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Background. In patients with severe respiratory failure from COVID-19, extracorporeal membrane oxygenation (ECMO) treatment can facilitate lung-protective ventilation and may improve outcome and survival if conventional therapy fails to assure adequate oxygenation and ventilation. We aimed to perform a confrmatory propensity-matched cohort study comparing the impact of ECMO and maximum invasive mechanical ventilation alone (MVA) on mortality and complications in severe COVID-19 pneumonia. Materials and Methods. All 295 consecutive adult patients with confrmed COVID-19 pneumonia admitted to the intensive care unit (ICU) from March 13th, 2020, to July 31st, 2021 were included. At admission, all patients were classifed into 3 categories: (1) full code including the initiation of ECMO therapy (AAA code), (2) full code excluding ECMO (AA code), and (3) do-not-intubate (A code). For the 271 non-ECMO patients, match eligibility was determined for all patients with the AAA code treated with MVA. Propensity score matching was performed using a logistic regression model including the following variables: gender, P/F ratio, SOFA score at admission, and date of ICU admission. Te primary endpoint was ICU mortality. Results. A total of 24 ECMO patients were propensity matched to an equal number of MVA patients. ICU mortality was signifcantly higher in the ECMO arm (45.8%) compared with the MVA cohort (16.67%) (OR 4.23 (1.11, 16.17); p � 0.02). Treemonth mortality was 50% with ECMO compared to 16.67% after MVA (OR 5.91 (1.55, 22.58); p < 0.01). Applied peak inspiratory pressures (33.42 ± 8.52 vs. 24.74 ± 4.86 mmHg; p < 0.01) and maximal PEEP levels (14.47 ± 3.22 vs. 13.52 ± 3.86 mmHg; p � 0.01) were higher with MVA. ICU length of stay (LOS) and hospital LOS were comparable in both groups. Conclusion. ECMO therapy may be associated with an up to a three-fold increase in ICU mortality and 3-month mortality compared to MVA despite the facilitation of lung-protective ventilation settings in mechanically ventilated COVID-19 patients. We cannot confrm the positive results of the frst propensity-matched cohort study on this topic. Tis trial is registered with NCT05158816. This study was supported by the foundation Limburg Sterk Merk, Province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Te study was funded solely by departmental funding

Supplemental Material for Predictors of poor outcome in critically ill patients with COVID-19 pneumonia treated with extracorporeal membrane oxygenation by Nick Pans, Jul Vanherf, Jeroen Vandenbrande, Jeroen Lehaen, Alaaddin Yilmaz, Jan Verwerft, Michiel Van Tornout, Laurien Geebelen, Ina Callebaut, Lieven Herbots, Jasperina Dubois and Björn Stessel in Perfusion

Background/Objectives Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG. Methods/Design In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG. Results In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups. Conclusions The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI. Trial registration Registered on ClinicalTrials.gov (NCT02979782)

Background: COVID-19 patients are related with an elevated risk for deep venous thrombosis (DVT). We evaluated the prevalence of DVT in our intubated and mechanically ventilated COVID-19+ patients at March 29th. Methods: We performed a Mono-center, investigator-initiated, observational, cross-sectional study. A total of 12 intubated COVID-19+ patients at intensive care unit (ICU) ward C3 of the Jessa Hospital, Hasselt, Belgium at March 29th were included. All patients received a prophylactic dose of low-molecular-weight heparin (LMWH). All intubated and mechanically ventilated patients were screened for the presence of DVT in femoral, popliteal, jugular and inferior caval veins with duplex ultrasound. Results: In total, 8 from all 12 intubated and ventilated COVID 19+ patients had already developed minimally one DVT. No relevant correlations could be detected. Conclusions: The prevalence of DVT in critically ill ICU patients with COVID-19 is over 60% despite adequate treatment with a prophylactic dose of LMWH. We suggest the use of graduated compression (elastic) stockings (GCS) and intermediate-dose LMWH for thrombosis prophylaxis in all COVID-19 patients. Since there were no clinical signs of DVT, we suggest to routinely screen all COVID-19 patients admitted to ICU for DVT via ultrasound. Future research should focus on the mechanisms underlying these observations.