Six-Month Outcomes after Extracorporeal Membrane Oxygenation Therapy for Severe COVID-19-Related Pulmonary Failure

Background: Little is known on the impact of COVID-19-associated intensive care medical therapy including extracorporeal life support/membrane oxygenation (ECMO) on the long-term well-being of survivors. The aim of this study is to comprehensively characterize recovery six months after ECMO treatment for COVID-19-associated pulmonary failure.

Method: All patients requiring veno-venous or veno-arterial ECMO for COVID-19-associated respiratory and/or circulatory failure between April 2020 and September 2021 were included in this retrospective analysis. Parameters included age, gender, time of ECMO treatment, and survival at hospital discharge and 6 months post-ECMO initiation. Comprehensive follow-up covering cardiopulmonary, neurocognitive, psychological, and functional status, as well as the health-related quality of life was assessed in discharged survivors.

Results: Sixty patients (median age: 60.5 [51.0–65.0] years, range: 20–72 years, 23.3% female) were treated with veno-venous or veno-arterial ECMO for severe COVID-19-related pulmonary failure with or without associated circulatory failure. 41.7% (n = 25) were successfully weaned off ECMO after 24.0 (17.5–32.5, range: 10–65) days, and 40.0% (n = 24) survived to hospital discharge. At 6 months post ECMO initiation, 20 patients were alive (33.3% of all patients, 83.3% survival conditioned on survival to discharge). Of these, 19 underwent comprehensive follow-up after 6.0 (5.0–9.0) months (133 months of cumulative follow-up time). 57.9% showed no relevant or only mild deficits, while 26.3% showed moderate, and 15.8% severe deficits. Cardiopulmonary status (mMRC level: 2.0 [1.0–2.0], 84.2% ≤ 2, NYHA level 2.0 [2.0–3.0], no patient in need of home oxygen) and level of independence (73.7% with no or mild disability and independent in daily life) were satisfactory. The rate of cognitive impairments was substantial (52.6%). In 21.1%, minimal or slight depression was observed, in 26.3% moderate depression, and 15.8% showed signs of post-traumatic stress disorder. Altogether, marked impacts on social and work life were observed.

Conclusion: ECMO can serve as a salvage therapy for patients with severest COVID-19-related pulmonary failure, but the total burden of deficits six months after ECMO initiation is substantial with effects on social life and work status. The focus of our efforts thus needs to shift from solely acute survival to meaningful long-term recovery.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 January 2023