Abstract
BackgroundExtracorporeal membrane oxygenation (ECMO) has become an established rescue therapy for severe acute respiratory distress syndrome (ARDS) in several etiologies including influenza A H1N1 pneumonia. The benefit of receiving ECMO in coronavirus disease 2019 (COVID-19) is still uncertain. The aim of this analysis was to compare the outcome of patients who received veno-venous ECMO for COVID-19 and Influenza A H1N1 associated ARDS.MethodsThis was a multicenter retrospective cohort study including adults with ARDS, receiving ECMO for COVID-19 and influenza A H1N1 pneumonia between 2009 and 2021 in seven Italian ICU. The primary outcome was any-cause mortality at 60 days after ECMO initiation. We used a multivariable Cox model to estimate the difference in mortality accounting for patients’ characteristics and treatment factors before ECMO was started. Secondary outcomes were mortality at 90 days, ICU and hospital length of stay and ECMO associated complications.ResultsData from 308 patients with COVID-19 (N = 146) and H1N1 (N = 162) associated ARDS who had received ECMO support were included. The estimated cumulative mortality at 60 days after initiating ECMO was higher in COVID-19 (46%) than H1N1 (27%) patients (hazard ratio 1.76, 95% CI 1.17–2.46). When adjusting for confounders, specifically age and hospital length of stay before ECMO support, the hazard ratio decreased to 1.39, 95% CI 0.78–2.47. ICU and hospital length of stay, duration of ECMO and invasive mechanical ventilation and ECMO-associated hemorrhagic complications were higher in COVID-19 than H1N1 patients.ConclusionIn patients with ARDS who received ECMO, the observed unadjusted 60-day mortality was higher in cases of COVID-19 than H1N1 pneumonia. This difference in mortality was not significant after multivariable adjustment; older age and longer hospital length of stay before ECMO emerged as important covariates that could explain the observed difference.Trial registration number: NCT05080933, retrospectively registered.
Highlights
Since the early 2000s, the critical care community experienced several waves of Acute Respiratory Distress Syndrome (ARDS)-associated pneumonia caused by virus infection that challenged the capacity of health care systems to provide high quality care for these critically ill patients [1,2,3,4]
We collected data on all consecutive adult patients who were supported with VV Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) due to confirmed COVID-19 and influenza A (H1N1)
Median P aCO2 and driving pressure were higher in COVID-19 than H1N1 patients, while median Positive end expiratory pressure (PEEP) was higher in H1N1 than COVID-19 patients
Summary
Since the early 2000s, the critical care community experienced several waves of Acute Respiratory Distress Syndrome (ARDS)-associated pneumonia caused by virus infection that challenged the capacity of health care systems to provide high quality care for these critically ill patients [1,2,3,4]. In two multicenter studies that enrolled highly selected patients who received the best standard of care at the early stage of the disease, a probability of 60- and 90-day mortality was significantly lower (31 and 38%, respectively) [9, 10], and hospital mortality of 37% was similar to that from robust metanalysis of observational studies and randomized clinical trials examining ECMO in adults with COVID19 ARDS [11] Considering these dissimilar results, the present study assessed whether the outcome of patients who received VV-ECMO for COVID-19 and Influenza A H1N1 associated ARDS depends on different viral etiologies. The aim of this analysis was to compare the outcome of patients who received veno-venous ECMO for COVID-19 and Influenza A H1N1 associated ARDS
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