Rapid Expansion of VV-ECMO Support during the COVID-19 Pandemic: Experiences from a Community Hospital

ABSTRACT

Purpose: We report the clinical outcomes of an Adult Respiratory ECMO (VV-ECMO) program that was rapidly established in a community hospital within a 4-week period. The program was launched in response to increasing patients presenting with acute respiratory failure due to COVID-19. Method(s) Our institution supported urgent preparedness to add VVECMO therapy to our established, nurse-run Adult VA-ECMO program. ICU nurses were trained to run VV-ECMO through interdisciplinary collaboration with neonatal-pediatric ECMO nurses, cardiac perfusionists, providers (NP, PA), respiratory therapists, and physicians. Retrospective data of VV-ECMO therapy was collected between November 2020 and June 2022. Result(s) 29 patients with ARDS due to COVID-19 received VV-ECMO. Of the 29 patients were 23 males and 6 females, of median age 48 (31-59) years and median body mass index (BMI) 31.4 kg/m2 (20.5-49.2). The mean duration of VV-ECMO was 970 hours (44.1 days) and the longest run time was 2752 hours (114.6 days). Patient survival rate to VV-ECMO explant was 66%. Patient survival to discharge with a return to pre-ECMO functional capacity was 55%, defined as supplemental oxygen requirements less than 3L nasal cannula and rehabilitating to activities of daily living. Conclusion(s) In the setting of the COVID-19 pandemic, an Adult VV-ECMO program was rapidly developed and executed in an advanced community hospital system. Our VV-ECMO program results are comparable to programs at major academic centers, with survival rates on par with statistics reported by the ELSO registry. Additionally, our outcomes demonstrate that a nurse-run VV-ECMO program can be both feasible and successful.