Abstract 14814: Predictors and Outcomes of Extracorporeal Membrane Oxygenation in COVID-19 Patients With Acute Respiratory Distress Syndrome: A Propensity-Matched National Analysis

Abstract

Background: The current data is limited for understanding extracorporeal membrane oxygenation (ECMO) indicators and outcomes in COVID-19 patients with acute respiratory distress syndrome (ARDS). Methods: The National In-patient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with ARDS who received endotracheal intubation and further divided into ECMO and Non-ECMO subgroups. Multivariate regression analysis and propensity score matching (PSM) were done to compare outcomes among both cohorts. Results: Among 1,666,960 patients (weighted) admitted with COVID-19, 99,785 (5.98%) patients developed acute respiratory distress syndrome (ARDS), and 60,114 (60.2%) were placed on mechanical ventilation. Of these mechanically ventilated COVID-ARDS, 2580 patients (4.3%) were placed on ECMO. Patients with ECMO intervention had higher adjusted odds of blood loss anemia (aOR 9.1, 95% CI: 6.16 - 13.5, PSM 42% vs. 5.4%, P<0.001), major bleeding (aOR 3.79, 95% CI: 2.5 - 5.6, PSM 19.9% vs. 5.9%, P<0.001) and acute liver injury (aOR 1.7, 95% CI: 1.14 - 2.6 PSM 14% vs. 6%, P = 0.009) compared to patients without ECMO intervention. However, in-hospital mortality, acute kidney injury, and cardiac arrest were insignificant. Patients on ECMO had longer hospital stays and higher total costs of hospitalization. Patients placed on venoarterial-ECMO had higher odds of cardiogenic shock (aOR 13.4, CI 3.95 to 46, P<0.001), cardiac arrest (aOR 3.5, CI 1.45 to 8.47, P = 0.005), acute heart failure (aOR 4.18, CI 1.05 to 16.5, P = 0.042) and lower odds of major bleeding (aOR 0.26, CI 0.07 to 0.92) than venovenous-ECMO. Conclusion: Mechanically intubated COVID-19 ARDS patients placed on ECMO had no significant difference in mortality. Despite being younger, they had higher rates of in-patient blood loss anemia, major bleeding, and acute liver injury. Resources utilization was significantly higher for the ECMO subgroup. ECMO.