Early Veno-Venous Extracorporeal Membrane Oxygenation after Intubation Increases Outcome in Critically Ill COVID-19 Patients

Background: Since March 2020, COVID-19 pandemic has tremendously challenged the global health care system. In patients with severe therapy-refractory acute respiratory distress syndrome (ARDS), veno-venous extracorporeal membrane oxygenation (vv-ECMO) remains the ultimo ratio therapy; however, the outcome is still not satisfying. Prolonged mechanically ventilation of ARDS patients, especially with high driving pressure, may further damage the lung and contributes to impaired outcome.

Method: Between 2020 and 2022, a total of 82 patients were treated with vv-ECMO for severe COVID-19-related ARDS in our department. The patients were prospectively enrolled into an institutional database and subsequent retrospectively reviewed. Patients were divided Patients were divided in regard to the duration of pre-ECMO mechanically ventilation (Group 1 [≤2 days]: n = 40; Group 2 [>2 days]: n = 36). The remaining n = 6 patients were excluded due to awake ECMO implantation.

Results: Except gender (Group 1: 22.5% female, Group 2: 58.3% female, p < 0.01), baseline characteristics such as demographic data and concomitant diseases were comparable between the two groups. The mean duration between the onset of the first COVID-19 related symptoms and ECMO implantation was 14 ± 7 days and between intubation and ECMO implantation 0.8 ± 0.8 days for Group 1 compared with 18 ± 7 days (p = 0.04), respectively, 7.6 ± 4.3 days (p < 0.001) for Group 2. We did not observed differences regarding the incidence of severe ECMO-related adverse events in regard to the pre-ECMO mechanical ventilation time. However, successful ECMO weaning rate was numerically increased in Group 1 (42.5%) compared with Group 2 (25.0%, p = 0.15) with shorter support time until weaning (Group 1: 16 ± 13 days, Group 2: 44 ± 44 days, p = 0.08). A similar trend was also found for in-hospital death (Group 1: 60.0%, Group 2: 77.8%, p = 0.08).

Conclusion: Early ECMO implantation after orotracheal intubation for severe COVID-19-related ARDS did not affect the peri-interventional morbidity. However, we observed a numerically increased weaning rate as well as increased survival in patients with early ECMO implantation after intubation. As lung-protective ventilation can be achieved by early ECMO implantation in COVID-19 patients, it potentially decreases the ventilator-associated lung damage.

Publication History

Article published online:
28 January 2023