Outcomes of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19 Patients: A Multi-Institutional Analysis

Abstract

Background: In March 2020, COVID-19 was announced as a global pandemic. The first COVID-19 patient was connected to an ECMO device in Israel during that time. Since then, over 200 patients have required ECMO support due to COVID-19 infection. The present study is a multi-institutional analysis of all COVID-19 patients requiring veno-venous (VV) ECMO in Israel. The aim was to characterize and compare the survivors and deceased patients as well as establish risk factors for mortality. Methods: This retrospective multi-institutional study was conducted from March 2020 to March 2021 in eleven of twelve ECMO centers operating in Israel. All COVID-19 patients on VV ECMO support were included in the cohort. The patients were analyzed based on their comorbidities, procedural data, adverse event on ECMO, and outcomes. Univariate and multivariate analyses were used to compare the deceased and the surviving patients. Results: The study included 197 patients, of which 150 (76%) were males, and the mean age was 50.7 ± 12 years. Overall mortality was 106 (54%). Compared with the deceased subjects, survivors were significantly younger (48 ± 11 vs. 53 ± 12 years), suffered less from ischemic heart disease (IHD) (3% vs. 12%), and were ventilated for a significantly shorter period (≤4 days) prior to cannulation (77% vs. 63%). Patients in the deceased group experienced more kidney failure and sepsis. Rates of other complications were comparable between groups. Conclusions: Based on this study, we conclude that early cannulation (≤4 days) of younger patients (≤55 years) may improve overall survival and that a history of IHD might indicate a reduced prognosis.

Outcomes of Extracorporeal Membrane Oxygenation in COVID-19: A Single-Center Study

“…Extensive research has been undertaken to pinpoint the primary risk factors linked to ECMO treatment in patients with COVID-19. Several studies have consistently identified older age as a risk factor for mortality [ 5 , 8 , 11 , 12 ].…”

“…Acute renal failure necessitating CRRT has been identified as a risk factor for mortality in patients with COVID-19 who receive ECMO [ 8 , 17 ]. In line with this finding, our observations revealed a significantly higher rate of CRRT initiation in mortality group than in survival group (94% versus 26.7%, respectively; p<0.001).…”

“…Previous studies have reported a range of 3 to 7 days for the duration of mechanical ventilation prior to the initiation of ECMO [ 3 , 8 , 11 , 19 ]. Makhoul et al [ 8 ] and Kieninger et al [ 11 ] found that mortality group experienced a longer duration of mechanical ventilation, and a meta-analysis by Tran et al [ 12 ] suggested that a longer period might be associated with increased mortality.…”

“…However, during the COVID-19 pandemic, the limited availability of ECMO resources has challenged healthcare professionals. This scarcity has necessitated difficult decisions regarding patient selection [ 3 , 4 , 8 - 10 ]. Thus, it is crucial to identify the factors associated with patient outcomes and mortality in this context.…”

Risk Factors for the Mortality of Patients With Coronavirus Disease 2019 Requiring Extracorporeal Membrane Oxygenation in a Non-Centralized Setting: A Nationwide Study

“…In Israel, which does not operate specialized ECMO centers, a study reported a mortality rate of 54% among COVID-19 patients who received ECMO. 12 Therefore, we aimed to determine the mortality rates of patients with severe COVID-19 who received ECMO and analyze the associated factors using nationwide data.…”