Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis.

Teresa Autschbach,Jan Spillner,Katharina Nubbemeyer,Nima Hatam,Rolf Rossaint,Sebastian Kalverkamp,Nikolaus Marx,Rashad Zayat,Oliver Grottke,Gernot Marx,Koray Durak,Michael Dreher,Alex Kersten

doi:10.3390/jcm10122547

Abstract

It remains unclear to what extent the outcomes and complications of extracorporeal membrane oxygenation (ECMO) therapy in COVID-19 patients with acute respiratory distress syndrome (ARDS) differ from non-COVID-19 ARDS patients. In an observational, propensity-matched study, outcomes after ECMO support were compared between 19 COVID-19 patients suffering from ARDS (COVID group) and 34 matched non-COVID-19 ARDS patients (NCOVID group) from our historical cohort. A 1:2 propensity matching was performed based on respiratory ECMO survival prediction (RESP) score, age, gender, bilirubin, and creatinine levels. Patients’ characteristics, laboratory parameters, adverse events, and 90-day survival were analyzed. Patients’ characteristics in COVID and NCOVID groups were similar. Before ECMO initiation, fibrinogen levels were significantly higher in the COVID group (median: 493 vs. 364 mg/dL, p < 0.001). Median ECMO support duration was similar (16 vs. 13 days, p = 0.714, respectively). During ECMO therapy, patients in the COVID group developed significantly more thromboembolic events (TEE) than did those in the NCOVID group (42% vs. 12%, p = 0.031), which were mainly pulmonary artery embolism (PAE) (26% vs. 0%, p = 0.008). The rate of major bleeding events (42% vs. 62%, p = 0.263) was similar. Fibrinogen decreased significantly more in the COVID group than in the NCOVID group (p < 0.001), whereas D-dimer increased in the COVID group (p = 0.011). Additionally, 90-day mortality did not differ (47% vs. 74%; p = 0.064) between COVID and NCOVID groups. Compared with that in non-COVID-19 ARDS patients, ECMO support in COVID-19 patients was associated with comparable in-hospital mortality and similar bleeding rates but a higher incidence of TEE, especially PAE. In contrast, coagulation parameters differed between COVID and NCOVID patients.

Highlights

As of 4 February 2021, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)has infected >105 million people and caused more than two million deaths worldwide [1].In cases with refractory hypoxemic respiratory failure and insufficient improvement despite mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) support is a life-rescuing treatment per the World Health Organization [2]
SARS-CoV-2 poses a high risk for thromboembolic events (TEE) since 31% of critically ill COVID-19 patients developed arterial and venous thromboembolism [7,8]
Propensity-matched cohort study, data from critically ill COVID19 patients suffering from acute respiratory distress syndrome (ARDS) who were treated in our institution with venovenous (VV) ECMO between March 2020 to May 2020 were prospectively collected (n = 19)

Summary

Introduction

As of 4 February 2021, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)has infected >105 million people and caused more than two million deaths worldwide [1].In cases with refractory hypoxemic respiratory failure and insufficient improvement despite mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) support is a life-rescuing treatment per the World Health Organization [2]. ECMO therapy has gained acceptance as beneficial rescue therapy in acute respiratory distress syndrome (ARDS). Data on ECMO therapy of critically ill COVID-19 patients are scarce; the effects of ECMO support in COVID-19 ARDS patients are uncertain. ECMO support presents an increased risk of bleeding and thromboembolic events (BE and TEE, respectively) [6]. SARS-CoV-2 poses a high risk for TEE since 31% of critically ill COVID-19 patients developed arterial and venous thromboembolism [7,8]. Treating COVID-19 infection with ECMO treatment may negatively synergize the effect of increased TEE and BE. Data regarding outcome and complication, including TEE and BE, incidences during ECMO support for ARDS in COVID-19 patients remain scarce. We conducted this study to analyze and compare the outcomes and adverse events of ECMO therapy between COVID-19 ARDS and non-COVID-19 ARDS patients

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