Milica Antic, BS, MD, MS
Fellow
Jewish Hospital Mercy Health
Cincinnati, Ohio
Disclosure information not submitted.
Mudher Al-Shathir, MD
Pulmonary/Critical Care Physician
The Jewish Hospital of Cincinnati
Cincinnati, Ohio, United States
Disclosure information not submitted.
Erich Walder, MD
Pulmonary/Critical Care Physician
The Jewish Hospital of Cincinnati
Cincinnati, Ohio, United States
Disclosure information not submitted.
Title: Extracorporeal membrane oxygenation for COVID-19 ARDS treatment in a community hospital
Introduction/Hypothesis: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is a resource and labor-intensive salvage therapy in those with refractory acute respiratory distress syndrome (ARDS). Careful patient selection is crucial prior to ECMO commitment, especially in a pandemic. Two meta-analyses have been published summarizing outcome data in ECMO-supported COVID patients with 45.9% mortality in US studies and 37% mortality world-wide. These results are comparable to the mortality rates seen in EOLIA and CESAR trials which evaluated ECMO in those with ARDS due to non-COVID etiologies. This report was created to describe the single institutional experience for our COVID patients on ECMO.
Methods: A retrospective analysis of six COVID patients treated with VV ECMO between 03/2020 and 05/2021 was performed. All patients had severe ARDS with PaO2/FiO2 ratio < 100 and Murray score of >3. The primary outcome was in-hospital mortality. Secondary outcomes included patient characteristics, hospital length of stay, days on ECMO, duration of mechanical ventilation before ECMO, and complications during ECMO.
Results: In-hospital mortality was 83%. Mean age was 56 (range: 37 - 71 years) and mean BMI was 39+9 kg/m2. The cohort was mostly male (67%), white (83%), and non-smokers (67%). The most common comorbidities were hypertension (83%), diabetes (33%), asthma (33%) and obesity (83%). Mean length of stay was 23.5+15.7 days with mean 11+7.7 days spent on ECMO. Mean duration of mechanical ventilation prior to ECMO was 5.2+5 days. One third had clotting of the oxygenator. One had pneumothorax. One patient had displacement of the ECMO catheter leading to arrest. One had a hemorrhagic stroke. Two patients experienced significant epistaxis. Half had nosocomial bloodstream infections leading to septic shock. Four patients had renal failure requiring CRRT. Our 71-year-old survivor was the only patient with a BMI < 30 kg/m2 and no other medical comorbidities.
Conclusions: In this small study of 6 patients, complications associated with ECMO resulted in high mortality. In each case, we saw at least one major complication associated with ECMO including bleeding, sepsis, pneumothorax, clotting, and renal failure. Obesity was a major risk factor for death. Future research is needed to evaluate which patients with COVID-19 and ARDS would benefit from ECMO.