Multi-institutional Analysis of 200 COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation: Outcomes and Trends
MD Jeffrey P Jacobs, MSA, CCP (Emeritus Alfred H Stammers, MD James D St Louis, J W Awori Hayanga, MD Michael S Firstenberg, CCP (Emeritus Linda B Mongero, PhD Eric A Tesdahl, MD Keshava Rajagopal, PhD Faisal H Cheema, MD Kirti Patel, CCP Tom Coley, CCP Anthony K Sestokas, PhD Marvin J Slepian, MD Vinay Badhwar
The Annals of Thoracic Surgery, doi:10.1016/j.athoracsur.2021.06.026
BACKGROUND 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. METHODS 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 c 2 tests for categoric variables and Kruskal-Wallis rank sum tests and Welch's analysis of variance for continuous variables.
RESULTS 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). CONCLUSIONS 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.
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