Clinical Characteristics and Outcomes of Extracorporeal Membrane Oxygenation Support in COVID-19: Retrospective Study of Single Center Experience

PURPOSE: The use of extracorporeal membrane oxygenation (ECMO) support is increasingly used in the management of COVID-19-related acute respiratory distress syndrome (ARDS). The effect of ECMO for patients with severe ARDS in the context of COVID-19 is unclear. This study is to summarize the clinical features, and outcomes of patients with severe ARDS due to COVID-19 treated with ECMO. We analyzed the incidence of morbidity including ischemic/hemorrhagic stroke, gastrointestinal bleeding, pump malfunction, oxygenator dysfunction, infection during VV ECMO. We also compared COVID ECMO patients to non COVID-19 ECMO patients. METHODS: This is a retrospective review of an institutional ECMO database. We included consecutive patients from January 2015 through July 2020. 138 patients (mean age, 47.0 ± 14.4 y) with respiratory failure who underwent VV ECMO implantation were included in this study. Patients were stratified into two cohorts: those with COVID-19 or non COVID-19. RESULTS: Patients with COVID-19 had higher body mass index (33.4 ± 5.9 vs 28.8 ± 8.9, p<0.01), also had lower albumin level (2.7 ± 0.5 vs 3.1 ± 0.7, p<0.01). Patients with COVID-19 demonstrated not significantly lower survival rates (p=0.16). There was also no significant difference between 2 groups in incidence of acute kidney injury (p=0.17), dialysis (p=0.82), tracheostomy, (p=0.22), neurological dysfunction (p=0.19), gastrointestinal bleeding (p=0.42), oxygenator dysfunction (p=0.37), and sepsis (p=0.75). However, ECMO support days were significantly longer in COVID ECMO patients. (29.0 ± 27.5 vs 15.9 ± 19.6 days, p<0.01). CONCLUSION: These findings suggest that COVID related ARDS was not associated with a higher postoperative mortality rate than non COVID related ARDS patients, even though support days of ECMO was longer in those groups. ECMO should be considered for patients developing ARDS despite optimised care.