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Risk Factors of Mortality for Patients Receiving Venovenous Extracorporeal Membrane Oxygenation for COVID-19 Acute Respiratory Distress Syndrome.
Bergman, Zachary R; Wothe, Jillian K; Alwan, Fatima S; Lofrano, Arianna E; Tointon, Kelly M; Doucette, Melissa; Bohman, John K; Saavedra-Romero, Ramiro; Prekker, Matthew E; Lusczek, Elizabeth R; Beilman, Greg; Brunsvold, Melissa E.
  • Bergman ZR; Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
  • Wothe JK; University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA.
  • Alwan FS; University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA.
  • Lofrano AE; Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.
  • Tointon KM; Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
  • Doucette M; Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
  • Bohman JK; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
  • Saavedra-Romero R; Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
  • Prekker ME; Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.
  • Lusczek ER; Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA.
  • Beilman G; Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
  • Brunsvold ME; Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Surg Infect (Larchmt) ; 22(10): 1086-1092, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1398071
ABSTRACT

Background:

Venovenous extracorporeal membrane oxygenation (VV-ECMO) for select adults with severe acute respiratory distress syndrome (ARDS) cause by coronavirus disease 2019 (COVID-19) infection is a guideline-supported therapy with associated hospital survival of 62%-74%, similar to expected survival with VV-ECMO for other indications. However, ECMO is a resource-heavy intervention, and these patients often require long ECMO runs and prolonged intensive care unit (ICU) care. Identifying factors associated with mortality in VV-ECMO patients with COVID-19 infection can inform the evaluation of ECMO candidates as well as prognostication for those patients on prolonged VV-ECMO. Patients and

Methods:

This was a retrospective cohort study that included all patients who received either VV- or venoarteriovenous (VAV)-ECMO at one of four ECMO Centers of Excellence in the state of Minnesota between March 1, 2020 and November 1, 2020. The primary outcome was 60-day survival. Secondary outcomes were hospital complications, infectious complications, and complications from ECMO.

Results:

There were 46 patients who met criteria during this study period and 30 survived to 60-day follow-up (65.2%). Prior to cannulation, older patient age (55.5 in non-survivors vs. 49.1 years in survivors; p = 0.03), lower P/F ratio (62.1 vs. 76.2; p = 0.04), and higher sequential organ failure assessment (SOFA) score (8.1 vs. 6.6; p = 0.02) were identified as risk factors for mortality. After ECMO cannulation, increased mortality was associated with increased number of antibiotic days (25.9 vs. 14.5; p = 0.04), increased number of transfusions (23.9 vs. 9.9; p = 0.03), elevated white blood cell (WBC) count at post-ECMO days one through three, elevated D-dimer at post-ECMO day 21-27, and decreased platelet count from post-ECMO days 14 and onward using univariable analysis.

Conclusions:

Multiple markers of infection including leukocytosis, thrombocytopenia, and increased antibiotic days are associated with increased mortality in patients placed on VV-ECMO for COVID-19 infection and subsequent ARDS. Knowledge of these factors may assist with determining appropriate candidates for this limited resource as well as direct goals of care in prolonged ECMO courses.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Surg Infect (Larchmt) Journal subject: Bacteriology Year: 2021 Document Type: Article Affiliation country: Sur.2021.114

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Extracorporeal Membrane Oxygenation / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: Surg Infect (Larchmt) Journal subject: Bacteriology Year: 2021 Document Type: Article Affiliation country: Sur.2021.114