CHARACTERISTICS AND OUTCOMES OF COVID-19 PATIENTS MEETING VENO-VENO ECMO ELIGIBILITY CRITERIA RECEIVING ECMO VS CONVENTIONAL THERAPY ALONE

ABSTRACT

SESSION TITLE ECMO and ARDS in COVID-19 Infections SESSION TYPE Rapid Fire Original Inv PRESENTED ON 10/17/2022 1215 pm - 115 pm PURPOSE: To compare characteristics and outcomes of COVID-19 patients with respiratory failure meeting ECMO eligibility criteria who received ECMO vs. conventional therapy (CT) alone. METHODS: Retrospective analysis of COVID-19 patients (admitted April 2020 -December 2021) meeting ECMO eligibility criteria (PaO2/FiO2 <50 for more than 3 hours, PaO2/FiO2 < 80 for more than 6 hours, or pH < 7.25 with a pCO2 of at least 60 mm Hg for more than 6 hours within the first 7 days of mechanical ventilation (MV)) was performed. All patients received optimal therapies according to current guidelines. Due to the criteria evolution over the course of the pandemic, two intensivists confirmed eligibility by independent chart review. Differences between CT and ECMO groups were analyzed using Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests as appropriate. RESULTS: 62 patients met ECMO eligibility criteria, and 20 of them received CT alone. Reasons for not receiving ECMO included high BMI, comorbid conditions, improving gas exchange, or treatment team preference. CT patients had higher BMI (39.0 vs. 32.5, p=0.01), higher incidence of acute kidney injury (70% vs. 42.9%, p=0.05), and lower prevalence of current smoking (10% vs. 33%) compared to ECMO patients. In-hospital mortality for CT was 60% vs. 47.6% for ECMO (p= 0.36). Overall, CT patients had a significantly shorter duration of MV, ICU and hospital length of stay (LOS) than ECMO patients (18.0 vs. 41.0, 19.0 vs. 44.5, and 18.0 vs. 49 days respectively, p< 0.001). CT survivors had a shorter duration of MV, and shorter ICU and hospital LOS than ECMO survivors (23.5 vs. 44.5, 25.0 vs. 52.0, 31.5 vs. 56.0 days respectively, p <0.05). Among CT patients, survivors were younger (38.5 vs. 55, p=0.01), had higher P/F ratio (66.0 vs. 53.5, p=0.05), and lower pCO2 (71.5 vs. 86.0, p= 0.02) during the first week of MV than non-survivors. Respiratory acidosis was the principal ECMO eligibility criteria in 50% of CT survivors and 8.3% of non-survivors. CONCLUSIONS: The difference in mortality between ECMO-eligible patients treated with ECMO vs. CT alone didn’t reach statistical significance, possibly due to small sample size. ECMO was associated with a longer duration of MV, and ICU and hospital LOS. In CT patients, younger age and less severe oxygenation and ventilation abnormalities were associated with survival. Observed survival differences in relation to respiratory acidosis vs. hypoxemia as the main ECMO indication require confirmation. CLINICAL IMPLICATIONS A significant number of patients meeting ECMO eligibility criteria survived with CT alone. ECMO is resource-intensive and is not universally available, especially at the peaks of the pandemic. We demonstrate characteristics of survivors receiving CT alone which may help further refine ECMO indications in COVID-19 patients. DISCLOSURES No relevant relationships by Roman Melamed No relevant relationships by Ramiro Saavedra Romero No relevant relationships by Lynn Sipsey No relevant relationships by Ashley Stenzel No relevant relationships by David Tierney