This study demonstrated favorable survival in patients receiving ECMO as a bridge to lung transplantation and achieved high rates of physical therapy and avoidance of mechanical ventilation while ECMO was used in patients awaiting lung transplantation. With more than half of these patients successfully bridged to lung transplantation, we gained insight into the factors influencing patients' outcomes, including patient selection, timing of ECMO, and patient management.

No abstract

For patients with severe acute respiratory distress syndrome (ARDS), receipt of ECMO(1) may improve survival. During the COVID-19 pandemic, the number of patients with COVID-19 referred for ECMO has exceeded the capacity of specialized centers to provide ECMO(2,3). The outcomes of patients with COVID-19 who are eligible to receive ECMO, but do not because of limited health system capacity, have not been reported. MethodsWe analyzed prospectively collected clinical data from all consecutive patients with SARS-CoV-2 who were referred for ECMO to a single center between January 1, 2021 and August 31, 2021. For all referrals, a standardized case report form was used to record patient characteristics (as listed in Table 1) and the result of a multidisciplinary committee's determination of whether the patient was eligible for ECMO.Patients were considered medically eligible for ECMO if: (1) criteria for sufficiently severe ARDS, as defined by the EOLIA inclusion criteria, were present(1); (2) none of the following absolute contraindications were present: age greater than 60 years, body mass index (BMI) greater than 55 kg/m 2 , duration of mechanical ventilation greater than 7 days, irreversible neurologic injury, chronic lung disease, active malignancy, or advanced multiple organ dysfunction; and (3) three or fewer of the following relative contraindications were present: age greater than 50 years, BMI greater than 45 kg/m 2 , presence of comorbidities, duration of mechanical ventilation greater than 4 days, presence of acute kidney injury, receipt of vasopressors, duration of hospitalization greater than 14 days, or greater than 4 weeks since 4). Contraindications used to determine eligibility were selected by the committee based on published guidance (3), published data on factors associated with death during ECMO for COVID-19 (4), and investigator experience.

We created a risk score that classifies patients with ILD with acute respiratory failure from low to high risk for in-hospital mortality. The score could aid providers in counseling these patients and their families.