Critical Care Explorations (Feb 2023)

Extracorporeal Membrane Oxygenation for COVID-19: Comparison of Outcomes to Non-COVID-19–Related Viral Acute Respiratory Distress Syndrome From the Extracorporeal Life Support Organization Registry

  • Abhimanyu Chandel, MD,
  • Nitin Puri, MD, FCCP,
  • Emily Damuth, MD,
  • Christopher Potestio, MD,
  • Lars-Kristofer N. Peterson, MD, FACEP, FAAEM,
  • Julia Ledane, BS,
  • Craig R. Rackley, MD,
  • Christopher S. King, MD, FCCP,
  • Steven A. Conrad, MD, PhD, FFCM, MCCM,
  • Adam Green, MD, MBA

DOI
https://doi.org/10.1097/CCE.0000000000000861
Journal volume & issue
Vol. 5, no. 2
p. e0861

Abstract

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OBJECTIVES:. To compare complications and mortality between patients that required extracorporeal membrane oxygenation (ECMO) support for acute respiratory distress syndrome (ARDS) due to COVID-19 and non-COVID-19 viral pathogens. DESIGN:. Retrospective observational cohort study. SETTING:. Adult patients in the Extracorporeal Life Support Organization registry. PATIENTS:. Nine-thousand two-hundred ninety-one patients that required ECMO for viral mediated ARDS between January 2017 and December 2021. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. The primary outcomes of interest were mortality during ECMO support and prior to hospital discharge. Time-to-event analysis and logistic regression were used to compare outcomes between the groups. Among 9,291 included patients, 1,155 required ECMO for non-COVID-19 viral ARDS and 8,136 required ECMO for ARDS due to COVID-19. Patients with COVID-19 had longer duration of ECMO (19.6 d [interquartile range (IQR), 10.1–34.0 d] vs 10.7 d [IQR, 6.3–19.7 d]; p < 0.001), higher mortality during ECMO support (44.4% vs 27.5%; p < 0.001), and higher in-hospital mortality (50.2% vs 34.5%; p < 0.001). Further, patients with COVID-19 were more likely to experience mechanical and clinical complications (membrane lung failure, pneumothorax, intracranial hemorrhage, and superimposed infection). After adjusting for pre-ECMO disease severity, patients with COVID-19 were more than two times as likely to die in the hospital compared with patients with non-COVID-19 viral ARDS. CONCLUSIONS:. Patients with COVID-19 that require ECMO have longer duration of ECMO, more complications, and higher in-hospital mortality compared with patients with non-COVID-19–related viral ARDS. Further study in patients with COVID-19 is critical to identify the patient phenotype most likely to benefit from ECMO and to better define the role of ECMO in the management of this disease process.