Outcomes between COVID versus nonCOVID patients receiving venovenous extracorporeal membrane oxygen

ABSTRACT

INTRODUCTION: Similar to use during the H1N1 pandemic as a means of improved survival in patients with severe acute respiratory distress syndrome (ARDS), there may be a role for extracorporeal membrane oxygenation (ECMO) in patients with severe ARDS secondary to the novel coronavirus (SARS-CoV2 causing COVID). Limited data, however, exists for the use of ECMO in this population. The purpose of this study was to evaluate outcomes between COVID and non- COVID patients receiving venovenous (VV) ECMO. METHODS: This was a retrospective review of 15 COVID and 15 non-COVID patients receiving VV ECMO at Rush University Medical Center. Patients were excluded if they were receiving ECMO at the time of data analysis. The primary outcome was days requiring mechanical ventilation (MV) and ECMO. Secondary outcomes included discharge disposition, hospital length of stay (LOS) and survival. Data collected included demographics, co-morbidities, ECMO characteristics, MV and ECMO days, hospital LOS, discharge disposition, and survival. RESULTS: In our cohort, the median age was 45.0 [36.0-51.0] versus 47.0 [36.0-52.0] in the COVID versus non-COVID groups, respectively. Similarly, BMI and comorbidities were not different between groups. A majority of patients in the COVID group were Hispanic (46.7%) versus the non-COVID group (33.3%). Inhaled epoprostenol was delivered prior to ECMO in 73.3% of COVID patients versus 20.0% of non-COVID patients. A 31 French Protek was placed in all COVID ECMO patients versus 46.7% of non-COVID ECMO patients. Days receiving MV were 12.0 [6.0-24.0] and 18.0 [12.0-35.0] and receiving ECMO were 30.0 [23.0-50.0] versus 27.0 days [19.0-56.0] in the COVID and non-COVID groups, respectively. Hospital LOS was 37.0 [29.5-52.5] in the COVID group versus 46.0 [29.0-60.0] days in the non-COVID group. Of note, two patients in the COVID group were hospitalized at the time of data analysis. Survival was 93.3% in both ECMO groups and a majority of patients were discharged to a rehabilitation facility (53.3%). CONCLUSIONS: These data suggest that ECMO may be a useful means of supporting patients with refractory hypoxic respiratory failure secondary to COVID. Future studies are needed to thoroughly evaluate the role of ECMO in this patient population.