tetano
Editor, Senior Moderator
JTCVS Open
. 2022 Sep 8.
doi: 10.1016/j.xjon.2022.08.007. Online ahead of print.
Venovenous Extracorporeal Membrane Oxygenation Support in Patients with COVID-19 Respiratory Failure: A Multicenter Study
Navin G Vigneshwar[SUP] 1 [/SUP], Muhammad F Masood[SUP] 2 [/SUP], Ivana Vasic[SUP] 3 [/SUP], Martin Krause[SUP] 4 [/SUP], Karsten Bartels[SUP] 5 [/SUP], Mark T Lucas[SUP] 1 [/SUP], Michael Bronsert[SUP] 6 [/SUP], Craig H Selzman[SUP] 7 [/SUP], Shaun Thompson[SUP] 5 [/SUP], Jessica Y Rove[SUP] 1 [/SUP], Thomas B Reece[SUP] 1 [/SUP], Joseph C Cleveland[SUP] 1 [/SUP], Jay D Pal[SUP] 1 [/SUP], David A Fullerton[SUP] 1 [/SUP], Muhammad Aftab[SUP] 1 [/SUP]
Affiliations
Abstract
Objective: The COVID -19 pandemic presents a high mortality rate amongst patients who develop severe acute respiratory distress syndrome (ARDS). The purpose of this study was to evaluate the outcomes of venovenous ECMO in COVID-19-related ARDS and identify the patients that benefit the most from this procedure.
Methods: Adult COVID-19 patients with severe ARDS requiring VV-ECMO support at four academic insititutions between March and October 2020 were included. Data were collected through retrospective chart reviews. Bivariate and multivariable analysis were performed with the primary outcome of in-hospital mortality.
Results: Fifty-one consecutive patients underwent VV-ECMO with a mean age of 50.4 years; 64.7% were male. Survival to hospital discharge was 62.8%. Median ICU and hospitalization duration were 27.4 (IQR:17-37) and 34.5 days (IQR:23-43), respectively. Survivors and non-survivors had a median ECMO cannulation time of 11 days (IQR 8-18) and 17 days (IQR: 12-25). The average post decannulation length of stay was 17.5 days (IQR: 12.4-25) for survivors and 0 days for non-survivors (IQR 0-6 days). Only one non-survivor was able to be decannulated. Clinical characteristics associated with mortality between non-surviors and survivors included increasing age (p=0.0048), hemorrhagic stroke (p=0.0014), and post operative dialysis (p=0.0013)were associated with mortality in a bivariate model and retained statistical significance in a multivariable model.
Conclusion: This multicenter study confirms the effectiveness of VV-ECMO in selected critically ill patients with COVID-19-related severe ARDS. The survival of these patients is comparable to non-COVID-19-related ARDS.
Keywords: (ARDS), Acute respiratory distress syndrome; (COVID-19), Coronavirus disease 2019; (DIC), disseminated intravascular coagulation; (SARS-CoV-2), severe acute respiratory syndrome coronavirus 2; (VV-ECMO), Veno-Venous Extracorporeal Membrane Oxygenation; COVID-19 infection; Respiratory failure; Severe ARDS; VV-ECMO; mechanical support.
. 2022 Sep 8.
doi: 10.1016/j.xjon.2022.08.007. Online ahead of print.
Venovenous Extracorporeal Membrane Oxygenation Support in Patients with COVID-19 Respiratory Failure: A Multicenter Study
Navin G Vigneshwar[SUP] 1 [/SUP], Muhammad F Masood[SUP] 2 [/SUP], Ivana Vasic[SUP] 3 [/SUP], Martin Krause[SUP] 4 [/SUP], Karsten Bartels[SUP] 5 [/SUP], Mark T Lucas[SUP] 1 [/SUP], Michael Bronsert[SUP] 6 [/SUP], Craig H Selzman[SUP] 7 [/SUP], Shaun Thompson[SUP] 5 [/SUP], Jessica Y Rove[SUP] 1 [/SUP], Thomas B Reece[SUP] 1 [/SUP], Joseph C Cleveland[SUP] 1 [/SUP], Jay D Pal[SUP] 1 [/SUP], David A Fullerton[SUP] 1 [/SUP], Muhammad Aftab[SUP] 1 [/SUP]
Affiliations
- PMID: 36097635
- PMCID: PMC9451935
- DOI: 10.1016/j.xjon.2022.08.007
Abstract
Objective: The COVID -19 pandemic presents a high mortality rate amongst patients who develop severe acute respiratory distress syndrome (ARDS). The purpose of this study was to evaluate the outcomes of venovenous ECMO in COVID-19-related ARDS and identify the patients that benefit the most from this procedure.
Methods: Adult COVID-19 patients with severe ARDS requiring VV-ECMO support at four academic insititutions between March and October 2020 were included. Data were collected through retrospective chart reviews. Bivariate and multivariable analysis were performed with the primary outcome of in-hospital mortality.
Results: Fifty-one consecutive patients underwent VV-ECMO with a mean age of 50.4 years; 64.7% were male. Survival to hospital discharge was 62.8%. Median ICU and hospitalization duration were 27.4 (IQR:17-37) and 34.5 days (IQR:23-43), respectively. Survivors and non-survivors had a median ECMO cannulation time of 11 days (IQR 8-18) and 17 days (IQR: 12-25). The average post decannulation length of stay was 17.5 days (IQR: 12.4-25) for survivors and 0 days for non-survivors (IQR 0-6 days). Only one non-survivor was able to be decannulated. Clinical characteristics associated with mortality between non-surviors and survivors included increasing age (p=0.0048), hemorrhagic stroke (p=0.0014), and post operative dialysis (p=0.0013)were associated with mortality in a bivariate model and retained statistical significance in a multivariable model.
Conclusion: This multicenter study confirms the effectiveness of VV-ECMO in selected critically ill patients with COVID-19-related severe ARDS. The survival of these patients is comparable to non-COVID-19-related ARDS.
Keywords: (ARDS), Acute respiratory distress syndrome; (COVID-19), Coronavirus disease 2019; (DIC), disseminated intravascular coagulation; (SARS-CoV-2), severe acute respiratory syndrome coronavirus 2; (VV-ECMO), Veno-Venous Extracorporeal Membrane Oxygenation; COVID-19 infection; Respiratory failure; Severe ARDS; VV-ECMO; mechanical support.