Outcomes of Extracorporeal Membrane Oxygenation in Patients with Severe Acute Respiratory Distress Syndrome Caused by COVID-19 versus Influenza

Shih, Emily; Squiers, John J.; DiMaio, J. Michael; George, Timothy; Banwait, Jasjit; Monday, Kara; Blough, Britton; Meyer, Dan; Schwartz, Gary S.

Background Extracorporeal membrane oxygenation (ECMO) can be effective for refractory acute respiratory distress syndrome (ARDS) in patients with influenza, but its utility in patients with COVID-19 is uncertain. We compared outcomes of patients with refractory ARDS from COVID-19 and Influenza placed on ECMO. Methods We conducted a retrospective analysis of 120 patients with refractory ARDS due to COVID-19 or Influenza placed on ECMO at two referral centers from 1/2013 to 10/2020. Patient characteristics and clinical outcomes were compared. The primary endpoint was survival to discharge. Results Baseline characteristics and comorbidities were similar. During the study period, 53 patients with COVID-19 and 67 patients with Influenza were supported. Veno-venous ECMO was the predominant initial cannulation strategy in both groups (COVID 92.5% vs Influenza 95.5%; p=0.5). Survival to hospital discharge was 62.3% (33/53 patients) in the COVID-19 group and 64.2% (43/67) in the Influenza group (p=0.8). In patients successfully decannulated, median length of time on ECMO was longer in COVID-19 patients (14 days [IQR 9-30] vs. Influenza 10.5 [IQR 6.8-14.3] days, p=0.004). Among patients discharged alive, COVID-19 patients had longer overall length of stay (COVID 37 [IQR 27-62] vs Influenza 13.5 [IQR 9.3-24] days; p=0.007). Conclusions In patients with refractory ARDS from COVID-19 or Influenza placed on ECMO, there was no significant difference in survival to hospital discharge. In patients surviving to decannulation, the duration of ECMO support and total length of stay were longer in COVID-19 patients.