Clinical outcomes of severe COVID-19 patients receiving early VV-ECMO and the impact of pre-ECMO ventilator use

Abstract

Acute respiratory distress syndrome (ARDS) in COVID-19 patients is associated with poor clinical outcomes and high mortality rates, despite the use of mechanical ventilation. Veno-Venous Extracorporeal membrane Oxygenation (VV-ECMO) in these patients is a viable salvage therapy. We describe clinical outcomes and survival rates in 52 COVID-19 patients with ARDS treated with early VV-ECMO at a large, high-volume center ECMO program. Outcomes included arterial blood gases, respiratory parameters, inflammatory markers, adverse events, and survival rates. Patients’ mean age was 47.8 ± 12.1 years, 33% were female, and 75% were Hispanic. At the end of study period, 56% ( n = 29) of the patients survived and were discharged and 44% ( n = 23) of the patients expired. Survival rate was 75.0% (9 out of 12) in patients placed on ECMO prior to mechanical ventilation. Longer duration on mechanical ventilation prior to ECMO intervention was associated with a 31% (aOR = 1.31, 95% CI, 1.00–1.70) increased odds of mortality after adjusting for age, gender, BMI, number of comorbid conditions, and post-ECMO ventilator days. Early and effective ECMO intervention in critical ill COVID-19 patients might be a valuable strategy in critical care settings to increase their odds of survival.

Prognostic factors associated with mortality among patients receiving venovenous extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

“…Of 2888 studies identified ( figure ), we selected 123 for full-text review. We included 42 observational cohort studies 13 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 involving 17 449 patients ( table 1 ), predominantly from North America or Europe. We did not identify any randomised controlled trials that met our eligibility criteria.…”

“…In the second analysis, we excluded adjusted analyses from studies with a potential risk of bias due to poor adherence to best practice methodological guidelines for prediction model development. 35 , 36 , 37 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 We considered the use of metaregression to further explore subgroups of interest, but did not have a sample size of ten or more studies per adjusted variable, as recommended by Cochrane guidance. 47 For the unadjusted analyses, we decided not to use study-level metaregression because it was unlikely to further benefit the analysis.…”

Severe COVID-19 in a kidney transplant recipient with acquired hypogammaglobulinemia: A case report

“…Venovenous extracorporeal membrane oxygenation is a lifesaving intervention that leads to reduced mortality in selected patients with COVID-19-associated ARDS [18]. However, prolonged pre-ECMO ventilation is associated with increased mortality in COVID-19 patients due to barotrauma, volotrauma, and infections [19]. Thus, early intervention is important, and we believe that VV-ECMO initiation was performed at an ideal time in our patient.…”

Impact of BMI on outcomes in respiratory ECMO: an ELSO registry study

“…Confounder adjustment in this study was limited to demographics and comorbidities. Paucity of data in COVID-related ECMO are contradictory [ 15 – 17 , 38 ]. We consistently showed decreased mortality among patients with BMI ≥ 35 kg/m 2 across multiple analyses extensively adjusted for confounders, associated with reduced hospital length of stay.…”