Outcomes of extracorporeal membrane oxygenation in acute respiratory distress syndrome due to COVID‐19: The lessons learned from the first wave of COVID‐19

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19), but there has been little evidence of its efficacy.We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID-19.Methods: All adult patients who were placed on ECMO for ARDS due to COVID-19 between April 2020 and June 2020 (during the first wave of COVID-19) were identified. The clinical characteristics and outcomes of these patients were analyzed with a specific focus on the differences between patients who survived to hospital discharge and those who did not.Results: In total, 20 COVID-19 patients were included in this study. All patients were placed on veno-veno ECMO. Comparing survivors and non-survivors, older age was found to be associated with hospital mortality (p = .02). The following complications were observed: renal failure requiring renal replacement therapy (35%, n = 7), bacteremia during ECMO (20%, n = 4), coinfection with bacterial pneumonia (15%, n = 3), cannula site bleeding (15%, n = 3), stroke (10%, n = 2), gastrointestinal bleeding (10%, n = 2), and liver failure (5%, n = 1). The complications associated with patient mortality were culture-positive septic shock (p = .01), culture-negative systemic inflammatory response syndrome (p = .01), and renal failure (p = .01). The causes of death were septic shock (44%, n = 4), culture-negative systemic inflammatory response syndrome (44%, n = 4), and stroke (11%, n = 1).Conclusions: Based on our experience, ECMO can improve refractory ARDS due to COVID-19 in select patients. Proper control of bacterial infections during COVID-19 immunomodulation therapy may be critical to improving 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.…”

“… 35 , 36 , 37 , 38 , 39 Studies were judged to be at some risk of bias for confounding adjustment and for statistical analysis and reporting if they did not account for clinically important confounders using either logistic regression or Cox proportional hazards models. 15 , 39 , 44 , 46 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 Studies reporting adjusted analyses were judged to be at some risk of bias for statistical analysis 35 , 36 , 37 , 40 , 41 , 42 , 43 , 44 , 45 , 46 if they did not adhere to methodological standards set by the PROGRESS guidelines, 19 , 20 , 21 , 22 in particular with regards to a priori selection of clinically important confounders and consideration of an appropriate sample size to minimise potential overfitting. 28 , 76 The composition and methodological quality of individual prediction models for each study and funnel plots used to evaluate for publication bias among variables that were assessed in at least ten studies are included in the appendix (p 36–41 ).…”

Determinants of survival in patients on extracorporeal membrane oxygenation therapy due to severe covid-19

“… 6 , 8 , 9 Gastrointestinal and pulmonary complications during vv-ECMO are similar to data provided in the literature. 10 – 12 …”

Extracorporeal Membrane Oxygenation in COVID-19

“…Because one of the main reported causes of death in this population is septic shock, identifying strategies to maximize source control and appropriate treatments of infections is paramount. 4…”

“…2,3 Resembling other etiologies of ARDS, the treatment of severe presentations of COVID-19 frequently involves invasive mechanical ventilation and, in most severe cases, extracorporeal membrane oxygenation (ECMO). 4…”