Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time

Abstract

The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ 2 tests for categorical variables and Kruskal–Wallis rank-sum tests and Welch’s analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8–22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.

Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort

“…Several determinants of the prognosis of ECMO patients have been described [ 29 ]: first demographic characteristics with in the front-line, age, which has been found as a factor influencing mortality in our cohort, and in other cohorts of COVID-19 patients under ECMO [ 13 , 14 , 23 , 25 , 30 , 31 ]. Second, the number of organ dysfunctions before ECMO impacts prognosis in particular acute renal failure [ 14 ] and hyperlactatemia [ 15 ] .…”

Impact of asthma on COVID-19 mortality in the United States: Evidence based on a meta-analysis

“…After evaluating and assessing as much as 257 potential studies, 201 studies were removed due to outcome of interest being not available. In the end, what underlay this meta-analysis were eligible fifty-six articles with 426,261 COVID-19 patients [5] , [6] , [7] , [8] , [9] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] . The detail of selection process is shown by a chart flow in Figure 1 .…”

Clinical update on COVID-19 for the emergency clinician: Airway and resuscitation

“…An early single-site study of 27 COVID-19 patients on V-V ECMO found the survival rate to be 96.3% [ 126 ]. As the pandemic has progressed, other studies have not been as promising, with a multi-institutional analysis of 100 ECMO patients to have a survival rate from 25% (V-A ECMO) to 51% (V-V ECMO) [ 127 ]. A meta-analysis of 22 studies of 1896 COVID-19 patients on ECMO (98.6% V-V ECMO) found the pooled in-hospital mortality to be 37.1% (95% CI 32.3%–42.0%) [ 128 ].…”