Long ECMO runs in patients with COVID-19 disease. A subanalysis of the ECMOVIBER study

ABSTRACT

Objective: Describe the population of patients with COVID-19 disease needing long ECMO runs and compare characteristics and outcomes with shorter runs. Methods: Descriptive analysis of the ECMOVIBER registry, including 25 ECMO centers in Spain (23) and Portugal (2). All adult COVID-19 patients requiring VVECMO between 1stMarch and 1stDecember 2020 were included. Follow-up period ended 1stDecember. Patients still with support at this time point were excluded for the analysis. Long ECMO run was defined if lasted >30D. High volume center was defined as supporting >15 COVID-19 patients during the study period. Variables described as mean(SD)/median(IQR) or frequency(percentage). For comparisons, the Chi2, Fisher's exact or Mann-Whitney U were use. Results: Of 316 patients, 266 completed the ECMO run at the end of follow up. 46(17%) received long support and 220(83%) shorter runs. Comparisons between the two cohorts are detailed in the table-figure. Patients with longer runs were older and suffered more frequently hypertension but the respiratory condition prior to ECMO was similar. Interestingly, at day 3 of support tidal volume was lower and sweep gas flow was higher in the long run cohort. Supplemental therapies such as prone positioning and CRRT were more frequently implemented in long runs and complications occurred more frequently in this group. However, neither ECMO mortality, nor hospital mortality were higher. Conclusions: In patients with extracorporeal support due to COVID-19, tidal volume and gas flow at day 3 may discriminate those needing long runs. Long runs are not associated with worse survival despite having higher complication rates.