Challenges Faced During Extracorporeal Membrane Oxygenation (ECMO) Management of COVID-19 Patients in India: A Retrospective, Multicentered, Observational Study

Abstract

Background: Very limited data have been published for Extracorporeal membrane oxygenation (ECMO) in patients of COVID-19 from India. We have conducted this survey-based study to understand the challenges faced during ECMO management of COVID-19 patients in India. Materials and methods: This was a retrospective, multicentered, observational study conducted through a questionnaire-based survey. The survey addressed hospital characteristics, their experience of ECMO, and the various challenges faced during ECMO management of COVID-19 patients. The main four categories were technical challenges, operational challenges, clinical challenges, and major complications during ECMO of these patients. These challenges were probed in relation to the first and second waves of COVID-19 pandemic separately. The questions related to challenges faced during ECMO were ranked questions. Results: In total, 22 hospitals have responded to the survey. Almost 60% of the participant hospitals were doing less than 10 ECMOs per year before COVID-19 pandemic. Limited availability of ECMO machines and the cost of ECMO therapy were the major technical challenges faced, both in the first and second waves. Resistance from staff to work and risk of getting cross-infection with other team members were serious operational challenges during the first wave, while high workload, limited staffing, and difficulty in transporting patients were challenges in the second wave. Difficulty in counseling, an apprehension/hesitancy in medical colleagues, lack of public awareness, and limited evidence in favor of ECMO therapy were the clinical challenges faced during the first wave, while complications during ECMO, and poor outcomes were the common clinical challenges faced during the second wave. Hospital-acquired sepsis was the most severe complication faced in both waves. Conclusions: Managing ECMO in COVID-19 patients was found to be a challenging task. Sharing pre-ECMO strategies and protocols across usual referral centers and increased collaboration between ECMO centers is warranted to improve the outcome of patients.