Abstract
Introduction: Extracorporeal membrane oxygenation (ECMO) has
been used as a refractory treatment for acute respiratory distress
syndrome (ARDS) due to COVID-19, but there has been little evidence of
its efficacy. We conducted this study to share our experience using ECMO
as a bridge to recovery for ARDS due to COVID-19.
Methods: All adult patients who were placed on ECMO for ARDS
due to COVID -19 between April 2020 and June 2020 (during the first wave
of COVID-19) were identified. The clinical characteristics and outcomes
of these patients were analyzed with a specific focus on the differences
between patients who survived to hospital discharge and those who did
not.
Results: 20 COVID-19 patients were included in this study. All
patients were placed on veno-veno ECMO. Comparing between survivors and
non-survivors, older age was associated with hospital mortality
(p=0.02). The following complications were observed: renal failure
requiring renal replacement therapy (35%, n=7), bacteremia during ECMO
(20%, n=4),coinfection with bacterial pneumonia (15%, n=3), cannula
site bleeding (15%, n=3), stroke (10%, n=2), gastrointestinal bleeding
(10%, n=2), and liver failure (5%, n=1). The complications associated
with patient mortality were culture positive septic shock (p=0.01),
culture-negative systemic inflammatory response syndrome (p=0.01), and
renal failure (p=0.01). The causes of death were septic shock (44%,
n=4), culture-negative systemic inflammatory response syndrome (44%,
n=4), and stroke (11%, n=1).
Conclusions: Based on our experience, ECMO can improve
refractory ARDS due to COVID-19 in select patients. Proper control of
bacterial infections during COVID-19 immunomodulation therapy may be
critical to improving survival.