Adult: Mechanical Circulatory Support
Characteristics and outcomes of patients with COVID-19 supported by extracorporeal membrane oxygenation: A retrospective multicenter study

https://doi.org/10.1016/j.jtcvs.2021.04.089Get rights and content

Abstract

Objective

To determine characteristics, outcomes, and clinical factors associated with death in patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) support.

Methods

A multicenter, retrospective cohort study was conducted. The cohort consisted of adult patients (18 years of age and older) requiring ECMO in the period from March 1, 2020, to September 30, 2020. The primary outcome was in-hospital mortality after ECMO initiation assessed with a time to event analysis at 90 days. Multivariable Cox proportional regression was used to determine factors associated with in-hospital mortality.

Results

Overall, 292 patients from 17 centers comprised the study cohort. Patients were 49 (interquartile range, 39-57) years old and 81 (28%) were female. At the end of the follow-up period, 19 (6%) patients were still receiving ECMO, 25 (9%) were discontinued from ECMO but remained hospitalized, 135 (46%) were discharged or transferred alive, and 113 (39%) died during the hospitalization. The cumulative in-hospital mortality at 90 days was 42% (95% confidence interval [CI], 36%-47%). Factors associated with in-hospital mortality were age (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.06-1.61 per 10 years), renal dysfunction measured according to serum creatinine level (aHR, 1.21; 95% CI, 1.01-1.45), and cardiopulmonary resuscitation before ECMO placement (aHR, 1.87; 95% CI, 1.01-3.46).

Conclusions

In patients with severe COVID-19 necessitating ECMO support, in-hospital mortality occurred in fewer than half of the cases. ECMO might serve as a viable modality for terminally ill patients with refractory COVID-19.

Graphical abstract

A multicenter, retrospective cohort study of 292 patients with COVID-19 given extracorporeal membrane oxygenation (ECMO) in 17 centers across the United States from March 1, 2020 to September 30, 2020. Clinical characteristics and outcomes were entered into a Research Electronic Data Capture (REDCap) database. The primary outcome of cumulative in-hospital mortality at 90 days was 42% (95% confidence interval [CI], 36%-47%).

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Key Words

COVID-19
ECMO
ARDS
mortality

Abbreviations and Acronyms

aHR
adjusted hazard ratio
ARDS
acute respiratory distress syndrome
CI
confidence interval
ECMO
extracorporeal membrane oxygenation
ELSO
Extracorporeal Life Support Organization
FiO2
fraction of inspired oxygen
IQR
interquartile range
PaO2
partial pressure of oxygen
VA
venoarterial
VV
venovenous

Cited by (0)

O.S. is supported by the National Institutes of Health/National Heart, Lung and Blood Institute (K23HL145140). The research described was supported by a National Institutes of Health/National Center for Advancing Translational Science Clinical and Translational Science Award grant to Einstein-Montefiore (UL1TR002556).

Omar Saeed and Daniel J. Goldstein contributed equally to this work.

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