Venovenous Extracorporeal Membrane Oxygenation for Patients with Refractory Covid-19: Multicenter Experience of Referral Hospitals in a Large Healthcare System

Shih, Emily; DiMaio, J. Michael; Squiers, John J.; Banwait, Jasjit K.; Meyer, Dan M.; George, Timothy J.; Schwartz, Gary S.; Blough, Britton A.; Gottlieb, Robert L.; Gonzalez-Stawinski, Gonzo; Krueger, Anita R.; Monday, Kara; Reddy, Ramachandra C.; Velazco, Jorge F.; Hernandez, Omar; Martin, Chris; Sheasby, Jenelle

Background The benefit of extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress from COVID-19 refractory to medical management and lung-protective mechanical ventilation has not been adequately determined. Methods We reviewed the clinical course of 37 patients with laboratory-confirmed SARS-CoV-2 infection supported by venovenous ECMO at four ECMO referral centers within a large healthcare system. Patient characteristics, progression of hemodynamics and inflammatory markers, and clinical outcomes were evaluated. Results The patients had median age of 51 years (interquartile range [IQR] 40-59), and 73% were male. Peak plateau pressures, vasopressor requirements, and arterial PaCO2 all improved with ECMO support. In our patient population, 24/37 patients (64.8%) survived to decannulation and 21/37 patients (56.8%) survived to discharge. Among patients discharged alive from the ECMO facility, 12 patients were discharged to a long-term acute care or rehabilitation facility, 2 were transferred back to the referring hospital for ventilatory weaning, and 7 were discharged directly home. For patients who were successfully decannulated, median length of time on ECMO was 17 days (IQR 10-33.5). Conclusions Venovenous ECMO represents a useful therapy for patients with refractory severe acute respiratory distress syndrome from COVID-19.