Extracorporeal membrane oxygenation for respiratory failure in phases of COVID‐19 variants

Abstract

Background Adaptive mutations of the severe acute respiratory syndrome‐related coronavirus (SARS‐CoV‐2) virus have emerged throughout the coronavirus disease 2019 (COVID‐19) pandemic. The characterization of outcomes in patients requiring extracorporeal membrane oxygenation (ECMO) for severe respiratory distress from COVID‐19 during the peak prevalence of different variants is not well known. Methods There were 131 patients with laboratory‐confirmed SARS‐CoV‐2 infection supported by ECMO at two referral centers within a large healthcare system. Three predominant variant phase time windows (Pre‐Alpha, Alpha, and Delta) were determined by a change‐point analyzer based on random population sampling and viral genome sequencing. Patient demographics and outcomes were compared. Results The average age of patients was 46.9 ± 10.5 years and 70.2% (92/131) were male. Patients cannulated for ECMO during the Delta variant wave were younger compared to earlier Pre‐Alpha (39.3 ± 7.8 vs. 48.0 ± 11.1 years) and Alpha phases (39.3 ± 7.8 vs. 47.2 ± 7.7 years) ( p < .01). The predominantly affected race in the Pre‐Alpha phase was Hispanic (52.2%; 47/90), while in Alpha (61.5%; 16/26) and Delta (40%; 6/15) variant waves, most patients were White ( p < .01). Most patients received a tracheostomy (82.4%; 108/131) with a trend toward early intervention in later phases compared to Pre‐Alpha ( p < .01). There was no significant difference between the duration of ECMO, mechanical support, intensive care unit (ICU) length of stay (LOS), or hospital LOS over the three variant phases. The in‐hospital mortality was overall 41.5% (54/131) and was also similar. Six‐month survival of patients who survived to discharge was 92.2% (71/77). Conclusions There was no significant difference in survival or time on ECMO support in patients during the peak prevalence of the three variants.

Outcomes of Prolonged Extracorporeal Membrane Oxygenation (>30 days) in COVID-19 Patients on Conservative Management

“…Although there was wide variability in the patient age groups across studies, many studies reported the average age of the patient to be in the fourth decade of life like those in our study. [6][7][8] However, few studies observed that the patients were nearly a decade older than those in our study. [9][10][11] The literature on the effect of a higher age on mortality is inconclusive.…”

“…Many of the authors reported a high BMI (>30) in their study group. 8,9,11,13 All these studies came from the Western world which is nutritionally better than Indian subcontinent. This explains why BMI was higher in the cited studies as compared to our study population.…”

Outcomes for COVID-19 Patients Undergoing Tracheostomy With or Without Extracorporeal Membrane Oxygenation (ECMO)

“…While nine-month mortality of patients requiring tracheostomy during hospitalization for COVID-19 has been reported to be up to 70%, recent data suggest that those undergoing tracheostomy after intubation for COVID-related ARDS have decreased mortality compared to intubated patients who did not receive a tracheostomy [ 18 , 19 ]. Furthermore, much of the published literature suggests better outcomes associated with early tracheostomy, defined as tracheostomy performed within 7-14 days of endotracheal intubation [ 2 , 3 , 7 , 16 ].…”

“…With regards to the timing of tracheostomy for patients on ECMO, there are conflicting reports surrounding the benefit of early tracheostomy, in part due to an overall poor prognosis. One study of 131 patients who were cannulated for VV-ECMO demonstrated better outcomes for earlier ECMO cannulation and earlier tracheostomy placement [ 16 ]. However, another series showed that patients who were on ECMO suffered higher rates of hemorrhagic complications after undergoing early tracheostomy and did not achieve better outcomes [ 17 ].…”

Severe COVID-19 Infection during Pregnancy Requiring ECMO: Case Report and Review of the Literature

“…ECMO has been successfully used to manage pregnant patients in critical condition [ 5 , 7 , 8 ]. Potential indications for ECMO in pregnant women are pulmonary embolism, amniotic fluid embolism, cardiomyopathy, and primary pulmonary hypertension with right heart failure [ 9 ].…”