Prolonged ECMO Therapy Outcomes: What's Next?

ABSTRACT

Houston Methodist Hospital treated 130 patients requiring ECMO from January 2021 to June 10, 2022. Out of this targeted population, 37 patients belonged to the long group with > 6 weeks ECMO run. This group has 2 (5.4%) VA and 35 (94.6%) VV and 78% of these patients had been diagnosed with COVID-19. The second group with a shorter ECMO run, had 93 ECMO cases, with 44 (47.3%) VA and 49 (64.6%) VV including 2 currently admitted. 54% were diagnosed with COVID-19. Result(s) Bleeding complications (GI, surgical, peripheral, pulmonary) occurred in both groups. There was no association between the length of ECMO runs to the day of bleeding occurrences in either groups where heparin was the anticoagulant of choice. Fifty-eight percent of the COVID patients ended up with transplants, the remaining expired, recovered, or are still in the hospital. Currently, the mortality rate in this group of COVID-19 patients on prolonged ECMO therapy is 29% where superimposed respiratory infection was identified and 54% had bacteremia. The survivors in this group went to rehab, LTACH, or home with 3 patients still in the hospital. Conclusion(s) Based on the data analysis of 130 patients from a single institution, the results showed no difference in the mortality in both groups based on length of ECMO run. Common ECMO-related complications like bleeding, acute kidney injury and limb ischemia may also not affect mortality. The question arises about how long an ECMO can be run without transplant and meaningful recovery. How and when to define futility.