Venovenous extracorporeal membrane oxygenation for COVID-19 associated severe respiratory failure: Case series from a Hungarian tertiary centre.

Abstract

Venovenous extracorporeal membrane oxygenation (V-V ECMO) is recommended for the support of patients with severe COVID-19 associated severe respiratory failure (SRF). We report the characteristics and outcome of COVID-19 patients supported with V-V ECMO in a Hungarian centre. We retrospectively collected data on all patients admitted with proven SARS CoV-2 infection who received V-V ECMO support between March 2021 and May 2022. Eighteen patients were placed on ECMO during this period, (5 women, age (mean ± SD) 44 ± 10years, APACHE II score (median (interquartile range)) 12 (10-14.5)). Before ECMO support, they had been hospitalised for 6 (4-11)days. Fifteen patients received noninvasive ventilation for 4 (2-8)days, two patients had high flow nasal oxygen therapy, for one day each. They had already been intubated for 2.5 (1-6)days. Prone position was applied in 15 cases. On the day before ECMO initiation the Lung Injury Score was 3.25 (3-3.26), the PaO2/FiO2 ratio was 71 ± 19mmHg. The duration of V-V ECMO support was 26 ± 20days, and the longest run lasted 70days. Patients were mechanically ventilated for 34 ± 23days. The intensive care unit (ICU) and the hospital length of stay were 40 ± 28days and 45 ± 31days, respectively. Eleven patients were successfully weaned from ECMO. The ICU survival rate was 56%, the in-hospital survival was 50%. All patients who were discharged from hospital reported a good health-related quality of life Rankin score (0-2) at the 5-16months follow-up. During the last three waves of the COVID-19 pandemic, we achieved a 56% ICU and a 50% hospital survival rate at our low volume centre.