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

Chandel, Abhimanyu; Puri, Nitin K.; Damuth, Emily; Potestio, Christopher; Peterson, Lars-Kristofer N.; Ledane, Julia; Rackley, Craig R.; King, Christopher S.; Conrad, Steven A.; Green, Adam

doi:10.1097/cce.0000000000000861

Cited by 6 publications

(5 citation statements)

References 27 publications

(43 reference statements)

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“…This finding differs from previous smaller studies examining the outcomes of V-V ECMO for COVID-related respiratory failure, which have shown comparable rates of mortality to historical V-V ECMO 9,10 . However, our findings are similar to those of Chandel et al 12 who reported a 50.2% mortality for V-V ECMO for COVID-19 (n=8136) versus 34.5% among V-V ECMO for non-COVID causes (n=1155). Barbaro et al 13 demonstrated that early in the pandemic, patients were kept on mechanical ventilation for longer periods of time before being placed on ECMO and that late-adopting centers had significantly higher mortality rates, both factors that may have contributed to the high mortality rates seen in this study for patients undergoing V-V ECMO for COVID causes.…”

Section: Discussioncontrasting

confidence: 97%

Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies

Ruhi-Williams

Nahmias

et al. 2023

Annals of Surgery

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Objective: This study analyzed the characteristics and outcomes of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to COVID-19 versus non-COVID causes at US academic centers. Background Data: V-V ECMO support has been utilized for COVID-19 patients with ARDS since the beginning of the pandemic. Mortality for ECMO in COVID-19 has been reported to be high but similar to reported mortality for ECMO support for non-COVID causes of respiratory failure. Methods: Using ICD-10 codes, data of patients who underwent V-V ECMO for COVID-19 ARDS were compared with patients who underwent V-V ECMO for non-COVID causes between April 2020 and December 2022. The primary outcome was in-hospital mortality. Secondary outcome measures included length of stay and direct cost. Multivariate logistic regression modeling was performed to analyze differences in mortality between COVID and non-COVID groups, adjusting for other important risk factors (age, sex, and race/ethnicity). Results: We identified and compared 6382 patients who underwent V-V ECMO for non-COVID causes to 6040 patients who underwent V-V ECMO for COVID-19. There was a significantly higher proportion of patients aged ≥ 65 years who underwent V-V ECMO in the non-COVID group compared with the COVID group (19.8% vs. 3.7%, respectively, P<0.001). Compared with patients who underwent V-V ECMO for non-COVID causes, patients who underwent V-V ECMO for COVID had increased in-hospital mortality (47.6% vs. 34.5%, P<0.001), length of stay (46.5±41.1 days vs. 40.6±46.1, P<0.001), and direct hospitalization cost ($207,022±$208,842 vs. $198,508±205,510, P=0.02). Compared with the non-COVID group, the adjusted odds ratio (OR) for in-hospital mortality in the COVID group was 2.03 (95% CI: 1.87–2.20, P<0.001). In-hospital mortality for V-V ECMO in COVID-19 improved during the study time period (50.3% in 2020, 48.6% in 2021, and 37.3% in 2022). However, there was a precipitous drop in the ECMO case volume for COVID starting in quarter 2 of 2022. Conclusions: In this nationwide analysis, COVID-19 patients with ARDS requiring V-V ECMO support had increased mortality compared with patients who underwent V-V ECMO for non-COVID etiologies.

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Section: Discussioncontrasting

confidence: 97%

Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies

Ruhi-Williams

Nahmias

et al. 2023

Annals of Surgery

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“…Some studies compared ECMO in non-COVID-ARDS patients and COVID-ARDS patients. Although similar results were gathered about oxygenation (99,100), the treatment time and complications were different. Chandel et al (99) analyzed 9,271 patients who required ECMO between 2017 and 2021.…”

Section: Ecmo In Non Covid-ards Versus Covid-ards Patientsmentioning

confidence: 61%

New and personalized ventilatory strategies in patients with COVID-19

et al. 2023

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Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus and may lead to severe respiratory failure and the need for mechanical ventilation (MV). At hospital admission, patients can present with severe hypoxemia and dyspnea requiring increasingly aggressive MV strategies according to the clinical severity: noninvasive respiratory support (NRS), MV, and the use of rescue strategies such as extracorporeal membrane oxygenation (ECMO). Among NRS strategies, new tools have been adopted for critically ill patients, with advantages and disadvantages that need to be further elucidated. Advances in the field of lung imaging have allowed better understanding of the disease, not only the pathophysiology of COVID-19 but also the consequences of ventilatory strategies. In cases of refractory hypoxemia, the use of ECMO has been advocated and knowledge on handling and how to personalize strategies have increased during the pandemic. The aims of the present review are to: (1) discuss the evidence on different devices and strategies under NRS; (2) discuss new and personalized management under MV based on the pathophysiology of COVID-19; and (3) contextualize the use of rescue strategies such as ECMO in critically ill patients with COVID-19.

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“…The COVID-19 pandemic resulted in increased referrals for VV ECMO ( 1 ). A prior analysis of the ELSO registry suggested that patients with ARDS related to COVID-19 had worse VV ECMO-related outcomes compared with patients with ARDS related to other conditions ( 14 ). However, it is not clear if these observed differences in outcome remain when considering only patients supported with prolonged VV ECMO.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Survival of Prolonged Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: An Analysis of the Extracorporeal Life Support Organization Registry

Chandel,

Fabyan,

Mendelsohn

et al. 2024

Critical Care Medicine

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OBJECTIVES: To examine trends in utilization and outcomes among patients with the acute respiratory distress syndrome (ARDS) requiring prolonged venovenous extracorporeal membrane oxygenation (VV ECMO) support. DESIGN: Retrospective observational cohort study. SETTING: Adult patients in the Extracorporeal Life Support Organization registry. PATIENTS: Thirteen thousand six hundred eighty-one patients that required ECMO for the support of ARDS between January 2012 and December 2022. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mortality while supported with VV ECMO and survival to hospital discharge based on ECMO duration were examined utilizing multivariable logistic regression. Among the 13,681 patients supported with VV ECMO, 4,040 (29.5%) were supported for greater than or equal to 21 days and 975 (7.1%) for greater than or equal to 50 days. Patients supported with prolonged VV ECMO were less likely to be discharged alive from the hospital compared with those with short duration of support (46.5% vs. 59.7%; p < 0.001). However, among patients supported with VV ECMO greater than or equal to 21 days, duration of extracorporeal life support was not significantly associated with mortality (odds ratio [OR], 0.99; 95% CI, 0.98–1.01; p = 0.87 and adjusted OR, 0.99; 95% CI, 0.97–1.02; p = 0.48). Even in those supported with VV ECMO for at least 120 days (n = 113), 52 (46.0%) of these patients were ultimately discharged alive from the hospital. CONCLUSIONS: Prolonged VV ECMO support of ARDS has increased and accounts for a substantial portion of cases. Among patients that survive for greater than or equal to 21 days while receiving VV ECMO support, duration is not predictive of survival to hospital discharge and clinical recovery may occur even after very prolonged VV ECMO support.

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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

Cited by 6 publications

References 27 publications

Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies

Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies

New and personalized ventilatory strategies in patients with COVID-19

Prevalence and Survival of Prolonged Venovenous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: An Analysis of the Extracorporeal Life Support Organization Registry

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