Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Alshahrani, Mohammed S.; Sindi, Anees; Alshamsi, Fayez; Al-Omari, Awad; El Tahan, Mohamed; Alahmadi, Bayan; Zein, Ahmed; Khatani, Naif; Al-Hameed, Fahad; Alamri, Sultan; Abdelzaher, Mohammed; Alghamdi, Amenah; Alfousan, Faisal; Tash, Adel; Tashkandi, Wail; Alraddadi, Rajaa; Lewis, Kim; Badawee, Mohammed; Arabi, Yaseen M.; Fan, Eddy; Alhazzani, Waleed

BACKGROUND: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. RESULTS: Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). CONCLUSIONS: ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.