Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis

Abstract

It remains unclear to what extent the outcomes and complications of extracorporeal membrane oxygenation (ECMO) therapy in COVID-19 patients with acute respiratory distress syndrome (ARDS) differ from non-COVID-19 ARDS patients. In an observational, propensity-matched study, outcomes after ECMO support were compared between 19 COVID-19 patients suffering from ARDS (COVID group) and 34 matched non-COVID-19 ARDS patients (NCOVID group) from our historical cohort. A 1:2 propensity matching was performed based on respiratory ECMO survival prediction (RESP) score, age, gender, bilirubin, and creatinine levels. Patients’ characteristics, laboratory parameters, adverse events, and 90-day survival were analyzed. Patients’ characteristics in COVID and NCOVID groups were similar. Before ECMO initiation, fibrinogen levels were significantly higher in the COVID group (median: 493 vs. 364 mg/dL, p < 0.001). Median ECMO support duration was similar (16 vs. 13 days, p = 0.714, respectively). During ECMO therapy, patients in the COVID group developed significantly more thromboembolic events (TEE) than did those in the NCOVID group (42% vs. 12%, p = 0.031), which were mainly pulmonary artery embolism (PAE) (26% vs. 0%, p = 0.008). The rate of major bleeding events (42% vs. 62%, p = 0.263) was similar. Fibrinogen decreased significantly more in the COVID group than in the NCOVID group (p < 0.001), whereas D-dimer increased in the COVID group (p = 0.011). Additionally, 90-day mortality did not differ (47% vs. 74%; p = 0.064) between COVID and NCOVID groups. Compared with that in non-COVID-19 ARDS patients, ECMO support in COVID-19 patients was associated with comparable in-hospital mortality and similar bleeding rates but a higher incidence of TEE, especially PAE. In contrast, coagulation parameters differed between COVID and NCOVID patients.

Extracorporeal Membrane Oxygenation Support in COVID-19 Patients: A Propensity Score Analysis

“…In COVID-19, derangements in the coagulation cascade leading to increased thromboembolic events and bleeding complications have been reported 7,8,21–23 . Indeed, our study’s results are similar to Autschbach et al 24 and Helms et al 8 who reported increased incidence of thromboembolic events and pulmonary artery embolism in COVID-19-related ARDS patients as compared with non-COVID-19-related ARDS patients (42% vs . 12%, p = 0.031 and 11.7% vs .…”

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19–Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis

“…In our study, no differences were found in 28- and 60-day mortality between COVID-19–associated ARDS and non-COVID-19 ARDS, both unadjusted as adjusted for confounders. This is supported by previous studies showing equal survival at different time points ( 13 , 14 , 23 , 29 ). A recent study by Fanelli et al ( 23 ) found, when comparing patients receiving ECMO for either Influenza A H1N1 or COVID-19 ARDS, that 60-day mortality was only in the disadvantage of COVID-19 when unadjusted for confounders.…”

D-dimer levels in non-COVID-19 ARDS and COVID-19 ARDS patients: A systematic review with meta-analysis

“…Studies included in the present manuscript were conducted in 6 countries (USA, UK, Germany, France, Italy, China). Most studies (n = 12) were retrospective [ 12 – 17 , 20 – 24 , 26 ], and the only 3 prospective studies included historical cohorts of non-COVID-19 ARDS patients [ 18 , 19 , 25 ]. In total, data from 2,828 patients were included in our meta-analysis, with 1,404 (49.6%) having non-COVID-19 ARDS and 1,424 (50.4%) COVID-19 ARDS ( Fig 2 ).…”

“…The non-COVID-19 ARDS patients had statistically lower fibrinogen levels (mean 454 mg/dl vs. 653 mg/dl) [ 12 – 15 , 18 – 21 , 25 , 26 ] when compared to COVID-19 ARDS patients resulting in a MD of -173 mg/dl (95% CI: -232.48 to -113.63) p<0.001 (S3 Fig in S1 File ). In contrast, CRP levels [ 13 – 15 , 18 , 20 – 23 ] (MD -1.07 mg/dl [95% CI: -5.08 to 2.95, p = 0.60]) and PaO2/FiO2 ratio [ 12 , 13 , 17 – 25 ] (MD -2.75 mmHg [95% CI: -10.15 to 4.65, p = 0.47]) were similar between groups (S2 and S4 Figs in S1 File ).…”