COVID-19 can trigger severe, rapidly progressive, treatment-resistant ARDS. Evidence-based guidelines for the use of ECMO as supportive therapy to improve outcomes are lacking. Initial ECMO mortality rates for ARDS in COVID-19 were significant, leading some to doubt the usefulness of the therapy in treating this virus. The experiment led to better results. However, the optimal cannula recipient, cannulation window, and post-cannulation care plan have yet to be determined. From April 1, 2020 to July 31, 2020, the researchers screened the first 25 patients at their institution to get VV ECMO for COVID-19-related acute respiratory distress syndrome.
They compared the characteristics of those who survived until discharge from hospital with those who did not. The adjusted risk factors for death were modeled using a form of Poisson regression called the modified Poisson model. The hospital discharged 44 patients (about 11%) who were initially admitted. There were no significant variations in mean body mass index, diabetes prevalence, or PaO2 between cohorts, but survivors were younger (40.5 years versus 53.1 years; P<0.001). FiO2 less at the time of cannulation. The median time from symptom onset to cannulation was 12.5 days for survivors compared to 19.9 days for non-survivors (P = 0.028), and the median time spent in ICU before cannulation was 5.6 days for survivors and 11.7 days for non-survivors (P = 0.045).
The adjusted risk of death was 4% higher for each day between ICU admission and cannulation and 6% higher for each additional year of age. When COVID-19 causes severe, refractory ARDS, ECMO may be helpful. Increasing patient age and time since ICU admission were risk factors for mortality and should be considered when making treatment decisions. Further research is needed to determine optimal VV ECMO procedures for COVID-19.