Extracorporeal Membrane Oxygenation for COVID-19: Comparison of Outcomes to Non-COVID-19–Related Viral Acute Respiratory Distress Syndrome From the Extracorporeal Life Support Organization Registry. (3rd February 2023)

• Record Type: Journal Article
• Authors: Chandel, Abhimanyu; Puri, Nitin; Damuth, Emily; Potestio, Christopher; Peterson, Lars-Kristofer N.; Ledane, Julia; Rackley, Craig R.; King, Christopher S.; Conrad, Steven A.; Green, Adam
• Is Part Of: Critical care explorations. Volume 5:Number 2(2023)
• Page Start: e0861
• Publication Date: 2023-02-03
• Subjects: COVID-19 -- extracorporeal membrane oxygenation -- respiratory distress syndrome -- respiratory insufficiency -- viral pneumonia
• DOI: 10.1097/CCE.0000000000000861
• Languages: English
• ISSNs: 2639-8028

Abstract

Abstract : OBJECTIVES: To compare complications and mortality between patients that required extracorporeal membrane oxygenation (ECMO) support for acute respiratory distress syndrome (ARDS) due to COVID-19 and non-COVID-19 viral pathogens. DESIGN: Retrospective observational cohort study. SETTING: Adult patients in the Extracorporeal Life Support Organization registry. PATIENTS: Nine-thousand two-hundred ninety-one patients that required ECMO for viral mediated ARDS between January 2017 and December 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcomes of interest were mortality during ECMO support and prior to hospital discharge. Time-to-event analysis and logistic regression were used to compare outcomes between the groups. Among 9, 291 included patients, 1, 155 required ECMO for non-COVID-19 viral ARDS and 8, 136 required ECMO for ARDS due to COVID-19. Patients with COVID-19 had longer duration of ECMO (19.6 d [interquartile range (IQR), 10.1–34.0 d] vs 10.7 d [IQR, 6.3–19.7 d]; p < 0.001), higher mortality during ECMO support (44.4% vs 27.5%; p < 0.001), and higher in-hospital mortality (50.2% vs 34.5%; p < 0.001). Further, patients with COVID-19 were more likely to experience mechanical and clinical complications (membrane lung failure, pneumothorax, intracranial hemorrhage, and superimposed infection). After adjusting for pre-ECMO disease severity, patients with COVID-19 were more than two times as likely to die in the hospital compared with patients with non-COVID-19 viral ARDS. CONCLUSIONS: Patients with COVID-19 that require ECMO have longer duration of ECMO, more complications, and higher in-hospital mortality compared with patients with non-COVID-19–related viral ARDS. Further study in patients with COVID-19 is critical to identify the patient phenotype most likely to benefit from ECMO and to better define the role of ECMO in the management of this disease process.