Extracorporeal membrane oxygenation for COVID-19: An evolving experience through multiple waves. Artif Organs 2022 Nov;46(11):2257-2265
Date
08/13/2022Pubmed ID
35957490Pubmed Central ID
PMC9538401DOI
10.1111/aor.14381Scopus ID
2-s2.0-85135294133 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has shown variable results in COVID-19 pneumonia however, some evidence supports benefit. Here we compare our institution's ECMO outcomes across multiple waves of the COVID-19 pandemic.
METHODS: All patients who received ECMO for COVID-19 between March 1, 2020, and March 1, 2021, were reviewed. Patients received venovenous (VV) or right ventricular assist device (RVAD/ECMO) ECMO. Early (March 1-July 6, 2020, Era 1) and late (July 7, 2020-March 1, 2021, Era 2) pandemic RVAD/ECMO patients were compared.
RESULTS: Fifty-four patients received ECMO of which 16 (29.6%) patients received VV ECMO and 38 (70.4%) RVAD/ECMO. Median age was 53.0 years, body mass index 36.1 kg/m2 , 41.2% female, and 49% Caucasian. The most common pre-cannulation treatments included steroids (79.6%) and convalescent plasma (70.4%). Median time from admission to cannulation was 7.0 days. Median support time was 30.5 days (VV ECMO 35.0 days, RVAD/ECMO 26.0 days). In- hospital mortality was 42.6% (39.5% RVAD/ECMO, 50.0% VV ECMO). Significant morbidities included infection (80.8%), bleeding events (74.5%), and renal replacement therapy (30.8%). Cumulative mortality 120-days post-cannulation was 45.7% (VV ECMO 60.8%, RVAD/ECMO 40.0%). RVAD/ECMO Era 1 demonstrated a significantly lower cumulative mortality (16.2%) compared to Era 2 (60.4%). Competing risk analysis found age (HR 0.95, [95% CI 0.92, 0.98] p = 0.005) to be a protective factor for survival.
CONCLUSION: ECMO support for COVID-19 is beneficial but carries significant morbidity. RVAD/ECMO support demonstrated consistent advantages in survival to VV-ECMO, but with declining efficacy across time during the COVID-19 pandemic.
Author List
Smith NJ, Park S, Zundel MT, Dong H, Szabo A, Cain MT, Durham LA 3rdAuthors
Lucian A. Durham MD, PhD Associate Professor in the Surgery department at Medical College of WisconsinAniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Michael Tracy Zundel MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Extracorporeal Membrane OxygenationFemale
Humans
Male
Middle Aged
Pandemics
Retrospective Studies