ABSTRACT
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) has been utilized as a rescue therapy for patients with severe ARDS. Multiple case series have suggested that the duration of veno-venous ECMO support in patients with COVID-19 pneumonia may be longer than patients with ARDS secondary to alternative etiology. However, the impact of longer run of ECMO on patient outcomes are not clear. METHOD(S): This was a retrospective study performed at Mayo Clinic Florida and Mayo Clinic Rochester, tertiary ECMO centers in USA. Analysis includes all consecutive patients who were placed on VV ECMO for COVID-19- induced ARDS between January 2019 to March 2022. The study population was classified into two groups: short term ECMO duration (< 4 weeks) and prolonged ECMO support (>4 weeks). Demographic data, baseline clinical characteristics, treatments administered, mechanical ventilator data, lab data, ECMO data and outcome related data were collected and analyzed. RESULT(S): A total of 63 COVID-19 patients were included. For the entire cohort, the 30 day mortality was 6%, the 90 day mortality was 30% and the median duration of ECMO support was 35 days (IQR 38). A total of 6 (10%) patients went on to receive lung transplant. Among these, 25(40%) patients required ECMO for < 4 weeks and 38(60%) patients for >4 weeks. The median SOFA values (13 vs 11, 0.016) for the <=4 weeks cohort was higher. Both groups received similar COVID-19 therapies: glucocorticoids (96 vs 100%, p=0.397), tocilizumab (52 vs 50%, p=1.000), antivirals (88 vs 87%, p=1.000), and convalescent plasma (48 vs 45%, p=1.000). The cumulative mortality rates for the 2 groups were 8% vs 5% at 30 days (p=1.0), 12% vs 42% at 60 days (p=0.013), 12% vs 50% at 90 days (p=0.002) and 12% vs 50%(p=0.002) at 180 days. CONCLUSION(S): The study demonstrated that a substantial number of COVID19 patients require ECMO for > 4 weeks. In this cohort, the mortality rate in the first 4 weeks of ECMO support was low, at 6%. The patients who required ECMO for >4 weeks were more likely to have higher mortality compared to the patients treated with ECMO for shorter duration.