Early outcomes show survival benefit with ECMO support in severe COVID-19

Early outcomes of a single-center study demonstrate clinical benefit of extracorporeal membrane oxygenation support in patients with severe COVID-19, according to a study published in The Annals of Thoracic Surgery.

“Our experience differs from other published data which suggested that ECMO is of limited value for patients with COVID-19. Although still early in many of these patients’ clinical courses, these initial outcomes are encouraging with an overall current survival of 96%, with nearly half of the patients already weaned from ECMO support, mechanical ventilation and supplemental oxygen. Furthermore, a significant number of these patients have been discharged from the hospital,” Zachary N. Kon, MD, cardiothoracic surgeon in the department of cardiothoracic surgery at NYU Langone Health, and colleagues wrote.

Researchers conducted a retrospective analysis of 321 endotracheal-intubated patients with COVID-19 from March 10 to April 24, 2020 Of those, 77 (24%) were evaluated for ECMO support. ECMO support was selected based on patients’ partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio less than 150 mm Hg or pH less than 7.25 with an arterial partial pressure of carbon dioxide greater than 60 mm Hg.

Patients were cannulated and managed with protective lung ventilation, early tracheostomy, bronchoscopies and proning in NYU Langone Health’s Manhattan campus ICU.

Primary outcome was survival and lung recovery defined by weaning off ECMO support, mechanical ventilation and supplemental oxygen.

Veno-venous ECMO support was used in 27 patients (8.4%; median age, 40 years; median BMI, 32 kg/m²). Median time on ECMO support for the cohort was 11 days.

Survival was 96.3%, with one death that occurred over more than 350 days of ECMO support.

Thirteen patients (48.1%) remained on ECMO support, 11 (41%) were successfully decannulated, two patients (7.4%) were weaned and decannulated off ECMO but remained on mechanical ventilation, seven patients (25.9%) were discharged and six patients (22.2%) remained hospitalized.

Eleven patients (41%) had ECMO-associated complications.

No health care workers involved in ECMO cannulation developed symptoms or were tested positive for COVID-19 infection.

The researchers noted that this study evaluated only early outcomes.

“This report describes the largest known U.S. single institution experience with ECMO support for COVID-19 patients,” the researchers wrote. “Further follow-up will determine the overall 30-day and 90-day mortality for these patients and their ultimate degree of lung recovery and functional status.”