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

• 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
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.14090

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%.