The Lancet Respiratory Medicine has published three international collaborative papers on extracorporeal membrane oxygenation (ECMO) with the leadership of Dr. Jordi Riera, director of the adult ECMO program at Vall d'Hebron University Hospital and principal investigator of the Shock, Organ Dysfunction and Resuscitation (SODIR) research group at Vall d'Hebron Research Institute (VHIR). The publications present the experience with the use of extracorporeal life support in respiratory critically ill patients and advance the knowledge of factors to increase the success of treatment.

Vall d'Hebron is one of the world's leading centers in the use of ECMO, especially in patients with COVID-19, due to the high number of patients treated. In addition to the quality of care, defined by the optimization of safety in care and compliance with international recommendations, active participation in international collaborative research networks that have a direct impact on improving patient care is also key.

Blood transfusions in ECMO patients

The first publication is based on the results of PROTECMO study, whose objective was to identify the cases in which blood transfusions are necessary in ECMO patients. In this case, Dr. Jordi Riera was one of the six coordinators of the study, and Vall d'Hebron was one of the centers with the highest number of patients participating.

Blood transfusion is an important practice for getting oxygen to the tissues. However, it can cause some undesirable effects such as inflammatory processes or adverse reactions. Therefore, it is necessary to know the thresholds above which the benefits outweigh the risks. Until now, there was little evidence on what this threshold is in ECMO patients and, for this, this work was carried out in which 604 patients from 41 centers worldwide participated between December 2018 and February 2022.

The researchers confirmed that transfusion in ECMO patients is recommended when the hemoglobin concentration is below 7 g/dL. It is in these cases when a transfusion decreases patient mortality and the benefits outweigh the potential risks.

The effect of the delta variant and the concentration of cases in centers with large numbers of patients

At the beginning of the COVID-19 pandemic, the use of ECMO was recommended for critically ill patients, but there were few data on the factors influencing their clinical course. The European ECMO-SURGES network was created with the aim of expanding this knowledge, the results of which are presented in a publication co-led by Vall d'Hebron and the Pitié-Salpêtrière University Hospital in Paris and co-directed by Dr. Jordi Riera, together with Dr. Alain Combes and Dr. Matthieu Schmidt.

The study was based on the follow-up of 1345 patients with COVID-19 requiring ECMO at 21 centers in 8 countries during 2020 and 2021. Among the results, it highlights the higher mortality of patients infected by the Delta variant of SARS-CoV-2 compared to the other variants detected until then.

On the other hand, the study confirms the better evolution of patients who are attended by centers with a high number of cases, as is the case of Vall d'Hebron, because they achieve a higher quality of care thanks to the high experience of the teams. Thus, the researchers recommend concentrating resources in these high-volume centers to achieve better results.

Follow-up of patients during and after ECMO

The third paper reports observations from the EuroECMO-COVID study, in which 133 centers from 21 countries participated and in which Vall d'Hebron plays a leading role. The research was co-led by Dr. Jordi Riera, together with other members of the EuroELSO International Society. In this case, the evolution of 1215 patients with COVID-19 who required ECMO between March and September 2020 was analyzed. For this purpose, not only the hospital stay was taken into account, but also follow-up for 6 months.

Once the patients were discharged, researchers observed low mortality, but a high presence of other respiratory, cardiac or neurocognitive symptoms that can lead to subsequent admissions and the need for rehabilitation and prevent reincorporation to their usual working life. In this sense, it shows the need to carry out post-ECMO programs dedicated to improve the recovery of patients and avoid possible subsequent health complications.

To carry out the studies, the multidisciplinary collaboration of medical and nursing personnel has been essential. Disciplines such as intensive care medicine, cardiology, cardiac surgery, anesthesiology and transplant coordination have a direct role in the care of patients on extracorporeal life support.