Adult: Mechanical Circulatory Support
Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19

Read at the 101st Annual Meeting of The American Association for Thoracic Surgery: A Virtual Learning Experience, April 30-May 2, 2021.
https://doi.org/10.1016/j.jtcvs.2021.11.099Get rights and content

Abstract

Objective

We sought to determine the influence of venovenous extracorporeal membrane oxygenation (ECMO) on outcomes of mechanically ventilated patients with COVID-19 during the first 120 days after hospital discharge.

Methods

Five academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 admitted during March through May 2020. Survivors had access to a multidisciplinary postintensive care recovery clinic. Physical, psychological, and cognitive deficits were measured using validated instruments and compared based on ECMO status.

Results

Two hundred sixty two mechanically ventilated patients were compared with 46 patients cannulated for venovenous ECMO. Patients receiving ECMO were younger and traveled farther but there was no significant difference in gender, race, or body mass index. ECMO patients were mechanically ventilated for longer durations (median, 26 days [interquartile range, 19.5-41 days] vs 13 days [interquartile range, 7-20 days]) and were more likely to receive inhaled pulmonary vasodilators, neuromuscular blockade, investigational COVID-19 therapies, blood transfusions, and inotropes. Patients receiving ECMO experienced greater bleeding and clotting events (P < .01). However, survival at discharge was similar (69.6% vs 70.6%). Of the 217 survivors, 65.0% had documented follow-up within 120 days. Overall, 95.5% were residing at home, 25.7% had returned to work or usual activity, and 23.1% were still using supplemental oxygen; these rates did not differ significantly based on ECMO status. Rates of physical, psychological, and cognitive deficits were similar.

Conclusions

Our data suggest that COVID-19 survivors experience significant physical, psychological, and cognitive deficits following intensive care unit admission. Despite a more complex critical illness course, longer average duration of mechanical ventilation, and longer average length of stay, patients treated with venovenous ECMO had similar survival at discharge and outcomes within 120 days of discharge.

Graphical abstract

This retrospective multisite study examined posthospitalization outcomes for critically ill patients with COVID-19 with and without the support of extracorporeal membrane oxygenation.

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Key Words

coronavirus
ECMO
critical illness
long-term outcomes

Abbreviations and Acronyms

ARDS
acute respiratory distress syndrome
ECMO
extracorporeal membrane oxygenation
ELSO
Extracorporeal Life Support Organization
ICU
intensive care unit
ORACLE
Outcomes and Recovery after COVID-19 leading to ECMO
PICS
postintensive care syndrome
PTSD
posttraumatic stress disorder
VV
venovenous

Cited by (0)

Members of the ORACLE group are listed in the Acknowledgments.

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