Comparative outcomes between COVID-19 and influenza patients placed on veno-venous extracorporeal membrane oxygenation

1. COVID-19 patients with severe ARDS on veno-venous extracorporeal membrane oxygenation were nearly three times as likely to experience in-hospital death compared with influenza patients.

Evidence Level Rating: 3 (Average)

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is an established supportive therapy for patients with severe acute respiratory distress syndrome (ARDS) refractory to more conventional therapies. As the COVID-19 pandemic continues to place stress on the healthcare system, providers may have to triage the use of V-V ECMO among patients with ARDS secondary to COVID-19 or to influenza, which peaks during winter months and will again impose a dual burden on healthcare workers. There are very little data highlighting the differences between using V-V ECMO to manage ARDS in these two patient populations, and this study evaluated the differences in patient characteristics and clinical outcomes. Using data from a large quaternary medical center, the first 32 adult COVID-19 patients with severe ARDS placed on V-V ECMO were compared with the last 28 adult influenza patients with severe ARDS placed on V-V ECMO. The primary outcome was survival to hospital discharge. Secondary outcomes included ECMO-related complications, such as bleeding events, air emergencies, and organ failure. COVID-19 patients were significantly older (47.8±10.3 vs. 41.2±12.8 years, p = 0.033). Furthermore, there were significantly more Hispanic patients in the COVID-19 group and the prevalence of diabetes was significantly higher. The duration of V-V ECMO was significantly longer in the COVID-19 cohort with a mean of 12.4 days compared with 7.7 days in the influenza cohort (p = 0.002); additionally, the time to canulation from symptom onset and ICU admission was longer. The need for a circuit change due to oxygenation failure was also higher among COVID-19 patients. Finally, crude in-hospital mortality was significantly higher in the COVID-19 cohort compared with the influenza cohort (65.6% vs. 36.3%). Cox regression modeling adjusted for age, race, organ failure while on ECMO, and Charles Comorbidity Index (CCI) revealed an adjusted hazard ratio over sixty days for COVID-19 patients compared to influenza patients of 2.81 (95% CI 1.07 to 7.35). In all, this retrospective analysis revealed that COVID-19 patients with severe ARDS on V-V ECMO had a nearly threefold increased risk of in-hospital death compared with influenza patients. The limitations of this study were myriad, including a single center perspective, but suggest that more robust data are needed to define critical care management of COVID-19 patients with ARDS on V-V ECMO.

Click to read the study in the AJS

Image: PD

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