Neuron-specific enolase (NSE) is a marker used to assess neurological impairment. Notwithstanding, the release of NSE into the circulation can also originate from erythrocytes and thrombocytes, signifying that even mild instances of hemolysis have the potential to induce heightened serum NSE levels. The present study addresses the question of whether the serum NSE level is a reliable parameter for assessing potential brain damage in patients undergoing extracorporeal membrane oxygenation (ECMO). To this end, NSE values of all non-resuscitated ECMO patients treated at our clinic from January 2020 to March 2022 were retrospectively evaluated. Serum NSE levels were found to be median 35.95 µg/L, with significant intrapersonal variability during ECMO therapy. A comparative analysis in ECMO patients with and without diagnosed brain damage revealed no statistically significant differences. In contrast, the concurrent measurement of serum LDH and NSE levels exhibited a significant positive correlation (Spearman Rho 0.69), indicating that the elevated serum NSE levels exhibited by patients devoid of cerebral impairment were attributable to the occurrence of ECMO-induced hemolysis. Consequently, the prognostic value of serum NSE levels in patients undergoing ECMO is restricted. The data also demonstrate that individual measurements of serum NSE levels in ECMO patients should be regarded as snapshots with only limited significance.

During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome achieved. Retrospective analysis of data from intensive care patients enrolled in the Lean European Open Survey on SARS-CoV2-Infected Patients (LEOSS) cohort found that a patient’s age and comorbidity burden in fact influenced their mortality rate and the use of ventilation therapy. Evidence showed that advanced age and multimorbidity were associated with the restrictive use of invasive ventilation therapies, particularly ECMO. Geriatric patients with a high comorbidity burden were clustered in the sub-cohort of non-ventilated ICU patients characterized by a high mortality rate. The risk of death generally increased with older age and accumulating comorbidity burden. Here, the more aggressive an applied procedure, the younger the age in which a majority of patients died. Clearly, geriatric, multimorbid COVID-19 patients benefit less from invasive ventilation therapies. This implies the need for a holistic approach to therapy decisions, taking into account the patient’s wishes.

Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy.