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Multi-institutional Analysis of 200 COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation: Outcomes and Trends.

Authors
  • Jacobs, Jeffrey P1
  • Stammers, Alfred H2
  • St Louis, James D3
  • Hayanga, J W Awori4
  • Firstenberg, Michael S5
  • Mongero, Linda B2
  • Tesdahl, Eric A2
  • Rajagopal, Keshava6
  • Cheema, Faisal H7
  • Patel, Kirti2
  • Coley, Tom2
  • Sestokas, Anthony K2
  • Slepian, Marvin J8
  • Badhwar, Vinay4
  • 1 Medical Department, SpecialtyCare, Inc, Nashville, Tennessee; Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida; Department of Pediatrics, Congenital Heart Center, University of Florida, Gainesville, Florida. Electronic address: [email protected]
  • 2 Medical Department, SpecialtyCare, Inc, Nashville, Tennessee.
  • 3 Children's Hospital of Georgia, Augusta, Georgia. , (Georgia)
  • 4 Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
  • 5 Medical Center of Aurora, Aurora, Colorado.
  • 6 University of Houston, Houston, Texas.
  • 7 University of Houston, Houston, Texas; HCA Research Institute, Nashville, Tennessee.
  • 8 University of Arizona, Tucson, Arizona.
Type
Published Article
Journal
The Annals of thoracic surgery
Publication Date
May 01, 2022
Volume
113
Issue
5
Pages
1452–1460
Identifiers
DOI: 10.1016/j.athoracsur.2021.06.026
PMID: 34242641
Source
Medline
Language
English
License
Unknown

Abstract

The role of extracorporeal membrane oxygenation (ECMO) in the management of patients with COVID-19 continues to evolve. The purpose of this analysis is to review our multi-institutional clinical experience involving 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO. This analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 1, 2020. Differences by mortality group were assessed using χ2 tests for categoric variables and Kruskal-Wallis rank sum tests and Welch's analysis of variance for continuous variables. Median ECMO time was 15 days (interquartile range, 9 to 28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with venovenous ECMO was 87 of 188 patients (46.3%), whereas survival with venoarterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, P < .001) and shorter median time from diagnosis to ECMO cannulation (8 versus 12 days, P = .003). For the 90 survivors, adjunctive therapies on ECMO included intravenous steroids (64), remdesivir (49), convalescent plasma (43), anti-interleukin-6 receptor blockers (39), prostaglandin (33), and hydroxychloroquine (22). Extracorporeal membrane oxygenation facilitates survival of select critically ill patients with COVID-19. Survivors tend to be younger and have a shorter duration from diagnosis to cannulation. Substantial variation exists in drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy. Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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