Infectious Disease

Mortality with ECMO higher in the second wave of patients with COVID-19

October 17, 2021

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ReddyR, et al. COVID Induced ARDS Abstract Poster 1. Presented at: CHEST Annual Meeting; October 17-20, 2021 (virtual meeting).

Disclosure:
Reddy does not report any relevant financial information.

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Mortality from extracorporeal membrane oxygenation was higher in the second wave of patients with COVID-19 despite improvements in treatment prior to the start of ECMO, according to data presented at the CHEST annual meeting.

“ECMO, which has been used as rescue therapy in previous virus outbreaks, has been used to support certain patients with refractory acute respiratory distress syndrome from COVID-19, but evidence of its effectiveness is limited,” Rohit Reddy, BS, second-year medical student at Thomas Jefferson University Hospital in Philadelphia said during a virtual presentation of the data. “Respiratory failure remained a very worrying complication in the second wave of the COVID-19 pandemic, but it is unclear how the evolution of the disease and pharmacological therapy have affected the clinical benefits of ECMO.”

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The researchers identified 41 adults with ARDS due to COVID-19 who required a venovene ECMO at Thomas Jefferson University Hospital from April 2020 to March 2021. During the COVID-19 pandemic, the patients were categorized according to “wave”: patients of the first wave (n = 28; median age 52 years; 68% men) started with ECMO from April to September 2020 and patients of the second wave (n = 13; median age 45 years; 69% men) started with ECMO from November 2020 to March 2021.

The median ECMO duration was a total of 16 days; Patients in the first wave had a median duration of 14 days and those in the second wave had a median duration of 20 days (P = 0.72).

The researchers reported no significant differences in vital signs or comorbidities prior to ECMO between patients in the first and second waves.

Patients treated during the second wave were more likely to receive pre-ECMO immunomodulators, including steroids (100% vs. 54%; P = 0.003) and remdesivir (Veklury, Gilead Sciences; 85% vs. 39%; P = 0.007 .). ) compared to those treated in the first wave. Patients in the second wave were also more likely to be placed in the prone position prior to ECMO (85% vs. 11%; p <0.001).

The survival rate was 67% in the patients treated in the second wave compared to 31% in the patients treated in the first wave (P = .03). The 30-day survival rates were not significantly different between the groups. The results found that sepsis and lung recovery failure were the leading causes of death with ECMO.

Compared to the first wave, patients treated in the second wave had higher complication rates. The most common complications were bleeding (n = 25) and new infections (n ​​= 22). The researchers found no centrifugal pump thrombosis in these patients.

“Controlling the infection for the patient with COVID-19 while on immunomodulation therapy is challenging, but necessary to improve outcomes,” Reddy said. “More research is needed to develop more stringent inclusion and exclusion criteria and improve management prior to ECMO to improve results.”

Data from the third wave, which represents the delta variant, were not included in this study, according to the researchers.

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CHEST annual meeting

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