Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends over Time

Jeffrey P. Jacobs, Alfred H. Stammers, James St Louis, J. W.Awori Hayanga, Michael S. Firstenberg, Linda B. Mongero, Eric A. Tesdahl, Keshava Rajagopal, Faisal H. Cheema, Kirti Patel, Feriel Esseghir, Tom Coley, Anthony K. Sestokas, Marvin J. Slepian, Vinay Badhwar

Research output: Contribution to journalArticlepeer-review

Abstract

The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ2tests for categorical variables and Kruskal-Wallis rank-sum tests and Welch's analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8-22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.

Original languageEnglish (US)
Pages (from-to)496-502
Number of pages7
JournalASAIO Journal
DOIs
StateAccepted/In press - 2021

Keywords

  • acute respiratory distress syndrome
  • coronavirus
  • COVID-19
  • extracorporeal membrane oxygenation
  • heart failure
  • outcomes
  • pulmonary failure
  • quality

ASJC Scopus subject areas

  • Biophysics
  • Bioengineering
  • Biomaterials
  • Biomedical Engineering

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