Multi-institutional Analysis of 200 COVID-19 Patients treated with ECMO:Outcomes and Trends

Jacobs, Jeffrey P.; Stammers, Alfred H.; St. Louis, James D.; Hayanga, J. W. Awori; Firstenberg, Michael S.; Mongero, Linda B.; Tesdahl, Eric A.; Rajagopal, Keshava; Cheema, Faisal H.; Patel, Kirti; Coley, Tom; Sestokas, Anthony K.; Slepian, Marvin J.; Badhwar, Vinay

Background The role of ECMO in the management of patients with COVID-19 continues to evolve. The purpose of this manuscript is to review a multi-institutional clinical experience in 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO. Methods This analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 9, 2020. Differences by mortality group were assessed using chi-square tests for categorical variables and Kruskal-Wallis rank sum tests and Welch’s ANOVA for continuous variables. Results Median ECMO time was 15 days (IQR=9-28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with veno-venous ECMO was 87 of 188 patients (46.3%), while survival with veno-arterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, p<0.001) and shorter median time interval from diagnosis to ECMO cannulation (8 days versus 12 days, p=0.003).In the 90 survivors, adjunctive therapies on ECMO included: intravenous steroids (64), Remdesivir (49), convalescent plasma (43), anti-interleukin-6 receptor blockers (39), prostaglandin (33), and hydroxychloroquine (22). Conclusions ECMO facilitates survival of select critically ill patients with COVID-19. Survivors tend to be younger and have a shorter duration from diagnosis to cannulation. Substantial variation exists in drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.