ABSTRACT
Background: Patients with COVID-19 are generally primarily treated in regional medical centers. Besides oxygen therapy, treatment usually involves mechanical ventilation and prone positioning should the patient develop acute respiratory distress syndrome (ARDS). In patients with refractory respiratory failure, initiation of veno-venous extracorporeal membrane oxygenation (vv-ECMO) may be the last therapeutic resort. Treatment with vv-ECMO requires highly experienced medical equipment and personnel. ECMO centers may be able to aid the regional medical centers, as this is not available for most hospitals. Implantation of the vv-ECMO system at the bedside and subsequently transporting the patient to a specialized center for further therapy could relieve both regional and specialized hospitals. Method(s): All patients in the participating centers of the DIVI between January 2020 and March 2021 with severe COVID-19induced ARDS were evaluated. Patients treated with vv-ECMO were included. Two groups were determined. The first group (group A) consisted of patients primarily treated in a regional medical center. These patients were cannulated at the bedside and transferred to the ECMO center. Group B consisted of patients directly referred to a specialized ECMO center. A comparison between mortality and ECMO-associated complications was made. Result(s): In total, 650 patients were treated with vv-ECMO in the timeframe. Group A consisted of 195 patients and group B of 455 patients. Patient characteristics such as sex, body mass index and pre-existing comorbidities were comparable. The time to admission to the intensive care unit was for both groups comparable. The delay from intubation to ECMO implantation was significantly shorter in group A 4.3 +/- 0.4 days versus 6.5 +/- 0.3 days (p < 0.001). Total time on mechanical ventilation, days spent in the intensive care unit and ECMO runtime were comparable in both groups. Furthermore, there was no significant difference in ECMO-associated complications and mortality. Conclusion(s): Respiratory failure due to severe COVID-19 pneumonia may primarily be treated in a regional medical center. There is no significant increase in ECMO-associated complications and mortality due to ECMO implantation and patient transfer to a specialized center, should therapy escalation be needed.