Outcomes of extracorporeal membrane oxygenation in influenza versus 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 coronavirus disease 2019 ). 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.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: A total of 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 = .04). Thirty days survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p = .13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 vs. 12 days; p = .025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy before ECMO initiation (p < .001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%; p = .03) and bacterial pneumonia (36% vs. 6%; p = .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.

Extracorporeal membrane oxygenation in COVID-19 compared to other etiologies of acute respiratory failure: A single-center experience

“…, 21. , 22. In a study from Germany, Jӓckel et al 16 compared 15 COVID ECMO patients against 47 influenza ECMO patients and found a numerically, but not statistically significantly, higher hospital survival in the influenza group versus the COVID group: 57.4% vs. 40.0%; p = 0.238.…”

“…ECMO duration was significantly longer in the COVID group: 14 days vs. 10.5 days; p = 0.0038. Finally, Blazoski et al 22 compared 28 COVID ECMO cases to 17 influenza ECMO cases. A comparison of duration of pre-ECMO mechanical ventilation was not performed.…”

“…Results in bold denote a statistically significant difference for that parameter in a given study as defined by its authors. Study COVID ECMO N= Flu ECMO N= Pre-ECMO MV COVID (days) Pre-ECMO MV Flu (days) ECMO Duration COVID (days) ECMO Duration Flu (days) Survival COVID Survival Flu Jӓckel 16 (Ger) 15 47 4.6 1.1 11.3 8.90 40.0% 57.4% Cousin 17 (Fr) 30 22 6.0 3.0 11.0 11.0 46.7% 54.5% Charlton 18 (UK) 34 26 4.9 2.4 13.2 12.3 53.0% 69.0% Fanelli 19 (Italy) 146 162 5.0 2.0 22.0 13.0 54.0% 73.0% Raff 20 (US) 32 28 4.5 1.5 12.4 7.70 34.4% 63.7% Shih 21 (US) 53 67 NR NR 14.0 10.5 62.3% 64.2% Blazoski 22 (US) 28 17 NR NR 21.4 12.2 68.0% 94.0% ECMO=Extracorporeal Membrane Oxygenation, MV=Mechanical Ventilation, NR=Not Reported …”

The Utility of ECMO in Acute Respiratory Distress Syndrome

“…Blazoski et al noted in their literature review how poor the overall mortality of COVID-ARDS was compared to influenza-ARDS [37]. For instance, those admitted to the ICU with COVID have a 3.7 times higher risk of death than those who are admitted for influenza.…”

Extracorporeal membrane oxygenation for the treatment of ARDS in Covid-19 and influenza patients: Does etiology matter?

“…8 There have been conflicting results when comparing the outcome of ECMO support in COVID 19 patients and those with ARDS related to other viral disease. [9][10][11][12][13][14][15] The primary objective of this study was to compare the outcome of ECMO treatment in COVID 19 and influenza patients referred to a tertiary care center.…”