Mortality Risk Assessment in COVID-19 Venovenous Extracorporeal Membrane Oxygenation

Area of Science:

• Critical Care Medicine
• Pulmonology
• Cardiovascular Medicine

Background:

• Acute respiratory distress syndrome (ARDS) is a severe complication of COVID-19.
• Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a life-saving treatment for ARDS refractory to conventional therapies.
• Existing mortality prediction scores for VV-ECMO are not validated for COVID-19 ARDS.

Purpose of the Study:

• To evaluate the utility of standard risk calculators in predicting mortality for COVID-19 ARDS patients undergoing VV-ECMO.
• To describe a single-center experience with VV-ECMO in a cohort of COVID-19 patients.

Main Methods:

• Retrospective review of a prospective database of COVID-19 patients who underwent VV-ECMO.
• Collection of demographic, clinical, and ECMO characteristics.
• Comparison of survivor and nonsurvivor cohorts using univariate and bivariate analyses.

Main Results:

• Forty COVID-19 patients were identified; 33 had ECMO discontinued, with an 82.5% survival rate to discharge.
• Nonsurvivors had a significantly higher Prediction of Survival on ECMO Therapy (PRESET)-Score (8.33 ± 0.8) compared to survivors (6.17 ± 1.8).
• The PRESET score accurately predicted mortality, with all patients scoring ≤6 surviving and those scoring ≥7 facing increased mortality risk.

Conclusions:

• Favorable outcomes are achievable for COVID-19 ARDS patients treated with VV-ECMO at high-volume centers.
• The PRESET-Score is associated with survival in COVID-19 ARDS patients undergoing VV-ECMO.
• Standard risk calculators, like the PRESET-Score, can assist in selecting appropriate patients for VV-ECMO therapy.