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Published on: October 24, 2018
Retrospective Study of Critically Ill COVID-19 Patients With and Without Extracorporeal Membrane Oxygenation Support
Wei Cheng1, Xu-Dong Ma2, Long-Xiang Su1
1Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Insights
Extracorporeal membrane oxygenation (ECMO) may help critically ill COVID-19 patients, reducing in-hospital mortality. Key factors for initiating ECMO include patient age, lymphocyte count, and available medical resources.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Cardiopulmonary Support
Background:
- Severe COVID-19 cases presented challenges for critical care, necessitating advanced life support.
- Extracorporeal membrane oxygenation (ECMO) was considered for critically ill COVID-19 patients during the epidemic.
- Guidance for ECMO initiation under resource constraints during the COVID-19 pandemic was unclear.
Purpose of the Study:
- To analyze clinical characteristics and in-hospital mortality of severe COVID-19 patients with and without ECMO support.
- To identify parameters for guiding ECMO initiation during the COVID-19 epidemic.
- To evaluate the effectiveness of ECMO in improving outcomes for critically ill COVID-19 patients.
Main Methods:
- An observational cohort study was conducted in Wuhan, China, involving critically ill COVID-19 patients indicated for ECMO.
- Data were collected from January 1 to May 1, 2020, comparing patients who received ECMO with those who did not.
- Logistic regression was used to analyze risk factors for mortality.
Main Results:
- ECMO support was associated with significantly lower in-hospital mortality (71.6% vs. 85.1%, P=0.033).
- Younger age (cutoff 51 years), higher lymphocyte count, and better CO2 removal were associated with survival in ECMO patients.
- Survivors had longer ICU and hospital stays, and ECMO use increased after resource supplementation.
Conclusions:
- ECMO may benefit severe COVID-19 patients, particularly early in the epidemic, despite high overall mortality.
- Patient age, lymphocyte count, and medical resource availability are crucial considerations for ECMO initiation.
- Further research is needed to optimize ECMO use in critical care settings during pandemics.
Abstract:
Background: Extracorporeal membrane oxygenation (ECMO) might benefit critically ill COVID-19 patients. But the considerations besides indications guiding ECMO initiation under extreme pressure during the COVID-19 epidemic was not clear. We aimed to analyze the clinical characteristics and in-hospital mortality of severe critically ill COVID-19 patients supported with ECMO and without ECMO, exploring potential parameters for guiding the initiation during the COVID-19 epidemic. Methods: Observational cohort study of all the critically ill patients indicated for ECMO support from January 1 to May 1, 2020, in all 62 authorized hospitals in Wuhan, China. Results: Among the 168 patients enrolled, 74 patients actually received ECMO support and 94 not were analyzed. The in-hospital mortality of the ECMO supported patients was significantly lower than non-ECMO ones (71.6 vs. 85.1%, P = 0.033), but the role of ECMO was affected by patients' age (Logistic regression OR 0.62, P = 0.24). As for the ECMO patients, the median age was 58 (47-66) years old and 62.2% (46/74) were male. The 28-day, 60-day, and 90-day mortality of these ECMO supported patients were 32.4, 68.9, and 74.3% respectively. Patients survived to discharge were younger (49 vs. 62 years, P = 0.042), demonstrated higher lymphocyte count (886 vs. 638 cells/uL, P = 0.022), and better CO2 removal (PaCO2 immediately after ECMO initiation 39.7 vs. 46.9 mmHg, P = 0.041). Age was an independent risk factor for in-hospital mortality of the ECMO supported patients, and a cutoff age of 51 years enabled prediction of in-hospital mortality with a sensitivity of 84.3% and specificity of 55%. The surviving ECMO supported patients had longer ICU and hospital stays (26 vs. 18 days, P = 0.018; 49 vs. 29 days, P = 0.001 respectively), and ECMO procedure was widely carried out after the supplement of medical resources after February 15 (67.6%, 50/74). Conclusions: ECMO might be a benefit for severe critically ill COVID-19 patients at the early stage of epidemic, although the in-hospital mortality was still high. To initiate ECMO therapy under tremendous pressure, patients' age, lymphocyte count, and adequacy of medical resources should be fully considered.
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