Outcomes of extracorporeal membrane oxygenation in influenza versus COVID‐19 during the first wave of COVID‐19

Blazoski, Cameron M.; Baram, Michael; Yang, Qiong; Hirose, Hitoshi

PURPOSE: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2, also referred to as coronavirus disease 2019 [COVID‐19]). We conducted this study to compare the outcomes of influenza patients treated with veno‐venous‐ECMO (VV‐ECMO) to COVID‐19 patients treated with VV‐ECMO, during the first wave of COVID‐19. METHODS: Patients in our institution with ARDS due to COVID‐19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV‐ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed. RESULTS: A total of 28 COVID‐19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID‐19 patients and 94% (16/17) in influenza patients (p = .04). Thirty days survival rates after ECMO decannulation were 54% (15/28) in COVID‐19 patients and 76% (13/17) in influenza patients (p = .13). COVID‐19 patients spent a longer time on ECMO compared to flu patients (21 vs. 12 days; p = .025), and more COVID‐19 patients (26/28 vs. 2/17) were on immunomodulatory therapy before ECMO initiation (p < .001). COVID‐19 patients had higher rates of new infections during ECMO (50% vs. 18%; p = .03) and bacterial pneumonia (36% vs. 6%; p = .024). CONCLUSIONS: COVID‐19 patients who were treated in our institution with VV‐ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID‐19 immunomodulation therapies may increase the risk of other superimposed infections.