The Use of Venovenous Extracorporeal Membrane Oxygenation in COVID-19 Infection: One Region’s Comprehensive Experience

Bergman, Zachary; Wothe, Jillian K.; Alwan, Fatima; Dunn, Alex; Lusczek, Elizabeth R.; Lofrano, Arianna E; Tointon, Kelly M.; Doucette, Melissa; Saavedra-Romero, Ramiro; Prekker, Matthew E.; Brunsvold, Melissa E.

doi:10.1097/mat.0000000000001403

Cited by 11 publications

(22 citation statements)

References 21 publications

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“…16–18,21,22,25,27–29 COVID-19 survivors requiring ECMO support also required less vasopressors (76% vs 92%; OR 0.35; 95% CI 0.16-0.76; I 2 = 0%; P = .008) than nonsurvivors although the data were limited to six observational studies (Figure 5). 20–22,26,28,29…”

Section: Resultsmentioning

confidence: 99%

“…12 cohorts contained comparative body mass index (BMI) data for COVID-19 survivors and nonsurvivors receiving ECMO support (Figure 2). 16,[18][19][20][23][24][25][26][27][28][29] The BMI was comparable among COVID-19 survivors and nonsurvivors requiring ECMO support (mean 30.07kg/m 2 vs 30.86kg/ m 2 , SMD 0.06; 95% CI [ − 0.23, 0.34]; I 2 = 43%; P = .70).…”

Section: Study Characteristicsmentioning

confidence: 94%

“…16,18,19,21,22,27 Lastly, five studies reported comparable plateau pressure (mean 29.82 vs 30.5 cmH 2 0; SMD − 0.18; 95% CI [ − 0.39, 0.03];I 2 = 0%; P = .10) among COVID-19 survivors and nonsurvivors before ECMO support initiation (Figure 4). 16,21,22,26,31 Renal Replacement Therapy (RRT) and Vasopressor Requirement…”

Section: Total Days On Mechanical Ventilation (Mv) Before Ecmo Support Initiation and Ecmo Durationmentioning

confidence: 99%

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Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

Chong

Saha

Medarov

2021

J Intensive Care Med

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Background: The use of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19) for refractory respiratory failure, severe cardiac dysfunction, and bridge to lung transplantation has been steadily increasing during the ongoing global pandemic. Objective: Our meta-analysis aims to compare the clinical characteristics between COVID-19 survivors and nonsurvivors requiring ECMO support. Methods: A systematic search of Pubmed, Cochrane, Embase, Scopus, and Web of Science databases was performed between December first, 2019, to June first, 2021. Studies with comparative data of COVID-19 ECMO patients were selected, in which clinical characteristics and complications were assessed. Results: Sixteen cohort studies involving 706 COVID-19 patients requiring ECMO support with pooled mortality rate of 40% were included. Younger age (mean 51 years vs 55 years; P < .001), fewer comorbidities (23% vs 31%; odds ratio [OR] 0.55; P = .02), and less renal replacement therapy (RRT) (21% vs 39%; OR 0.41; P = .007) and vasopressor (76% vs 92%; OR 0.35; P = .008) requirement were demonstrated in COVID-19 survivors requiring ECMO support than nonsurvivors. Survivors also had higher pre-ECMO pH (mean 7.33 vs 7.26; P < .001) than nonsurvivors. No difference was observed in gender, body mass index, duration of mechanical ventilation (MV) before ECMO support initiation, total ECMO support duration, and pre-ECMO parameters of PaO2/FiO2 ratio, tidal volume (mL/kg), positive end-expiratory pressure, and plateau pressure. The rate of bleeding complications was lower in survivors (32% vs 59%; OR 0.36; P = .001) than nonsurvivors, but no difference was observed in thromboembolism and secondary infections. Conclusions: We found advanced age, multiple comorbidities, lower pre-ECMO pH, greater RRT, and vasopressor requirements, and bleeding are predictors of death in COVID-19 patients requiring ECMO support. The duration of MV before ECMO support initiation and total ECMO support duration was similar among survivors and nonsurvivors. Our study results have important clinical implications when considering ECMO support in critically ill COVID-19 patients.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 94%

