Complications during ECMO support in patients with COVID-19: A prospective observational study

ABSTRACT

Objective: To analyze the complications developed in patients with COVID-19 supported with ECMO and to evaluate their impact in outcomes. Methods: Prospective observational study including all the COVID-19 patients with ECMO support in the ICU of the VHUH from 15 March to 30 July. Infectious, renal, thrombotic, hemorrhagic and other complications during support were prospectively registered. Continuous variables expressed as median (interquartile range) and categorical variables as number (percentage). The impact of complications in mortality was analyzed using Chi-squared or Fisheŕs exact test as appropriate. Results: Twenty-four patients [55 (46-57) years, 58% male, BMI 32.1 (27-35)] received ECMO support [23 (96%) VV-ECMO] during 11 (5.7-19.2) days. The longest run lasted 67 days (awake ECMO). Eighteen (75%) patients could be decannulated and 16 (67%) were discharged alive from the ICU. Fifteen (63%) patients suffered hemorrhagic complications and 12 (48%) thrombotic events, with 7 (29%) patients needing circuit change. Ventilator-associated pneumonia (VAP) was diagnosed in 8 (33%) patients and acute kidney injury (AKI) in 7 (29%). Other complications were air leak (5 patients), fungal infection (4), CMV replication (3) and cardiac tamponade (1). Hemorrhage and thrombosis were not associated with mortality (P=1.0 and P=0.6, respectively). VAP and AKI were neither associated with mortality (P=0.3 both). Conclusions: Complications are frequent in COVID-19 patients supported with ECMO, especially thrombotic and hemorrhagic. VAP and AKI might be studied in further studies to confirm their association with a higher risk of mortality.