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Outcomes of Minority COVID-19 patients managed with ECMO: A single-center experience
Can Jones1, Yingyot Arora2, Renuka Reddy1
1Internal Medicine, Palm Beach Regional GME Consortium, University of Miami, Atlantis, Florida, USA.
Insights
Caucasian COVID-19 patients on extracorporeal membrane oxygenation (ECMO) had higher mortality than minority patients. This study found higher overall mortality in COVID-19 patients managed with ECMO, with Caucasians experiencing worse outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Health Disparities
Background:
- The COVID-19 pandemic has disproportionately affected minority populations, leading to higher hospitalization and mortality rates.
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for severe COVID-19-induced respiratory failure.
- Limited data exists on ethnic outcome differences in COVID-19 patients treated with ECMO.
Purpose of the Study:
- To investigate and compare mortality and complication rates between Caucasian and Minority COVID-19 patients receiving ECMO.
- To identify potential factors influencing outcomes in diverse patient groups undergoing ECMO for COVID-19.
Main Methods:
- Retrospective cohort study of 23 adult patients with COVID-19 and acute respiratory distress syndrome (ARDS) requiring ECMO.
- Primary outcome: mortality. Secondary outcome: ECMO-related complications.
- Comparison of outcomes between Caucasian and Minority patient groups.
Main Results:
- Overall mortality was high at 70%, exceeding rates reported in other COVID-19 ECMO studies.
- Caucasian patients exhibited a higher mortality rate (85.7%) compared to Minority patients (62.5%).
- No significant differences in ECMO-related complication rates were observed between ethnic groups.
Conclusions:
- The study highlights a high mortality rate in COVID-19 patients on ECMO, primarily driven by the Caucasian group.
- Severe respiratory acidosis prior to ECMO initiation in Caucasians may explain their poorer prognosis.
- Further large-scale, randomized studies are necessary to elucidate ethnic disparities in ECMO outcomes for COVID-19.
Background:
The coronavirus disease 2019 (COVID-19) pandemic has significantly burdened the global healthcare system since December 2019. Minority populations are found to have a higher incidence of hospitalization and higher mortality when compared to Caucasians. Extracorporeal membrane oxygenation (ECMO) is reserved for COVID-19 patients who develop respiratory failure refractory to conventional management. To our knowledge, no data has been reported on outcome differences between Minority COVID-19 patients and Caucasian COVID-19 patients managed with ECMO. We aimed to investigate the outcome differences between these two groups.
Methods:
Our retrospective cohort study had 23 adults (aged 18 and older) diagnosed with COVID-19 by polymerase chain reaction. All patients developed acute respiratory distress syndrome (ARDS), refractory to conventional treatment, and were managed on ECMO support. The primary outcome of interest was mortality; the secondary outcome was the rate of ECMO-related complications.
Results:
The overall mortality rate of our study was higher (70%) than other reports of the COVID-19 population on ECMO. Caucasians in our study had more severe respiratory acidosis with carbon dioxide retention and appeared to have a higher mortality rate of 85.7% compared to Minorities (62.5%). No differences in complication rates between these two groups were identified.
Conclusions:
Our cohort revealed a high overall mortality rate of COVID-19 patients on ECMO support. The Caucasian group was observed to have higher mortality than the Minority group. The high overall mortality was likely attributed to the Caucasian group, which had more severe respiratory acidosis before ECMO initiation, a known predictor of poor prognosis in ARDS patients. Our cohort's ethnic composition may also partially explain the high mortality rate since COVID-19 Minorities are reported to have worse outcomes than Caucasians. Larger and randomized studies are needed to investigate further the mortality and complication differences between Minority and Caucasian patients diagnosed with COVID-19 and managed by ECMO.
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