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

Abstract

Purpose: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as COVID-19). We conducted this study to compare the outcomes 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. Materials and Methods: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV -ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed. Results: 28 COVID-19 patients and 17 influenza patients were identified and included. 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). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 days vs. 12 days, p=0.025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy prior to ECMO initiation (p<0.001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%, p=0.03) and bacterial pneumonia (36% vs 6%, p=0.024). Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.

Venovenous ECMO application as bridge to recovery or lung transplantation; ongoing challenge as we look at a pre‐ and post‐COVID‐19 era

“…Once COVID patients develop barotrauma and bronchopulmonary fistula it becomes an even bigger challenge managing ARDS without being able to use high PEEP ventilation. 3 1 Recently others have published their data with more or less favorable results. 6 Future studies will show more predictive data and results as we engage more…”

“…The severity of respiratory involvement in COVID patients is certainly very case‐specific. Blazoski et al 1 report on their single‐center Philadelphia experience using venovenous (VV) extracorporeal membrane oxygenation (ECMO) as rescue therapy for COVID‐19 acute respiratory distress syndrome (ARDS) patients. Twenty‐eight COVID‐19 and seventeen flu patients were identified and included in the study 1 .…”

“…Blazoski et al 1 report on their single‐center Philadelphia experience using venovenous (VV) extracorporeal membrane oxygenation (ECMO) as rescue therapy for COVID‐19 acute respiratory distress syndrome (ARDS) patients. Twenty‐eight COVID‐19 and seventeen flu patients were identified and included in the study 1 . Thirty‐day survival rates after ECMO decannulation were 54% (COVID‐19 group) and 76% in flu patients.…”

“…Blazoski et al have very well shown the worse expected outcome of COVID‐19‐related ARDS based on their single‐center experience during the first pandemic surge in the United States 1 . Recently others have published their data with more or less favorable results 6 .…”