Outcomes after extracorporeal membrane oxygenation support in COVID‐19 and non‐COVID‐19 patients

Background Veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) support is increasingly used in the management of COVID‐19‐related acute respiratory distress syndrome (ARDS). However, the clinical decision‐making to initiate V‐V ECMO for severe COVID‐19 still remains unclear. In order to deter...

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Bibliographic Details
Published in:	Artificial organs Vol. 46; no. 4; pp. 688 - 696
Main Authors:	Kurihara, Chitaru, Manerikar, Adwaiy, Gao, Catherine Aiyuan, Watanabe, Satoshi, Kandula, Viswajit, Klonis, Alexandra, Hoppner, Vanessa, Karim, Azad, Saine, Mark, Odell, David D., Lung, Kalvin, Garza‐Castillon, Rafael, Kim, Samuel S., Walter, James McCauley, Wunderink, Richard G., Budinger, G. R. Scott, Bharat, Ankit
Format:	Journal Article
Language:	English
Published:	United States Wiley Subscription Services, Inc 01-04-2022 John Wiley and Sons Inc
Subjects:	artificial organs circulatory support devices Complications COVID-19 COVID-19 - complications COVID-19 - therapy Decision making Extracorporeal membrane oxygenation Extracorporeal Membrane Oxygenation - adverse effects Hemorrhage - etiology Humans Lung transplantation Lungs Main Text Membranes Mortality outcomes Oxygenation Patients Respiratory distress syndrome Respiratory Distress Syndrome - etiology Respiratory Distress Syndrome - therapy Retrospective Studies Time Factors Transplantation Transplants & implants V‐V ECMO COVID-19 V-V ECMO artificial organs circulatory support devices outcomes
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Summary:	Background Veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) support is increasingly used in the management of COVID‐19‐related acute respiratory distress syndrome (ARDS). However, the clinical decision‐making to initiate V‐V ECMO for severe COVID‐19 still remains unclear. In order to determine the optimal timing and patient selection, we investigated the outcomes of both COVID‐19 and non‐COVID‐19 patients undergoing V‐V ECMO support. Methods Overall, 138 patients were included in this study. Patients were stratified into two cohorts: those with COVID‐19 and non‐COVID‐19 ARDS. Results The survival in patients with COVID‐19 was statistically similar to non‐COVID‐19 patients (p = .16). However, the COVID‐19 group demonstrated higher rates of bleeding (p = .03) and thrombotic complications (p < .001). The duration of V‐V ECMO support was longer in COVID‐19 patients compared to non‐COVID‐19 patients (29.0 ± 27.5 vs 15.9 ± 19.6 days, p < .01). Most notably, in contrast to the non‐COVID‐19 group, we found that COVID‐19 patients who had been on a ventilator for longer than 7 days prior to ECMO had 100% mortality without a lung transplant. Conclusions These findings suggest that COVID‐19‐associated ARDS was not associated with a higher post‐ECMO mortality than non‐COVID‐19‐associated ARDS patients, despite longer duration of extracorporeal support. Early initiation of V‐V ECMO is important for improved ECMO outcomes in COVID‐19 ARDS patients. Since late initiation of ECMO was associated with extremely high mortality related to lack of pulmonary recovery, it should be used judiciously or as a bridge to lung transplantation. The survival in patients with COVID‐19 was statistically similar compared to non‐COVID‐19 patients, but the mortality of COVID‐19 patients who had been on a ventilator for longer than 7 days prior to the initiation of ECMO approached 100%.
Bibliography:	Funding information Ankit Bharat is supported by National Institutes of Health HL145478, HL147290, and HL147575 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0160-564X 1525-1594
DOI:	10.1111/aor.14090