Section: Total Days On Mechanical Ventilation (Mv) Before Ecmo Support Initiation and Ecmo Durationmentioning

confidence: 99%

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Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

Chong

Saha

Medarov

2021

J Intensive Care Med

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“…The institutional review board approved this study with a waiver of informed consent (University of Minnesota Internal Review Board Study 00010409: V-V ECMO in COVID). Our methodology has been published previously by Bergman et al ( 1 , 2 ) and was not modified for this study.…”

Section: Methodsmentioning

confidence: 99%

Increasing Mortality in Venovenous Extracorporeal Membrane Oxygenation for COVID-19–Associated Acute Respiratory Distress Syndrome

Braaten

Bergman

Wothe

et al. 2022

Critical Care Explorations

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OBJECTIVES:Determine the factors associated with mortality in venovenous extracorporeal membrane oxygenation (V-V ECMO) patients with COVID-19 infection and provide an updated report of clinical outcomes for patients treated with V-V ECMO for COVID-19 in Minnesota. DESIGN:Multicenter prospective observational study. SETTING:The four adult Extracorporeal Life Support Organization-certified Centers of Excellence in Minnesota. PATIENTS:A total of 100 patients treated with V-V ECMO for COVID-19-associated acute respiratory distress syndrome (ARDS) from March 2020 to May 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS:The primary outcome was 60-day survival for patients treated with V-V ECMO for COVID-19. Outcomes of patients treated from November 2020 to May 2021(cohort 2) were compared with data from a previous cohort of patients, collected from March 2020 to October 2020 (cohort 1). The data from both cohorts were merged into a single dataset (Combined Cohort). Survival on V-V ECMO due to COVID-19-associated ARDS significantly decreased after October 2020 (63% vs 41%; p = 0.026). The median interval from hospital admission to V-V ECMO cannulation was significantly associated with 60-day mortality (10 d [6-14 d] in nonsurvivors vs 7 d [4-9 d] in survivors; p = 0.001) in the Combined Cohort and was also significantly longer in cohort 2 than cohort 1 (10 d [7-14 d] vs 6 d [4-10 d]; p < 0.001). In the Combined Cohort, the 60-day survival for patients who did not receive steroids was 86% (n = 12) versus 45% (n = 39) for patients who received at least one dose of steroids (p = 0.005). CONCLUSIONS:There was a significant increase in mortality for patients treated with V-V ECMO for COVID-19-associated ARDS in cohort 2 compared with cohort 1. Further research is required to determine the cause of the worsening trend in mortality.

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“…The authors found that some case series reported mortality rates as high as 83–100%, while others reporting low mortality rates failed to take into account patients in coma or those on continuing ECMO at the time of publication. Similarly, Bergman et al 8 reported a 74% survival rate after ECMO in COVID but noted that 61% (16/26) of the surviving patients required oxygen therapy or mechanical ventilation even after discharge. Barbaro et al 9 analyzed a large registry of COVID acute respiratory distress syndrome patients undergoing ECMO and reported that only 34% (262/779) of patients were discharged alive to home.…”

mentioning

confidence: 95%

Extracorporeal Membrane Oxygenation in COVID-19 Patients: More Hype than Substance?

Trikha¹,

Venkateswaran²,

Soni³

2021

Indian Journal of Critical Care Medicine

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The Use of Venovenous Extracorporeal Membrane Oxygenation in COVID-19 Infection: One Region’s Comprehensive Experience

Abstract: Supplemental Digital Content is available in the text.

Cited by 11 publications

References 21 publications

Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

Increasing Mortality in Venovenous Extracorporeal Membrane Oxygenation for COVID-19–Associated Acute Respiratory Distress Syndrome

Extracorporeal Membrane Oxygenation in COVID-19 Patients: More Hype than Substance?

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