Venovenous extracorporeal membrane oxygenation support in patients with COVID-19 respiratory failure: A multicenter study

Navin G Vigneshwar; Muhammad F Masood; Ivana Vasic; Martin Krause; Karsten Bartels; Mark T Lucas; Michael Bronsert; Craig H Selzman; Shaun Thompson; Jessica Y Rove; Thomas B Reece; Joseph C Cleveland; Jay D Pal; David A Fullerton; Muhammad Aftab

doi:10.1016/j.xjon.2022.08.007

Venovenous extracorporeal membrane oxygenation support in patients with COVID-19 respiratory failure: A multicenter study

JTCVS Open. 2022 Dec:12:211-220. doi: 10.1016/j.xjon.2022.08.007. Epub 2022 Sep 8.

Authors

Affiliations

¹ Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo.
² Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.
³ University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo.
⁴ Department of Anesthesiology, University of San Diego, San Diego, Calif.
⁵ Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Neb.
⁶ Colorado Health Outcomes Program, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo.
⁷ Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah.

Abstract

Objective: The COVID-19 pandemic presents a high mortality rate amongst patients who develop severe acute respiratory distress syndrome (ARDS). The purpose of this study was to evaluate the outcomes of venovenous extracorporeal membrane oxygenation (VV-ECMO) in COVID-19-related ARDS and identify the patients who benefit the most from this procedure.

Methods: Adult patients with COVID-19 and severe ARDS requiring VV-ECMO support at 4 academic institutions between March and October 2020 were included. Data were collected through retrospective chart reviews. Bivariate and multivariable analyses were performed with the primary outcome of in-hospital mortality.

Results: Fifty-one consecutive patients underwent VV-ECMO with a mean age of 50.4 years; 64.7% were men. Survival to hospital discharge was 62.8%. Median intensive care unit and hospitalization duration were 27.4 days (interquartile range [IQR], 17-37 days) and 34.5 days (IQR, 23-43 days), respectively. Survivors and nonsurvivors had a median ECMO cannulation time of 11 days (IQR, 8-18) and 17 days (IQR, 12-25 days). The average postdecannulation length of stay was 17.5 days (IQR, 12.4-25 days) for survivors and 0 days for nonsurvivors (IQR, 0-6 days). Only 1 nonsurvivor was able to be decannulated. Clinical characteristics associated with mortality between nonsurviors and survivors included increasing age (P = .0048), hemorrhagic stroke (P = .0014), and postoperative dialysis (P = .0013) were associated with mortality in a bivariate model and retained statistical significance in a multivariable model.

Conclusions: This multicenter study confirms the effectiveness of VV-ECMO in selected critically ill patients with COVID-19-related severe ARDS. The survival of these patients is comparable to non-COVID-19-related ARDS.

Keywords: ARDS, acute respiratory distress syndrome; COVID-19 infection; ELSO, Extracorporeal Life Support Organization; EOLIA, ECMO to Rescue Lung Injury in Severe ARDS; VV-ECMO; VV-ECMO, venovenous extracorporeal membrane oxygenation; mechanical support; proBNP, B-type natriuretic peptide; respiratory failure; severe ARDS.