Venovenous extracorporeal membrane oxygenation support in patients with COVID-19 respiratory failure: A multicenter studyCentral MessagePerspective
Navin G. Vigneshwar, MD, MPH,
Muhammad F. Masood, MD,
Ivana Vasic, BS,
Martin Krause, MD,
Karsten Bartels, MD, PHD,
Mark T. Lucas, MPS,
Michael Bronsert, PhD,
Craig H. Selzman, MD,
Shaun Thompson, MD,
Jessica Y. Rove, MD,
Thomas B. Reece, MD,
Joseph C. Cleveland, MD,
Jay D. Pal, MD, PhD,
David A. Fullerton, MD,
Muhammad Aftab, MD
Affiliations
Navin G. Vigneshwar, MD, MPH
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Muhammad F. Masood, MD
Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo
Ivana Vasic, BS
University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Martin Krause, MD
Department of Anesthesiology, University of San Diego, San Diego, Calif
Karsten Bartels, MD, PHD
Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Neb
Mark T. Lucas, MPS
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Michael Bronsert, PhD
Colorado Health Outcomes Program, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Craig H. Selzman, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
Shaun Thompson, MD
Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Neb
Jessica Y. Rove, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Thomas B. Reece, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Joseph C. Cleveland, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Jay D. Pal, MD, PhD
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
David A. Fullerton, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
Muhammad Aftab, MD
Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo; Address for reprints: Muhammad Aftab, MD, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E 17th Ave, C-310, Room 6602, Aurora, CO 80045.
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.
