ECMO Duration for COVID-19 Patients - Does it Matter?

ABSTRACT

Objective: ECMO has acceptable outcomes for severe ARDS and is used for COVID-19 ARDS. This study investigated whether duration of ECMO supported its long-term usage. Method(s) A retrospective, IRB approved single-center study was conducted to review all patients placed on ECMO for refractory ARDS due to COVID-19 from 3/1/2020, to 3/1/2022. The review included demographics, ECMO run days, length of hospital stay, discharge disposition, and mortality (defined as in hospital death). Patient ECMO runs were binned into two categories based on days of ECMO support. Short Runs (SR) were defined as <= 30 days;Long Runs (LR) were > 30 days. Result(s) Overall, 164 patients and 165 ECMO runs comprised the study cohort. Demographics, age, and degree of respiratory failure were similar for both groups. SR were 15.7 days;LR were 80.6 days (p<0.01). Mortality was similar amongst the SR and LR groups (46.9% vs 39.3%, NS) despite duration of support. Discharge location was similar amongst both groups, but LR patients tend to require more use of long-term care (26.2% vs 18.5%, NS). LR was associated with increased use of cannulas (2.1 vs 3.1, p<0.01), increased membrane lungs (1.1 vs 2.9, p<0.01), and increased hospital stay days (94.8 vs 28.4, p<0.01). Conclusion(s) Our study demonstrated that duration of ECMO in COVID-19 was not a factor in mortality. LR patients experienced increased use of resources (cannulation, membrane lungs and length of stay) and were discharged to long term care facilities more often. More studies are needed to explore other aspects of survival.