COVID-19 pneumonia negatively impacts hospitalization outcomes on ECMO
Key takeaways:
- Patients who underwent ECMO for COVID-19 pneumonia or non-COVID-19 pneumonia were balanced based on sociodemographic factors and comorbidities.
- Four hospitalization factors were worse in the COVID-19 group.
Having COVID-19 pneumonia vs. non-COVID-19 pneumonia while receiving extracorporeal membrane oxygenation negatively impacted inpatient mortality odds and length of stay, according to data published in American Journal of Critical Care.
“Our findings help clarify the impact of severe COVID-19 cases requiring ECMO and, [by] establishing as a baseline patients with viral pneumonia who also required ECMO, we found that there were a significantly higher number of cases with COVID-19 pneumonia which underwent ECMO between 2020 and 2021, that these patients carried a higher mortality and that this was not contingent on comorbidities or sociodemographic factors,” Francisco J. Gallegos-Koyner, MD, resident physician at SBH Health System, told Healio.
Using 2016 to 2021 data from the National Inpatient Sample, Gallegos-Koyner and colleagues evaluated 5,680 adults who underwent ECMO for COVID-19 pneumonia (mean age, 46 years; 71.4% men; 16.8% Black/African American; 25.3% Hispanic) and 430 adults who underwent ECMO for non-COVID-19 pneumonia (mean age, 45.1 years; 61.6% men; 11.4% Black/African American; 15.2% Hispanic) to determine how inpatient mortality and five other hospitalization-related outcomes differ between the two sets of patients.
“The amount of patients with COVID-19 pneumonia who underwent ECMO only in 2020 and 2021 compared with patients with non-COVID pneumonia who underwent ECMO in all the prior years was a surprise,” Gallegos-Koyner told Healio.
Notably, researchers matched the groups based on propensity scores, leaving 1,136 patients with COVID-19 pneumonia and 86 patients with non-COVID-19 pneumonia “adequate[ly] balance[d]” in terms of sociodemographic factors and comorbidities for analysis.
The study reported significantly heightened odds for inpatient mortality among those with COVID-19 vs. non-COVID-19 pneumonia (OR = 1.98; 95% CI, 1.11-3.53; P = .02).
“The fact that sociodemographic factors or comorbidities were not the only culprit for the increase in mortality seen in patients with COVID-19 pneumonia who underwent ECMO was, for a part, unexpected,” Gallegos-Koyner told Healio.
When evaluating length of stay, the COVID-19 pneumonia group stayed for an average of 38 days, whereas the non-COVID-19 pneumonia group stayed for a shorter time, with an average of 28.5 days (P < .001), according to the study.
Researchers further found that total hospitalization costs amounted to significantly more among those with COVID-19 pneumonia vs. non-COVID-19 pneumonia (mean, $1,278,270 vs. $967,866; P = .002).
Compared with patients with non-COVID-19 pneumonia, patients with COVID-19 pneumonia also had decreased odds for being discharged home (OR = 0.42; 95% CI, 0.21-0.85; P = .02), according to the study.
Lastly, researchers reported that those with COVID-19 pneumonia had comparable rates of vascular complications and need for dialysis/continuous renal replacement therapy with those with non-COVID-19 pneumonia.
“The study is based on administrative databases, and one limitation of the study is that the accuracy and reliability of the results is based on correct classification of ICD-10 codes,” Gallegos-Koyner told Healio.
“Future studies could look at more years of the National Inpatient Sample database as they are released, the impact of ECMO on different diseases, or at comparison of pre-pandemic vs. post-pandemic experience and outcomes on cases requiring ECMO for hospitals with low pre-pandemic ECMO experience,” Gallegos-Koyner said.
For more information:
Francisco J. Gallegos-Koyner, MD, can be reached at fgallegos@sbhny.org.
Reference:
- COVID vs. non-COVID: Outcomes differ for ECMO patients. https://www.aacn.org/newsroom/covid-vs-non-covid-outcomes-differ-for-ecmo-patients. Published March 4, 2025. Accessed March 5, 2025.