ABSTRACT
SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The novel coronavirus (SARS-CoV-2) has become a global pandemic, with many suffering from resultant severe acute respiratory distress syndrome (ARDS). Initiation of veno-venous extracorporeal membrane oxygenation (ECMO) support, which can restore gas exchange, has been used in patients with refractory ARDS, and is now being trialed in select patients with SARS-CoV-2 infection. However, use of ECMO in ARDS remains controversial, and both its usage and data are limited in SARS-CoV-2 infection. We describe consecutive patients who received ECMO support for refractory COVID-19-related ARDS in our facility. METHODS: We performed a retrospective cohort analysis of the first fourteen COVID-19 patients admitted to Yale New Haven Hospital who required ECMO support between April 6 and May 23, 2020. RESULTS: All 14 subjects were male;median age 50 (range 32-61) years;median BMI 37 (IQR 32-41) kg/m2;the most common ethnicity Hispanic (79%);and most prevalent comorbidities included diabetes and hypertension (36% each). The majority of patients received a trial of prone positioning and neuromuscular blockade (100%), pulmonary vasodilators (71%), and Tocilizumab (93%) prior to initiation of ECMO (Table 1). Patients had higher levels of positive end-expiratory (median 16 cmH2O) and plateau (median 36 cmH2O) pressures, with P/F ratio consistent with severe ARDS category (median 75) at the time of cannulation (Table 2). Bleeding requiring transfusion (86%) and sepsis excluding pneumonia (29%) were the most common complications while on ECMO. Six patients (43%) were successfully de-cannulated, of which two patients were discharged from the hospital. Four patients have died (29%) and another four (29%) continue to receive ECMO support (Table 3). CONCLUSIONS: COVID-19 patients with severe ARDS refractory to invasive mechanical ventilator support, prone positioning, and neuromuscular blockade have significant mortality with limited therapeutic options. Although use of ECMO in such patients has been debated, our experience suggests otherwise. Successful decannulation (43%), mortality (40%), and complications are in keeping with those of all-cause pulmonary failure requiring ECMO support in global registries. CLINICAL IMPLICATIONS: Veno-venous extracorporeal membrane oxygenation should be considered a feasible therapeutic option in restoring gas exchange in COVID-19-related ARDS once standard methods of mechanical ventilation, proning, and paralysis have proven insufficient. DISCLOSURES: No relevant relationships by Pramod Bonde, source=Web Response No relevant relationships by Astha Chichra, source=Web Response Owner/Founder relationship with Vent Multiplexor Please note: $1-$1000 Added 06/01/2020 by Elaine Fajardo, source=Web Response, value=Equity Owner/Founder relationship with prevents Please note: $1-$1000 Added 06/01/2020 by Elaine Fajardo, source=Web Response, value=Intellectual property rights No relevant relationships by Jan Fouad, source=Web Response No relevant relationships by Arnar Geirsson, source=Web Response No relevant relationships by Phillip Joseph, source=Web Response No relevant relationships by Akhil Khosla, source=Web Response No relevant relationships by Andres Oswaldo Razo-Vazquez, source=Web Response No relevant relationships by Jonathan Siner, source=Web Response No relevant relationships by Inderjit Singh, source=Web Response No relevant relationships by Christopher Szabo, source=Web Response No relevant relationships by Hossam Tantawy, source=Web Response