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

Chitaru Kurihara, Adwaiy Manerikar, Catherine Aiyuan Gao, Satoshi Watanabe, Viswajit Kandula, Alexandra Klonis, Vanessa Hoppner, Azad Karim, Mark Saine, David D. Odell, Kalvin Lung, Rafael Garza-Castillon, Samuel S. Kim, James Mc Cauley Walter, Richard G. Wunderink, G. R.Scott Budinger, Ankit Bharat

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)688-696
Number of pages9
JournalArtificial Organs
Volume46
Issue number4
DOIs
StatePublished - Apr 2022

Keywords

  • COVID-19
  • V-V ECMO
  • artificial organs
  • circulatory support devices
  • outcomes

ASJC Scopus subject areas

  • Bioengineering
  • Medicine (miscellaneous)
  • Biomaterials
  • Biomedical Engineering

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