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J Thorac Cardiovasc Surg
. 2022 Mar 14;S0022-5223(22)00269-0.
doi: 10.1016/j.jtcvs.2021.11.099. Online ahead of print.
Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19
Lauren J Taylor 1 , Sarah E Jolley 2 , Chintan Ramani 3 , Kirby P Mayer 4 , Eric W Etchill 5 , Matthew F Mart 6 , Shoaib Fakhri 2 , Skyler Peterson 7 , Kathryn Colborn 1 , Carla M Sevin 6 , Alexandra Kadl 3 , Kyle Enfield 3 , Glenn J R Whitman 5 , Joseph B Zwischenberger 8 , Jessica Y Rove 9 , ORACLE group
Collaborators, Affiliations
- PMID: 35431034
- DOI: 10.1016/j.jtcvs.2021.11.099
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.
Keywords: ECMO; coronavirus; critical illness; long-term outcomes.