J Thorac Cardiovasc Surg . Venovenous extracorporeal membrane oxygenation for patients with refractory coronavirus disease 2019 (COVID-19): Multicenter experience of referral hospitals in a large health care system

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J Thorac Cardiovasc Surg


. 2020 Dec 1;S0022-5223(20)33145-7.
doi: 10.1016/j.jtcvs.2020.11.073. Online ahead of print.
Venovenous extracorporeal membrane oxygenation for patients with refractory coronavirus disease 2019 (COVID-19): Multicenter experience of referral hospitals in a large health care system


Emily Shih ¹ , J Michael DiMaio ² , John J Squiers ³ , Jasjit K Banwait ⁴ , Dan M Meyer ⁵ , Timothy J George ⁶ , Gary S Schwartz ⁵ , Baylor Scott & White ECMO for COVID Group



Collaborators, Affiliations

• PMID: 33419553
• DOI: 10.1016/j.jtcvs.2020.11.073

Abstract

Background: The benefit of extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress from coronavirus disease 2019 refractory to medical management and lung-protective mechanical ventilation has not been adequately determined.
Methods: We reviewed the clinical course of 37 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection supported by venovenous ECMO at 4 ECMO referral centers within a large health care system. Patient characteristics, progression of hemodynamics and inflammatory markers, and clinical outcomes were evaluated.
Results: The patients had median age of 51 years (interquartile range, 40-59), and 73% were male. Peak plateau pressures, vasopressor requirements, and arterial partial pressure of carbon dioxide all improved with ECMO support. In our patient population, 24 of 37 patients (64.8%) survived to decannulation and 21 of 37 patients (56.8%) survived to discharge. Among patients discharged alive from the ECMO facility, 12 patients were discharged to a long-term acute care or rehabilitation facility, 2 were transferred back to the referring hospital for ventilatory weaning, and 7 were discharged directly home. For patients who were successfully decannulated, median length of time on ECMO was 17 days (interquartile range, 10-33.5).
Conclusions: Venovenous ECMO represents a useful therapy for patients with refractory severe acute respiratory distress syndrome from coronavirus disease 2019.

Keywords: acute respiratory distress syndrome (ARDS); coronavirus (COVID-19); critical care; extracorporeal membrane oxygenation (ECMO).