre Jaquet, M.D., Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Brice Lortat-Jacob, M.D., Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Pierre Mordant, M.D., Ph.D., Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Patrick Nataf, M.D., Ph.D., Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Juliette Patrier, M.D., Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Morgan Roué, M.D., Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Romain Sonneville, M.D., Ph.D., Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Alexy Tran-Dinh, M.D., Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Paul-Henri Wicky, M.D., Public Assistance-Hospitals of Paris, Bichat-Claude Bernard Hospital, Paris University Hospital, Paris, France, provided and cared for study patients

Charles Al Zreibi, M.D., Public Assistance-Hospitals of Paris, European Hospital Georges Pompidou–Paris University Hospital, Paris, France, collected data, provided and cared for study patients

Bernard Cholley, M.D., Ph.D., Public Assistance-Hospitals of Paris, European Hospital Georges Pompidou–Paris University Hospital, Paris, France, collected data, provided and cared for study patients

Yannis Guyonvarch, M.D., Public Assistance-Hospitals of Paris, European Hospital Georges Pompidou–Paris University Hospital, Paris, France, collected data, provided and cared for study patients

Sophie Hamada, M.D., Public Assistance-Hospitals of Paris, European Hospital Georges Pompidou–Paris University Hospital, Paris, France, collected data, provided and cared for study patients

Claudio Barbanti, M.D., Public Assistance-Hospitals of Paris University Hospital, Paris, France, collected data, provided and cared for study patients

Anatole Harrois, M.D., Public Assistance-Hospitals of Paris Le Kremlin-Bicêtre, Paris University Hospital, Paris, France, collected data, provided and cared for study patients

Jordi Matiello, M.D., Public Assistance-Hospitals of Paris Le Kremlin-Bicêtre, Paris University Hospital, Paris, France, collected data, provided and cared for study patients

Thomas Kerforne, M.D., University Hospital of Poitiers, Poitiers, France, collected data, provided and cared for study patients

Nicolas Brechot, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Alain Combes, M.D., Ph.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Jean Michel Constantin, M.D., Ph.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Cosimo D'Alessandro, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Pierre Demondion, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Alexandre Demoule, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Martin Dres, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Muriel Fartoukh, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Guillaume Hekimian, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Charles Juvin, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Pascal Leprince, M.D., Ph.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

David Levy, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Charles Edouard Luyt, M.D., Ph.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Marc Pineton de Chambrun, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Matthieu Schmidt, M.D., Ph.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Thibaut Schoell, M.D., Public Assistance-Hospitals of Paris, Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France, collected data, provided and cared for study patients

Pierre Fillâtre, M.D., Ph.D., Hospital of Saint-Brieuc, Saint-Brieuc, France, collected data, provided and cared for study patients

Nicolas Massart, M.D., Hospital of Saint-Brieuc, Saint-Brieuc, France, collected data, provided and cared for study patients

Roxane Nicolas, M.D., University Hospital of Saint-Etienne, Saint-Etienne, France, collected data, provided and cared for study patients

Maud Jonas, M.D., Saint-Nazaire Hospital, Saint-Nazaire, France, collected data, provided and cared for study patients

Charles Vidal, M.D., University Hospital of Saint-Denis, La Réunion, Saint-Denis, France, collected data, provided and cared for study patients

Salvatore Muccio, M.D., University Hospital of Reims, Reims, France, collected data, provided and cared for study patients

Dario Di Perna, M.D., University Hospital of Reims, Reims, France, collected data, provided and cared for study patients

Bruno Mourvillier, M.D., Ph.D., University Hospital of Reims, Reims, France, collected data, provided and cared for study patients

Amedeo Anselmi, M.D., Ph.D., University Hospital of Rennes, Rennes, France, provided and cared for study patients

Karl Bounader, M.D., University Hospital of Rennes, Rennes, France, provided and cared for study patients

Maxime Esvan, M.Sc., University Hospital of Rennes, Rennes, France, performed statistical analysis

Claire Fougerou-Leurent, Pharm.D., University Hospital of Rennes, Rennes, France, critically reviewed the study proposal

Yoann Launey, M.D., Ph.D., University Hospital of Rennes, Rennes, France, provided and cared for study patients

Thomas Lebouvier, M.D., University Hospital of Rennes, Rennes, France, provided and cared for study patients

Alessandro Parasido, University Hospital of Rennes, Rennes, France, provided and cared for study patients

Florian Reizine, M.D., University Hospital of Rennes, Rennes, France, provided and cared for study patients

Philippe Seguin, M.D., Ph.D., University Hospital of Rennes, Rennes, France, provided and cared for study patients

Emmanuel Besnier, M.D., University Hospital of Rouen, Rouen, France, collected data, provided and cared for study patients

Dorothée Carpentier, M.D., University Hospital of Rouen, Rouen, France, collected data, provided and cared for study patients

Anne Olland, M.D., Ph.D., University Hospital of Strasbourg, Strasbourg, France, collected data, provided and cared for study patients

Marion Villard, M.D., University Hospital of Strasbourg, Strasbourg, France, collected data, provided and cared for study patients

Fanny Bounes, M.D., University Hospital of Toulouse, Toulouse, France, collected data, provided and cared for study patients

Vincent Minville, M.D., Ph.D., University Hospital of Toulouse, Toulouse, France, collected data, provided and cared for study patients

Antoine Guillon, M.D., University Hospital of Tours, Tours, France, collected data, provided and cared for study patients

Yannick Fedun, M.D., Bretagne Atlantique Hospital, Vannes, France, collected data, provided and cared for study patients

James T. Ross, M.D., University of California Davis, Sacramento, California, provided critical revisions of the manuscript

Sidebar

Editor's Perspective

What We Already Know about This Topic

• Venovenous extracorporeal membrane oxygenation is increasingly used for managing severe respiratory failure; however, the characteristics, management, and patient outcomes continue to be determined

• Determining factors associated with in-hospital mortality for both COVID-19 and non–COVID-19 patients are important factors to consider in patient management

What This Article Tells Us That Is New

• In this investigation, most patients were cannulated by a mobile extracorporeal membrane oxygenation unit without a negative impact on mortality

• Based on this report, venovenous extracorporeal membrane oxygenation support should be considered within the first week of mechanical ventilation initiation for optimal outcomes