ABSTRACT
SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: As of March 25, 2022, age-standardized data reported by the Centers for Disease Control and Prevention showed that Hispanic, Black and American Indian or Alaska Native are about twice as likely to die from coronavirus disease 2019 (COVID-19) as their White and Asian counterparts. However, there is paucity of data regarding the effect of race on outcomes in COVID-19 related acute respiratory distress syndrome (ARDS) patients managed with extracorporeal membrane oxygenation (ECMO). Our study aims to understand the differences in the outcome between White/Asian and other ethnically minority COVID-19 patients treated with ECMO in our intensive care unit (ICU). METHODS: Retrospective analysis of adult patients with COVID-19 related ARDS treated with ECMO in the ICUs of a quaternary care hospital between 03/01/2020 and 03/31/2022. Patients were divided into two groups: White/Asian (WA) and Other Minorities (OM). Demographics, clinical characteristics, and outcomes of the two groups were compared. RESULTS: Of the 36 COVID-19 patients managed with ECMO during the study period, 18 (50%) patients belonged to the WA group while 18 (50%) patients belonged to the OM group. In the WA group, 16 (89%) were white and 2 (11%) were Asians whereas in the OM group, 16 (89%) patients were Hispanics and 2 (11%) patients were African-American. Both groups were similar in terms of age, gender, comorbidity burden (measured by Charlson Comorbidity Index), and severity of illness at the time of ICU admission (assessed by APACHE-IV score). Mean RESP score was lower in the OM group but was not statistically significant (1.3 ± 3.9 vs 2.9 ± 2.3, p= 0.157). This was reflected in the higher hospital mortality in the OM group compared to the WA group [n= 9 (50%) vs. 15 (83%), p=0.075]. There was no significant difference between the groups in the rate of ECMO-related complications, including major bleeding requiring transfusion, transaminitis (alanine transaminase greater than 5 times of upper normal limit), stroke, myocardial dysfunction (defined as an ejection fraction < 30%), acute kidney injury requiring dialysis and positive sterile fluid cultures. CONCLUSIONS: Our study showed higher mortality in ethnically minority patients compared to the white and Asian population but the difference was not statistically significant. It is possible that the relatively small number of patients in our study led to a beta error. Higher mortality rates among people of color have been attributed to low socio-economic status, structural inequities in health care and differences in vaccination rates. CLINICAL IMPLICATIONS: Larger studies are needed to further explore differences in clinical characteristics and outcomes of COVID-19 patients of different races and ethnicities treated with ECMO. DISCLOSURES: No relevant relationships by ALEENA ARSHAD No relevant relationships by Dipak Chandy No relevant relationships by Subo Dey No relevant relationships by Oleg Epelbaum No relevant relationships by Daniel Greenberg No relevant relationships by Theresa Henson No relevant relationships by Lawrence Huang No relevant relationships by Daniel Peneyra No relevant relationships by Areen Pitaktong No relevant relationships by Hamid Yaqoob
ABSTRACT
SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The role of extracorporeal membrane oxygenation (ECMO) for patients with coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is evolving. Data from different waves of the pandemic has shown that mortality of COVID-19 patients treated with ECMO ranges from 40-94%. Pre-COVID studies have shown that ECMO is associated with bleeding in 30-50% of patients, thrombotic complications in about 10% and secondary infections in 40% of patients. However, there is a paucity of data regarding complications with the use of ECMO in COVID-19 patients. In this study, we describe the hospital course and complications seen in the COVID-19 patients admitted to our Intensive Care Unit (ICU) treated with ECMO. METHODS: Retrospective cohort analysis of adult patients with COVID-19 related ARDS admitted to the ICUs of a quaternary care hospital between 03/01/2020 and 03/31/2022 who were managed with ECMO. RESULTS: Of the 36 COVID-19 patients treated with ECMO, 23 (64%) patients were male. Median age was 48 years (IQR 36-59). Patients had a mean BMI of 36 ± 12. Median Charlson Comorbidity Index (assesses comorbidities) was 1 (0-2) and median APACHE-IV score (assesses severity of illness at the time of ICU admission) was 60 (51-72). Prior to initiation of ECMO, 14 (39%) patients were proned and 29 (81%) patients received a trial of neuromuscular blockade. Patients had high plateau pressures (mean 31 ± 8 cm H20) with pO2/FiO2 ratios consistent with severe ARDS (mean 63 ± 17) at the time of ECMO cannulation. Mean Respiratory ECMO Survival Prediction (RESP) score was 2.1 ± 3.3. The most common complications were bleeding requiring transfusion seen in 94% of patients and positive sterile fluid cultures (53% patients). Hemorrhagic stroke was seen in 3 patients (8%). None of the patients had limb ischemia or clotting of the cannula requiring catheter exchange. Withdrawal of care occurred in 3 patients (8%). 13 (35%) patients were successfully decannulated from ECMO;however only 12 (33%) patients were discharged alive. CONCLUSIONS: Our study shows a survival rate in COVID-19 patients treated with ECMO that is comparable to previously reported studies. High bleeding and infection rates can possibly be explained by steroid use and COVID-19 disease specific characteristics. CLINICAL IMPLICATIONS: Our study describes the hospital course of the COVID-19 patients treated with ECMO and can be used to evaluate it's role in the management of severe COVID-19 patients refractory to conventional ventilatory management. DISCLOSURES: No relevant relationships by ALEENA ARSHAD No relevant relationships by Dipak Chandy No relevant relationships by Oleg Epelbaum No relevant relationships by Daniel Greenberg No relevant relationships by Theresa Henson No relevant relationships by Lawrence Huang No relevant relationships by Daniel Peneyra No relevant relationships by Areen Pitaktong No relevant relationships by Hamid Yaqoob