Outcomes after extracorporeal membrane oxygenation support in COVID‐19 and non‐COVID‐19 patients. Issue 4 (4th November 2021)

• Record Type: Journal Article
• Authors: Kurihara, Chitaru; Manerikar, Adwaiy; Gao, Catherine Aiyuan; Watanabe, Satoshi; Kandula, Viswajit; Klonis, Alexandra; Hoppner, Vanessa; Karim, Azad; Saine, Mark; Odell, David D.; Lung, Kalvin; Garza‐Castillon, Rafael; Kim, Samuel S.; Walter, James McCauley; Wunderink, Richard G.; Budinger, G. R. Scott; Bharat, Ankit
• Is Part Of: Artificial organs. Volume 46:Issue 4(2022)
• Page Start: 688
• Page End: 696
• Publication Date: 2021-11-04
• Subjects: artificial organs -- circulatory support devices -- COVID‐19 -- outcomes -- V‐V ECMO; Artificial organs -- Periodicals; 617.956
• DOI: 10.1111/aor.14090
• Languages: English
• ISSNs: 0160-564X

Abstract

Abstract: Background: Veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) support is increasingly used in the management of COVID‐19‐related acute respiratory distress syndrome (ARDS). However, the clinical decision‐making to initiate V‐V ECMO for severe COVID‐19 still remains unclear. In order to determine the optimal timing and patient selection, we investigated the outcomes of both COVID‐19 and non‐COVID‐19 patients undergoing V‐V ECMO support. Methods: Overall, 138 patients were included in this study. Patients were stratified into two cohorts: those with COVID‐19 and non‐COVID‐19 ARDS. Results: The survival in patients with COVID‐19 was statistically similar to non‐COVID‐19 patients ( p = .16). However, the COVID‐19 group demonstrated higher rates of bleeding ( p = .03) and thrombotic complications ( p < .001). The duration of V‐V ECMO support was longer in COVID‐19 patients compared to non‐COVID‐19 patients (29.0 ± 27.5 vs 15.9 ± 19.6 days, p < .01). Most notably, in contrast to the non‐COVID‐19 group, we found that COVID‐19 patients who had been on a ventilator for longer than 7 days prior to ECMO had 100% mortality without a lung transplant. Conclusions: These findings suggest that COVID‐19‐associated ARDS was not associated with a higher post‐ECMO mortality than non‐COVID‐19‐associated ARDS patients, despite longer duration of extracorporeal support. Early initiation of V‐V ECMO is important for improved ECMO outcomes in COVID‐19 ARDS patients. Since late initiation of ECMO was associated with extremely high mortality related to lack of pulmonary recovery, it should be used judiciously or as a bridge to lung transplantation. Abstract : The survival in patients with COVID‐19 was statistically similar compared to non‐COVID‐19 patients, but the mortality of COVID‐19 patients who had been on a ventilator for longer than 7 days prior to the initiation of ECMO approached 100%.