Comparative outcomes between COVID-19 and influenza patients placed on veno-venous extracorporeal membrane oxygenation for severe ARDS

Abstract

Background ECMO is an established supportive adjunct for patients with severe, refractory ARDS from viral pneumonia. However, the exact role and timing of ECMO for COVID-19 patients remains unclear. Methods We conducted a retrospective comparison of the first 32 patients with COVID-19-associated ARDS to the last 28 patients with influenza-associated ARDS placed on V-V ECMO. We compared patient factors between the two cohorts and used survival analysis to compare the hazard of mortality over sixty days post-cannulation. Results COVID-19 patients were older (mean 47.8 vs. 41.2 years, p = 0.033), had more ventilator days before cannulation (mean 4.5 vs. 1.5 days, p < 0.001). Crude in-hospital mortality was significantly higher in the COVID-19 cohort at 65.6% (n = 21/32) versus 36.3% (n = 11/28, p = 0.041). The adjusted hazard ratio over sixty days for COVID-19 patients was 2.81 (95% CI 1.07, 7.35) after adjusting for age, race, ECMO-associated organ failure, and Charlson Comorbidity Index. Conclusion ECMO has a role in severe ARDS associated with COVID-19 but providers should carefully weigh patient factors when utilizing this scarce resource in favor of influenza pneumonia.

Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study

“…However, data comparing the clinical characteristics and outcome of these two groups with ARDS on vv-ECMO are scarce [20][21][22]. Reported mortality rates were mainly higher in patients with COVID-19 [20][21][22]. Clinical characteristics and differences between influenza and COVID-19 regarding severity of illness, demographic characteristics and age were comparable to our study [20][21][22].…”

“…Reported mortality rates were mainly higher in patients with COVID-19 [20][21][22]. Clinical characteristics and differences between influenza and COVID-19 regarding severity of illness, demographic characteristics and age were comparable to our study [20][21][22]. In one study, vv-ECMO specific prognostic scores before initiation were lower than in our study, which may have been due to different ECMO entry criteria [21].…”

“…Several studies investigated differences between COVID-19 and influenza in hospitalised patients. However, data comparing the clinical characteristics and outcome of these two groups with ARDS on vv-ECMO are scarce [20][21][22]. Reported mortality rates were mainly higher in patients with COVID-19 [20][21][22].…”

“…Further comorbidities are displayed in Table 1 and Supplementary Table S1. The disease severities displayed by the median SAPS II, APACHE II and SOFA score on admission were 32 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) vs. 27 (24-35.5) (p = 0.009), 17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) vs. 18 (14-22) (p = 0.885) and 10 (9-13) vs. 10 (8-13) (p = 0.877), respectively.…”

“…Clinical features regarding clinical symptoms and course of disease of COVID-19 and influenza are highly variable, and recent studies described differences regarding patient characteristics and outcomes [18,19]. For the comparison of patients with severe ARDS related to COVID-19 and influenza requiring ECMO there is limited data regarding clinical characteristics, complications and outcomes [20][21][22][23].…”