Ann Surg. 2021 Apr 9. doi: 10.1097/SLA.0000000000004870. Online ahead of print.
OBJECTIVE: This study analyzed the outcomes of COVID-19 patients with ARDS who were managed with extracorporeal membrane oxygenation (ECMO) across 155 US academic centers.
SUMMARY BACKGROUND DATA: ECMO has been utilized in COVID-19 patients with acute respiratory distress syndrome (ARDS) and refractory hypoxemia. Early case series with the use of ECMO in these patients reported high mortality exceeding 90%.
METHODS: Using ICD-10 codes, data of patients with COVID-19 with ARDS, managed with ECMO between April - September 2020 were analyzed using the Vizient clinical database. Outcomes measured included in-hospital mortality, hospital and ICU length of stay (LOS) and direct cost. For comparative purposes, the outcome of a subset of COVID-19 patients aged between 18-64 years and managed with vs. without ECMO were examined.
RESULTS: 1,1182 patients with COVID-19 and ARDS received ECMO. In-hospital mortality was 45.9%, mean LOS was 36.8 ± 24.9 days and mean ICU stay was 29.1 ± 17.3 days. In-hospital mortality, according to age group was 25.2% for 1-30 years; 42.2% for 31-50 years; 53.2% for 51-64 years; and 73.7% for ≥65 years. A subset analysis of COVID-19 patients, aged 18-64 years with ARDS requiring mechanical ventilation and managed with (n = 1113) vs without (n = 16,343) ECMO, showed relatively high in-hospital mortality for both groups (44.6% with ECMO vs 37.9% without ECMO).
CONCLUSIONS: In this large US study of patients with COVID-19 and ARDS managed with ECMO, the in-hospital mortality is high but much lower than initial reports. Future research is needed to evaluate which patients with COVID-19 and ARDS would benefit from ECMO.