EXTRACORPOREAL MEMBRANE OXYGENATION AS RESCUE THERAPY FOR COVID-19 INDUCED HYPOXIA: SINGLE-CENTER STUDY

Abstract

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To examine COVID-19 patients requiring invasive mechanical ventilation (MV) and/or Extracorporeal Membrane Oxygenation (ECMO) to better understand patient selection for ECMO, clinical management, and short-term outcomes. METHODS: Retrospective study of patients >18-years-old admitted to the hospital with COVID-19 requiring MV. Lung-protective ventilation was used in all patients with initial set PEEP of 8-10 cm H20 for plateau pressure <30 cm H20. ECMO was considered per pre-specified institutional criteria for refractory hypoxemia despite maximum-medical therapy, in qualifying patients. Exclusion criteria for ECMO included age >65 years, multi-system organ failure, and MV >10 d. Data captured included baseline patient characteristics, co-morbidities, pre-ECMO respiratory support, ECMO settings, laboratory results, and COVID-19 therapeutic interventions. RESULTS: We analyzed 59 patients who required invasive MV, including 13 who met criteria for ECMO. There were no between-group differences in gender, BMI, or co-morbidities. More ECMO patients received Tocilizumab (p=.003), but steroid use was similar (p=.44). Nine ECMO (69.2%) patients were decannulated. Crude ICU mortality was comparable between the ECMO and MV groups (6/13 [46.15%] vs. 22/46 patients [47.82%]; p=0.92). Higher pre-ECMO D-dimer (9.740 [4.84-20.00] mcg/mL vs. 3.800 [2.19-9.11] mcg/mL; p=0.05), LDH (1158 ±344.5 units/L vs. 575.9 ±124.0 units/L; p=0.001), and troponin (0.4315 ±0.465 ng/mL vs. 0.034 ±0.043 ng/mL; p=0.04) were associated with mortality. Time on MV was significantly longer in the ECMO group (563.3 [422.1-613.9] h vs. 247.9 [101.8-479] h in MV; p<.001) as well as ICU length of stay (LOS) (576.2 [457.5-652.8] h in ECMO vs. 322.2 [120.6-569.3] h in MV; p=0.01). CONCLUSIONS: ECMO was associated with prolonged MV and extended ICU LOS. Markers of coagulation, inflammation and cardiac injury were elevated in ECMO patients who did not survive. CLINICAL IMPLICATIONS: ECMO is a potentially effective rescue therapy for COVID-19 associated pneumonia. DISCLOSURES: No relevant relationships by Muhtadi Alnababteh, source=Web Response No relevant relationships by Rajus Chopra, source=Web Response Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: $5001 - $20000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Consulting fee Technical Editor Resp Care Journal relationship with American Association for Respiratory Care Please note: $1001 - $5000 Added 07/01/2020 by Gail Drescher, source=Web Response, value=Salary No relevant relationships by Muhammad Hashmi, source=Web Response No relevant relationships by Fatima Hayat, source=Web Response No relevant relationships by Akshay Kohli, source=Web Response No relevant relationships by Emil Oweis, source=Web Response No relevant relationships by Karthik Vedantam, source=Web Response No relevant relationships by Akram Zaaqoq, source=Web Response