Prolongedweaning after long-term ventilation due to SARS- CoV-2 infection: a multicenter retrospective analysis

Some of the patients with SARS- CoV- 2 infection (COVID-19) received invasive ventilation during inpatient care. Weaning from ventilation was difficult for some patients (so- called prolonged weaning). Patients Patients (n = 751) with prolonged weaning ( reason for ventilation "pneumonia" and "acute respiratory failure") from four centers for the period 2011-23 from the "WeanNet" registry were used as a matched group. Results The median duration of intensivemedical care was 39 ( 25-68) days. In 19% (37/ 193) of patients, ECMO support was necessary for a median of 27 (18- 51) days. In-hospital mortality was 8.3% (2.7% with vs. 9.6% without ECMO) and 6.8% died in the comparison group. At discharge, 84% ( vs. 77% in the control group) were completely weaned and 2.6% (vs. 17.6% in the control group) of patients received non-invasive treatment. Invasive ventilation was still necessary in 7.8% (control group 15.7%). In the observation period of 6 months after discharge, 22.4% of patients required inpatient care and a further 14.1% after 12 months. The overall mortality at 12-month follow-up was 20,6% (5.6% with vs. 24.6% without ECMO). Discussion The mortality rate of ventilated patients with COVID- 19 was very low at 8.3% in the four weaning centers studied. The mortality rate of patients with ECMO treatment was only 2.7 %. The mortality rate in the control group was 7.3 %. The lower mortality of patients with ECMO treatment was also evident at follow- up of up to 12 months. Patients with prolonged weaning who received invasive ventilation due to COVID-19 showed comparable results in terms of successful weaning and mortality compared to a control group from the WeanNet registry. The long- term results with a survival of more than 80% for the first year after discharge were encouraging.