Variation in Outcomes with Extracorporeal Membrane Oxygenation in the Era of Coronavirus: A Multi-institutional Analysis of 622 consecutive patients supported with ECMO
Jeffrey Phillip Jacobs1, Alfred H. Stammers,, CCP2, Eric A. Tesdahl, PhD2, Linda B. Mongero, BS, CCP2, Kirti H. Patel, CCP2, Courtney H. Petersen, CCP2, Anthony K. Sestokas, PhD2, Michael S. Firstenberg, MD3, James D. St. Louis, MD4, J.W. Awori Hayanga, MD5, J.W. A. Hayanga5.
1University of Florida, Gainesville, FL, USA, 2SpecialtyCare, Brentwood, TN, USA, 3Novick Cardiac Alliance, Memphis, TN, USA, 4Medical College of Georgia, Augusta, GA, USA, 5West Virginia University, Morgantown, WV, USA.
Background:Support with extracorporeal membrane oxygenation (ECMO) facilitates survival of critically ill patients with Coronavirus Disease 2019 (COVID-19). The aim of this study was to compare outcomes in patients supported with ECMO with and without COVID-19.
Methods:Utilizing a national database of ECMO patients, 622 consecutive patients supported with ECMO between April 2020 and May 2021 were reviewed. Indications for ECMO were stratified into three categories: Pulmonary (PULM, n=162), Cardiac (CARD, n=189) and COVID-19 (COVID, n=271). The primary outcome was in-hospital mortality. Secondary outcomes included: circuit failure requiring change-out, oxygenator failure, circuit clotting, and circuit hemolysis.
Results:Patients were older in the CARD group (CARD=57.5+15.9 years, COVID=48.1+12.2 years, PULM=50.9+16.3 years, p<0.001). Mortality was highest in COVID (COVID=46.9%, CARD=39.2%, PULM=34.0%, p=0.024). Circuit failure requiring change-out was highest in COVID (COVID=30.6%, CARD=11.6%, PULM=16.2%, p<0.001). Oxygenator failure rate was six times higher in the COVID group (COVID=15.9%, CARD=2.1%, PULM=4.3%, p<0.001). Circuit clots were seen more frequently in the COVID group (COVID=30.3%, CARD=6.9%, PULM=7.4%, p<0.001). Anticoagulation with direct thrombin inhibitors was used more often in COVID (COVID=37.5%, CARD=5.8%, PULM=12.0%, p<0.001). The occurrence of circuit hemolysis was over 10 times higher COVID (COVID=12.4%, CARD=1.2%, PULM=0.0%).
Conclusions:When ECMO is used for COVID-19 patients, mortality and circuit complications are higher.
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