Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19-Associated ARDS: Predictors of Mortality

Abstract

The aim of the study was to identify factors associated with hospital mortality in patients with COVID-19associated acute respiratory distress syndrome (ARDS) receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO).Materials and methods. The retrospective study included data from the medical records of 123 patients treated in the intensive care unit (ICU) № 7 of the City Clinical Hospital № 52 of Moscow Department of Health. ECMO was initiated in all patients for respiratory indications according to current recommendations. A number of factors potentially associated with mortality were systematized and analyzed. Statistical processing to identify predictors of death included univariate analysis and calculation of odds ratio (OR), ROC analysis with calculation of area under the ROC curve (AUROC).Results. The resulting mortality rate was 87% (107/123), 11% (14/107) of all deaths occurred after weaning from ECMO. High VV-ECMO flow, delayed initiation of mechanical ventilation and ECMO therapy, and low pH at the time of ECMO initiation were identified as independent predictors of death in the study group. Low median albumin concentration and prolonged use of vasopressors were identified as predictors of death within 28 days of initiation of VV-ECMO. Development of acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), septic shock and its recurrences, and the use of extracorporeal blood purification therapy for septic shock were found to be predictors of death during VV-ECMO therapy.Conclusion. High-flow VV-ECMO regimen, delayed initiation of mechanical ventilation and ECMO support, hypoalbuminemia, prolonged need for norepinephrine infusion, development of AKI requiring CRRT, septic shock occurrence and the number of its recurrences requiring extracorporeal blood purification therapy during VV-ECMO support were identified as predictors of death in patients with COVID-19-associated ARDS after initiation of VV-ECMO therapy.