ABSTRACT
The COVID-19 pandemic drove a sustained increase in the volume and duration of venovenous extracorporeal membrane oxygenation (VV-ECMO), accelerating a decade long trend. While current clinical consensus recommends a maximal support duration of 14-21 days, the observed change in practice may warrant revisiting this notion. To guide this, we describe our institution's experience with prolonged VV-ECMO support. We performed a retrospective cohort analysis of patients who received VV-ECMO support at a large academic medical center between 2018-2022 using medical records. This study is a descriptive report of patients who received prolonged VV-ECMO support, defined as >50 continuous days on circuit. Of the 130 patients who received VV-ECMO during the study period, 12 (9.2%) had a support duration of >50 days, 11 of whom suffered from adult respiratory distress syndrome (ARDS) secondary to COVID-19, while 1 patient with prior bilateral lung transplant suffered from ARDS secondary to bacterial pneumonia. The median duration of VV-ECMO support was 94 days [IQR: 69.5, 128], with a maximum support of 180 days. Median time from intubation to cannulation was 5 days [IQR: 2, 14]. On-circuit mobilization was performed in 9 patients (75%). Successful weaning of VV-ECMO support occurred in 8 patients (67%), with 6 (50%) bridged to lung transplantation and 2 (17%) bridged to recovery. A total of 7 patients (58%) were discharged from the hospital: 3 to home and 4 to a rehabilitation center. ECMO complications included cannulation site bleeding in 10 patients (83%), gastrointestinal bleeding in 4 patients (33%), oxygenator failure in 7 patients (58%), and required circuit exchanges in 9 patients (75%) (Figure 1). Extremely prolonged VV-ECMO support allows for successful recovery or optimization of lung transplant candidacy in a select group of patients at a high-volume institution, further supporting the expanded utilization of VV-ECMO. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)