COVID-19 outcomes of venovenous extracorporeal membrane oxygenation for acute respiratory failure vs historical cohort of non-COVID-19 viral infections

• Authors: Sagar Dave, Emory University; Ronald Rabinowitz, University of Maryland; Aakash Shah, University of Maryland; Ali Tabatabai, University of Maryland; Samuel M Galvagno, University of Maryland; Michael A Mazzeffi, George Washington; Raymond Rector, University of Maryland Medical; David J Kaczorowski, University of Pittsburgh; Thomas M Scalea, University of Maryland; Jay Menaker, Howard County General Hospital, Columbia
• Journal Title: PERFUSION-UK
• Publisher: SAGE PUBLICATIONS LTD | 2022-06-02, Pages 2676591221105603-2676591221105603
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/02676591221105603
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Peripheral Vascular Disease; Cardiovascular System & Cardiology; extracorporeal membrane oxygenation; COVID-19; acute respiratory failure; acute respiratory distress syndrome; critical care; influenza; viral; DISEASE 2019 COVID-19; LIFE-SUPPORT; MORTALITY; ADULT; INFLUENZA; DOCUMENT; OBESITY

Abstract

Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a support modality for patients with acute respiratory failure refractory to standard therapies. VV ECMO has been increasingly used during the current COVID-19 pandemic for patients with refractory respiratory failure. The object of this study was to evaluate the outcomes of VV ECMO in patients with COVID-19 compared to patients with non-COVID-19 viral infections. Methods: We retrospectively reviewed all patients supported with VV ECMO between 8/2014 and 8/2020 whose etiology of illness was a viral pulmonary infection. The primary outcome of this study was to evaluate in-hospital mortality. The secondary outcomes included length of ECMO course, ventilator duration, hospital length of stay, incidence of adverse events through ECMO course. Results: Eighty-nine patients were included (35 COVID-19 vs 54 non-COVID-19). Forty (74%) of the non-COVID-19 patients had influenza virus. Prior to cannulation, COVID-19 patients had longer ventilator duration (3 vs 1 day, p =.003), higher PaCO2 (64 vs 53 mmHg, p =.012), and white blood cell count (14 vs 9 ×103/μL, p =.004). Overall in-hospital mortality was 33.7% (n = 30). COVID-19 patients had a higher mortality (49% vs. 24%, p =.017) when compared to non-COVID-19 patients. COVID-19 survivors had longer median time on ECMO than non-COVID-19 survivors (24.4 vs 16.5 days p =.03) but had a similar hospital length of stay (HLOS) (41 vs 48 Extracorporeal Membrane Oxygenationdays p =.33). Conclusion: COVID-19 patients supported with VV ECMO have a higher mortality than non-COVID-19 patients. While COVID-19 survivors had significantly longer VV ECMO runs than non-COVID-19 survivors, HLOS was similar. This data add to a growing body of literature supporting the use of ECMO for potentially reversible causes of respiratory failure.