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Severe Patients With ARDS With COVID-19 Treated With Extracorporeal Membrane Oxygenation in China: A Retrospective

Wei Lai1, Shuanglei Li2, Zhongtao Du3

  • 1Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.

Frontiers in Medicine
|November 8, 2021
PubMed

Insights

Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients with severe respiratory failure had a 58% mortality rate. Early negative fluid balance and higher pre-ECMO oxygenation predicted better survival outcomes.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Pulmonology

Background:

  • COVID-19 pandemic created a global health crisis.
  • Extracorporeal membrane oxygenation (ECMO) is increasingly used for COVID-19-associated end-stage respiratory failure.
  • The impact of ECMO on COVID-19 patient outcomes, including complications and mortality, remains unclear.

Purpose of the Study:

  • To evaluate the characteristics, management, complications, and outcomes of COVID-19 patients with severe acute respiratory distress syndrome (ARDS) requiring ECMO support.
  • To identify predictors of survival in ECMO-treated COVID-19 patients.

Main Methods:

  • Retrospective study of 50 ECMO-treated COVID-19 patients in China.
  • Analysis of patient characteristics, clinical features, ventilator parameters, ECMO variables, management details, complications, and outcomes.
  • Comparison of pre-ECMO physiological parameters and fluid balance between survivors and non-survivors.

Main Results:

  • Overall mortality rate was 58.0% (29 out of 50 patients).
  • Survivors had significantly higher pre-ECMO PaO2 and PaO2/FiO2 ratios compared to non-survivors (P < 0.01).
  • Achieving a negative fluid balance within the first 3 days of resuscitation was associated with a higher survival rate (P = 0.0003).

Conclusions:

  • A low pre-ECMO PaO2/FiO2 ratio may indicate a poor prognosis in COVID-19 patients requiring ECMO.
  • Early negative fluid balance during ECMO treatment is a predictor of increased survival.
  • Findings highlight the importance of early physiological assessment and fluid management in ECMO therapy for severe COVID-19.

Keywords:
Chinacoronavirus (COVID-19)extracorporeal membrane oxygenation (ECMO)managementsevere acute respiratory syndrome

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