Outcomes of extracorporeal membrane oxygenation in acute respiratory distress syndrome due to COVID‐19: The lessons learned from the first wave of COVID‐19

Blazoski, Cameron; Baram, Michael; Hirose, Hitoshi

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID‐19), but there has been little evidence of its efficacy. We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID‐19. METHODS: All adult patients who were placed on ECMO for ARDS due to COVID‐19 between April 2020 and June 2020 (during the first wave of COVID‐19) were identified. The clinical characteristics and outcomes of these patients were analyzed with a specific focus on the differences between patients who survived to hospital discharge and those who did not. RESULTS: In total, 20 COVID‐19 patients were included in this study. All patients were placed on veno‐veno ECMO. Comparing survivors and non‐survivors, older age was found to be associated with hospital mortality (p = .02). The following complications were observed: renal failure requiring renal replacement therapy (35%, n = 7), bacteremia during ECMO (20%, n = 4), coinfection with bacterial pneumonia (15%, n = 3), cannula site bleeding (15%, n = 3), stroke (10%, n = 2), gastrointestinal bleeding (10%, n = 2), and liver failure (5%, n = 1). The complications associated with patient mortality were culture‐positive septic shock (p = .01), culture‐negative systemic inflammatory response syndrome (p = .01), and renal failure (p = .01). The causes of death were septic shock (44%, n = 4), culture‐negative systemic inflammatory response syndrome (44%, n = 4), and stroke (11%, n = 1). CONCLUSIONS: Based on our experience, ECMO can improve refractory ARDS due to COVID‐19 in select patients. Proper control of bacterial infections during COVID‐19 immunomodulation therapy may be critical to improving survival.