Outcomes of Extracorporeal Membrane Oxygenation in Influenza vs. COVID-19 During the First Wave of COVID-19

Abstract

Extracorporeal membrane oxygenation (ECMO) has historically been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and is currently being explored as a refractory treatment for ARDS due to COVID-19. We conducted this study to compare the outcomes in our institution of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19. Methods: All adult patients who were placed on VV-ECMO between March 1, 2016 and September 15, 2020 (encompassing the first wave of COVID-19) were identified within an IRB-approved database, and any patient with ARDS due to COVID-19 or influenza was included in this study. The clinical characteristics and outcomes of these patients were extracted and analyzed. Results: 28 COVID-19 patients and 17 influenza patients placed on VV-ECMO were identified and included in this study. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p=0.04). 30-day survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p=0.13). The COVID-19 patients had lower rates of pre-ECMO acute renal injury (29% vs. 59%, p=0.045), lower rates of coronary artery disease (0% vs. 18%, p=0.021), and a lower average body surface area (2.0 vs. 2.2, p=0.036). They were more likely to have ECMO initiated at an outside hospital (50% vs. 12%, p=0.009) and spend a longer time on ECMO (21 days vs. 12 days, p=0.025). COVID-19 patients had statistically higher complication rates of new infections during ECMO (50% vs. 18%, p=0.03), bacterial pneumonia (36% vs 6%, p=0.024), and blood culture-positive sepsis (32% vs. 6%, p=0.04). Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients with the same treatment. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections, as COVID-19 patients developed new infections, sepsis, and bacterial pneumonia more frequently than influenza patients. However, more research is needed to better understand the true efficacy rates of ECMO in treating both influenza and COVID-19.