Cardiopulmonary Outcomes After Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome

Venovenous extracorporeal membrane oxygenation (VV ECMO) may be a life-saving intervention for patients with severe respiratory failure. While short-term benefits are evident, there is still little data on ECMO in appropriately selected patients, and evidence on functional outcomes is limited. All patients from the Freiburg Extracorporeal Membrane Oxygenation Outcome Study (FEOS) with COVID-19 supported with VV ECMO between March 2020 and March 2022 at the Freiburg University were included. During the study period, 97 patients were supported with VV ECMO, and hospital survival was 44.3%. Survivors were invited to participate in a follow-up examination. Complete follow-up examination was available in 15 of 97 (15.5%) after 1.86 ± 0.41 years. In the 6 Minute Walk Test, patients walked 474 (216-591) m (81% of predicted), and desaturation occurred in 53.3%. Cardiopulmonary Exercise Testing showed peak peak oxygen uptake (VO2) of 17.8 ml/min/kg (10.8-23.3), with moderate exercise limitation in 13.3%. Tricuspid annular plane systolic excursion was preserved (24.4 ± 4.4 mm), and right ventricle (RV) and right atrium (RA) dilatation was mild to moderate in 46.7%. Body plethysmography showed a total lung capacity of 76.3% (51-99%) and reduced diffusing capacity for carbon monoxide of 66.2% (40-93%). These findings suggest that a substantial portion of VV ECMO survivors exhibit functional limitations after discharge and support the need for structured pulmonology and cardiology follow-up after VV ECMO.