Extra Corporeal Membrane Oxygenation and Long Term Neurological Function Among COVID-19 Patients

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) therapy is indicated for acute respiratory distress syndromes (ARDS) with refractory hypoxia1. ARDS associated with Severe Acute Respiratory Syndrome-Coronavirus-2 infection has been shown to have 45% mortality, secondary to elevated inflammatory cytokines2. Prolonged duration of ECMO leads to poor short term neurological function 3. However there is lack of data regarding long term quality of life among patients who undergo ECMO for ARDS. We plan to conduct a retrospective study among patients undergoing ECMO to assess their quality of life. Methods: Retrospectives chart review and phone interviews conducted approximately 6 months after receiving ECMO at New York University-Long Island Hospital. 22 patients have received veno-venous or veno-arterial ECMO since March 2020. Phone interviews of 10 patients have been conducted. Welch two sample t test will be used to detect differences between activities of daily living (ADL) between prolonged ECMO (more than 20 days) and routine ECMO (less than 20 days) groups. Association between ECMO parameters, laboratory values and ADL will be evaluated by using a multivariable logistic regression analysis. Result will be considered statistically significant if p<0.05 Results:11 out of 22 patients have been discharged from hospital, 1 patient continues to receive ECMO. Initial analysis of our data shows that patients undergoing prolonged ECMO have a low mean score of 14 for activities of daily living (bathing, independent use of toilet, cooking and eating meals, shopping, driving, and use of supplemental oxygen) when compared to a mean score of 30 among routine ECMO. Mean Interleukin-6 (IL-6) and D Dimer levels 24 hours prior to undergoing cannulation for ECMO among prolonged ECMO group was higher when compared to routine ECMO group. (table 1) Conclusion:Patients undergoing prolonged ECMO have reduced activities of daily living 6 months post hospital discharge. Immune and coagulation markers prior to receiving ECMO were elevated among prolonged ECMO group suggesting severe cytokine storm and immunothrombosis resulting in poor prognosis.