Outcomes of Extracorporeal Membrane Oxygenation in Patients With Severe Acute Respiratory Distress Syndrome Caused by COVID-19 Versus Influenza

Abstract

Background Extracorporeal membrane oxygenation (ECMO) can be effective for refractory acute respiratory distress syndrome (ARDS) in patients with influenza, but its utility in patients with COVID-19 is uncertain. We compared outcomes of patients with refractory ARDS from COVID-19 and Influenza placed on ECMO. Methods We conducted a retrospective analysis of 120 patients with refractory ARDS due to COVID-19 or Influenza placed on ECMO at two referral centers from 1/2013 to 10/2020. Patient characteristics and clinical outcomes were compared. The primary endpoint was survival to discharge. Results Baseline characteristics and comorbidities were similar. During the study period, 53 patients with COVID-19 and 67 patients with Influenza were supported. Veno-venous ECMO was the predominant initial cannulation strategy in both groups (COVID 92.5% vs Influenza 95.5%; p=0.5). Survival to hospital discharge was 62.3% (33/53 patients) in the COVID-19 group and 64.2% (43/67) in the Influenza group (p=0.8). In patients successfully decannulated, median length of time on ECMO was longer in COVID-19 patients (14 days [IQR 9-30] vs. Influenza 10.5 [IQR 6.8-14.3] days, p=0.004). Among patients discharged alive, COVID-19 patients had longer overall length of stay (COVID 37 [IQR 27-62] vs Influenza 13.5 [IQR 9.3-24] days; p=0.007). Conclusions In patients with refractory ARDS from COVID-19 or Influenza placed on ECMO, there was no significant difference in survival to hospital discharge. In patients surviving to decannulation, the duration of ECMO support and total length of stay were longer in COVID-19 patients.

Clinical Characteristics, Complications and Outcomes of Patients with Severe Acute Respiratory Distress Syndrome Related to COVID-19 or Influenza Requiring Extracorporeal Membrane Oxygenation—A Retrospective Cohort Study

“…Additionally, overall experience with initiation and handling of vv-ECMO over the study period may also have had an influence. The largest study compared 53 patients with COVID-19 and 67 patients with influenza and did not show significant outcome differences [23]. Duration on vv/va-ECMO and ICU length of stay in this study was significantly longer in patients with COVID-19, which is in line with our findings.…”

“…Previous studies reported a higher rate of bleeding events in patients with COVID-19 on vv/va-ECMO compared to influenza [21,23]. In our cohort we observed more bleeding complications in COVID-19 than in influenza patients.…”

“…Further comorbidities are displayed in Table 1 and Supplementary Table S1. The disease severities displayed by the median SAPS II, APACHE II and SOFA score on admission were 32 (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) vs. 27 (24-35.5) (p = 0.009), 17 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) vs. 18 (14-22) (p = 0.885) and 10 (9-13) vs. 10 (8-13) (p = 0.877), respectively.…”

“…Clinical features regarding clinical symptoms and course of disease of COVID-19 and influenza are highly variable, and recent studies described differences regarding patient characteristics and outcomes [18,19]. For the comparison of patients with severe ARDS related to COVID-19 and influenza requiring ECMO there is limited data regarding clinical characteristics, complications and outcomes [20][21][22][23].…”

Evaluation of Bivalirudin as the Primary Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation for SARS-CoV-2–Associated Acute Respiratory Failure

“…7-9 In reports surrounding the use of ECMO for COVID-19, outcomes remain dismal, with rates of survival to discharge of 62.3%, with longer durations of hospital stay compared to other viral illnesses (37 vs 13.5 days; P = 0.007). 10 Although trajectories of COVID-19 incidence under the influence of vaccine development and mass vaccination efforts have improved, global rates of new cases still exceed 1 million per week, with more than 40 000 new deaths per week. 1…”