Characteristics and Outcomes of Patients with COVID-19 Supported by Extracorporeal Membrane Oxygenation: A Retrospective Multicenter Study

Saeed, Omar; Tatooles, Antone J.; Farooq, Muhammad; Schwartz, Gary; Pham, Duc T.; Mustafa, Asif K.; D’Alessandro, David; Arbol, Sunil; Jorde, Ulrich P.; Gregoric, Igor D.; Radovancevic, Rajko; Lima, Brian; Bryner, Benjamin S.; Ravichandran, Ashwin; Salerno, Christopher T.; Spencer, Philip; Friedmann, Patricia; Silvestry, Scott; Goldstein, Daniel J.

Objective To determine characteristics, outcomes and clinical factors associated with death in patients with coronavirus disease 2019 (COVID-19) requiring ECMO support. Methods A multicenter, retrospective cohort study was conducted. The cohort consisted of adult patients (≥18 years old) requiring ECMO in the period from March 1, 2020 to September 30, 2020. The primary outcome was in-hospital mortality after ECMO initiation assessed through a time to event analysis at 90 days. Multivariable Cox proportional regression was utilized to determine factors associated with in-hospital mortality. Results Overall, 292 patients from 17 centers comprised the study cohort. Patients were 49 (IQR: 39-57) years old and 81 (28%) were female. At the end of the follow up period, 19 (6%) patients were still on ECMO, 25 (9%) were off ECMO but remained hospitalized, 135 (46%) were discharged or transferred alive and 113 (39%) expired during the hospitalization. The cumulative in-hospital mortality at 90-days was 42% (95% CI: 36-47%). Factors associated with in-hospital mortality were age (aHR: 1.31, 95% CI: 1.06-1.61 per 10 years), renal dysfunction as measured by serum creatinine (aHR: 1.21, 95% CI 1.01-1.45) and cardiopulmonary resuscitation prior to ECMO placement (aHR: 1.87, 95% CI 1.01-3.46). Conclusions In patients with severe COVID-19 necessitating ECMO support, in-hospital mortality occurred in fewer than half of the cases. ECMO may serve as a viable modality for terminally ill patients with refractory COVID-19.