ArticleBMC anesthesiology2026
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.
Article in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe 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.
methodsThis 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).
resultsC-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).
conclusionThis 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.
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