Mortality Risk Assessment in Covid-19 Veno-Venous Extracorporeal Membrane Oxygenation

Tabatabai, Ali; Ghneim, Mira H.; Kaczorowski, David J.; Shah, Aakash; Dave, Sagar; Haase, Daniel J.; Vesselinov, Roumen; Deatrick, Kristopher B.; Rabin, Joseph; Rabinowitz, Ronald P.; Galvagno, Samuel; O’Connor, James V.; Menaker, Jay; Herr, Daniel L.; Gammie, James S.; Scalea, Thomas M.; Madathil, Ronson J.

Background A life-threatening complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS) refractory to conventional management. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is used to support ARDS patients failing conventional management. Scoring systems to predict mortality in VV-ECMO remain unvalidated in COVID-19 ARDS. We describe the largest COVID-19 VV-ECMO single-center experience to date and assess the utility of standard risk calculators. Methods A retrospective review of a prospective database of all COVID-19 VV-ECMO patients, cannulated between March 15th and June 27th, 2020, at a single academic center was performed. Demographic, clinical, and ECMO characteristics were collected. The primary outcome was in hospital mortality; survivor and non-survivor cohorts were compared utilizing univariate and bivariate analyses. Results Forty COVID-19 ECMO patients were identified. Of the 33 patients (82.5%) off ECMO at time of analysis, 18 patients (54.5%) survived to hospital discharge and 15 (45.5%) died on ECMO. Non-survivors presented with a statistically significant higher Prediction of Survival on ECMO Therapy (PRESET)-Score (mean ± standard deviation 8.33 ± 0.8 vs. 6.17 ± 1.8, P = 0.001). The PRESET-Score demonstrated accurate mortality prediction. All patients with a PRESET-Score of ≤ 6 survived, and a score ≥ 7 was associated with a dramatic increase in mortality. Conclusions These results suggest favorable outcomes are possible in COVID-19 ECMO patients at high volume centers. This study is the first to demonstrate an association between the PRESET-Score and survival in COVID-19 VV-ECMO patients. Standard risk calculators may aid in appropriate COVID-19 ARDS patient selection for ECMO.