(719) Outcomes of Extremely Prolonged (> 50 Days) Venovenous Extracorporeal Membrane Oxygenation Support: A Single Center Experience

PURPOSE: The COVID-19 pandemic drove a sustained increase in the volume and duration of venovenous extracorporeal membrane oxygenation (VV-ECMO), accelerating a decade long trend. While current clinical consensus recommends a maximal support duration of 14-21 days, the observed change in practice may warrant revisiting this notion. To guide this, we describe our institution's experience with prolonged VV-ECMO support. METHODS: We performed a retrospective cohort analysis of patients who received VV-ECMO support at a large academic medical center between 2018-2022 using medical records. This study is a descriptive report of patients who received prolonged VV-ECMO support, defined as >50 continuous days on circuit. RESULTS: Of the 130 patients who received VV-ECMO during the study period, 12 (9.2%) had a support duration of >50 days, 11 of whom suffered from adult respiratory distress syndrome (ARDS) secondary to COVID-19, while 1 patient with prior bilateral lung transplant suffered from ARDS secondary to bacterial pneumonia. The median duration of VV-ECMO support was 94 days [IQR: 69.5, 128], with a maximum support of 180 days. Median time from intubation to cannulation was 5 days [IQR: 2, 14]. On-circuit mobilization was performed in 9 patients (75%). Successful weaning of VV-ECMO support occurred in 8 patients (67%), with 6 (50%) bridged to lung transplantation and 2 (17%) bridged to recovery. A total of 7 patients (58%) were discharged from the hospital: 3 to home and 4 to a rehabilitation center. ECMO complications included cannulation site bleeding in 10 patients (83%), gastrointestinal bleeding in 4 patients (33%), oxygenator failure in 7 patients (58%), and required circuit exchanges in 9 patients (75%) (Figure 1). CONCLUSION: Extremely prolonged VV-ECMO support allows for successful recovery or optimization of lung transplant candidacy in a select group of patients at a high-volume institution, further supporting the expanded utilization of VV-ECMO.