Results
During this study period, 20 patients with ARDS positive for COVID-19 underwent ECMO placement. All patients were placed on veno-veno ECMO, and the mean length of ECMO placement was 14.0 days. The average length of symptoms prior to ECMO placement was 11.4 days, with the average patient spending 10.3 days in the hospital prior to ECMO placement. The average time spent on a ventilator prior to ECMO placement was 147 hours. 75% of patients (n=15) were transferred from another institution to our hospital, and 60% of patients (n=12) had ECMO initiated at another institution prior to transfer. Pre-ECMO characteristics and patient demographics are displayed in Table 2. Patients were also treated with different therapies prior to starting ECMO placement. Therapy was administered in the form of steroids (65%, n=13), interleukin-6 inhibitors (55%, n=11), remdesivir (20%, n=4), and plasma (15%, n=3). None of the treatment therapies were associated with better or worse mortality rates. The types of treatment and their statistics are displayed in Table 3.
The ECMO survival rate was (15/20), and the survival rate to hospital discharge was 55% (11/20). 11 patients were labeled as Survivors and 9 as Non-Survivors based on their survival to hospital discharge. The only baseline characteristic that was statistically different between the two groups was age, as Non-Survivors were significantly older than Survivors (58.4 vs. 49.6, p=0.02).
The causes of death were septic shock (44%, n=4), culture-negative systemic inflammatory response syndrome (SIRS) (44%, n=4), and stroke (11%, n=1). The most common complication observed was renal failure requiring renal replacement therapy (35%, n=7). Complications that were associated with patient mortality between the two groups were blood culture positive sepsis (p=0.01), culture-negative systemic inflammatory response syndrome (SIRS) (p=0.01), cannula site bleeding (p=0.04), and renal failure (p=0.01). The complications are displayed in Table 4.