ECMO in Patients With COVID-19
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This international retrospective study compared outcomes of 71 patients with coronavirus 2019 (COVID-19) who were placed on extracorporeal membrane oxygenation (ECMO) therapy versus 48 patients with acute respiratory distress syndrome (ARDS) who received ECMO therapy but did not have COVID-19. The 28-day mortality rate was 37% and 27% in the COVID-19 and control groups, respectively. Compared with the control group, a higher percentage of the COVID-19 patients were male. However, complications and survival were similar between the groups.
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Based on these findings, the authors recommend that clinicians consider referring patients suffering from severe, refractory ARDS due to COVID-19 to ECMO centers, with ECMO therapy as a last resort when conventional therapies have been insufficient.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
To report and compare the characteristics and outcomes of COVID-19 patients on extracorporeal membrane oxygenation (ECMO) to non-COVID-19 acute respiratory distress syndrome (ARDS) patients on ECMO.
METHODS
We performed an international retrospective study of COVID-19 patients on ECMO from 13 intensive care units from March 1 to April 30, 2020. Demographic data, ECMO characteristics and clinical outcomes were collected. The primary outcome was to assess the complication rate and 28-day mortality; the secondary outcome was to compare patient and ECMO characteristics between COVID-19 patients on ECMO and non-COVID-19 related ARDS patients on ECMO (non-COVID-19; January 1, 2018 until July 31, 2019).
RESULTS
During the study period 71 COVID-19 patients received ECMO, mostly veno-venous, for a median duration of 13 days (IQR 7-20). ECMO was initiated at 5 days (IQR 3-10) following invasive mechanical ventilation. Median PaO2/FiO2 ratio prior to initiation of ECMO was similar in COVID-19 patients (58 mmHg [IQR 46-76]) and non-COVID-19 patients (53 mmHg [IQR 44-66]), the latter consisting of 48 patients. 28-day mortality was 37% in COVID-19 patients and 27% in non-COVID-19 patients. However, Kaplan-Meier curves showed that after a 100-day follow-up this non-significant difference resolves. Non-surviving COVID-19 patients were more acidotic prior to initiation ECMO, had a shorter ECMO run and fewer received muscle paralysis compared to survivors.
CONCLUSIONS
No significant differences in outcomes were found between COVID-19 patients on ECMO and non-COVID-19 ARDS patients on ECMO. This suggests that ECMO could be considered as a supportive therapy in case of refractory respiratory failure in COVID-19.
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Additional Info
Disclosure statements are available on the authors' profiles:
Extracorporeal Membrane Oxygenation in Patients With COVID-19: An International Multicenter Cohort Study
J Intensive Care Med 2021 Apr 07;[EPub Ahead of Print], SJ Raasveld, TSR Delnoij, LM Broman, AO Lansink-Hartgring, G Hermans, E De Troy, FS Taccone, M Quintana Diaz, F van der Velde, DDR Miranda, E Scholten, APJ VlaarFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.