Extracorporeal Membrane Oxygenation Outcomes: COVID-19 Pneumonia vs Non-COVID-19 Pneumonia

COVID-19 can cause severe acute respiratory distress syndrome or myocardial dysfunction requiring extracorporeal membrane oxygenation (ECMO). Whether comorbidities or sociodemographic factors influence outcomes in these patients is unclear.

Adult patients from the National Inpatient Sample dataset with COVID-19 pneumonia or non-COVID-19 pneumonia who underwent ECMO between 2016 and 2021 were included. Cohorts were matched in a 1:5 ratio using propensity scores. The primary outcome of interest was inpatient mortality; secondary outcomes included length of stay, total hospitalization costs, need for dialysis, rate of vascular complications, and discharge disposition.

Weighted patient groups (COVID-19 pneumonia, 5680 patients; non-COVID-19 pneumonia, 430 patients) were identified. Mean (SD) age was 46.0 (11.2) years in the COVID-19 group, 45.1 (12.5) years in the non-COVID-19 group. After matching, unweighted groups (COVID-19 pneumonia, 1136 patients; non-COVID-19 pneumonia, 86 patients) were compared. Patients with COVID-19 pneumonia had higher mortality risk (odds ratio [OR], 1.98; 95% CI, 1.11-3.53; P = .02), longer stays (38.0 vs 28.5 days, P < .001), higher costs ($1 278 270 vs $967 866, P = .002), and less likelihood of discharge home (OR, 0.42; 95% CI, 0.21-0.85; P = .02) than patients with non-COVID-19 pneumonia. Vascular complication rate (OR, 0.77; 95% CI, 0.27-2.26; P = .64) and need for dialysis (OR, 1.01; 95% CI, 0.49-2.08; P = .97) did not differ between groups.

Among patients undergoing ECMO, those with COVID-19 pneumonia had worse outcomes than those with non-COVID-19 pneumonia after adjustment for sociodemographic factors and comorbidities.