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Veno-Venous Extracorporeal Membrane Oxygenation in a Mouse
Published on: October 24, 2018
Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with
Jeffrey P Jacobs1,2, Alfred H Stammers1, James St Louis3
1From the Medical Department, SpecialtyCare, Inc., Nashville, Tennessee.
Insights
Extracorporeal membrane oxygenation (ECMO) can aid survival in critically ill COVID-19 patients. This study found a 50% survival rate, with younger patients generally faring better. ECMO offers a rescue strategy for severe cases.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Cardiopulmonary Support
Background:
- The management of severe coronavirus disease 2019 (COVID-19) remains challenging.
- Extracorporeal membrane oxygenation (ECMO) is an evolving therapy for critically ill patients.
- Understanding ECMO's role in COVID-19 is crucial for clinical decision-making.
Purpose of the Study:
- To review the multi-institutional clinical experience of 100 consecutive COVID-19 patients supported with ECMO.
- To analyze survival rates and patient characteristics associated with ECMO use in COVID-19.
- To evaluate the effectiveness of ECMO as a rescue strategy.
Main Methods:
- Retrospective analysis of 100 consecutive COVID-19 patients treated with ECMO across 20 hospitals.
- Data collection included patient demographics, ECMO type, duration, adjunctive therapies, and outcomes.
- Statistical analysis used χ2 tests, Kruskal-Wallis rank-sum tests, and Welch's analysis of variance.
Main Results:
- The overall survival rate was 50% (50 out of 100 patients).
- Veno-venous ECMO had a 51% survival rate (49/96), while veno-arterial ECMO had a 25% survival rate (1/4).
- Survivors were significantly younger (median age 47 vs. 56.5 years, p=0.014).
Conclusions:
- Extracorporeal membrane oxygenation can facilitate salvage and survival in selected critically ill COVID-19 patients.
- Younger patient demographics are associated with better survival outcomes on ECMO.
- ECMO represents a viable rescue therapy for severe COVID-19 when other treatments fail.
Abstract:
The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ2 tests for categorical variables and Kruskal-Wallis rank-sum tests and Welch's analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8-22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.
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