A Case Series of Black and Hispanic COVID-19 Patients Treated with ECMO

Abstract

PurposeExtracorporeal Membrane Oxygenation (ECMO) has been utilized as salvage therapy in patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19. We aim to present our experience with ECMO in a community hospital for minority patients with COVID-19.MethodsThis is a retrospective analysis of all SARS-CoV2 infected patients who developed ARDS and received ECMO at a tertiary cardiovascular care center between March and August 2020. Patient demographics, data pre- and on-ECMO, hemodynamics, and ventilation parameters were collected. Primary outcome of interest was mortality. Secondary outcomes were length of stay, bleeding requiring transfusion, coagulopathies, infections, and procedural-related complications.ResultsWe identified 10 COVID-19 patients with ARDS treated with ECMO. The mean age was 45 years and 70% were male. The racial composition of the patients consisted of Blacks (30%) and Hispanics (70%). Comorbidities included hypertension (40%), diabetes mellitus (50%), and hyperlipidemia (20%). Eight patients were treated with VV-ECMO, and the remaining patients with VA-ECMO. Hospital-acquired infections including ventilator-associated pneumonia and bacteremia were reported in 50% and 30%, respectively. Hemorrhage requiring transfusion was reported in all 10 patients, with 60% of patients having bleeding from a gastrointestinal source. 70% of patients developed thrombocytopenia, and 20% developed a clot within the ECMO circuit. Coagulation disorders reported, included heparin-induced thrombocytopenia (20%), deep vein thrombosis (30%), and pulmonary embolism (20%). 90% of patients died, and 1 patient was discharged to a long-term acute care hospital (See Table 1 for outcomes).ConclusionDespite using ECMO as rescue therapy, mortality among COVID-19 patients who developed ARDS remained high in minority groups. Further studies are needed to investigate management of COVID-19 related complications.