Infectious Disease

Venovenous ECMO for severe COVID-19 led to ‘exceptional early survival’ that was sustained

March 10, 2022

2 min read

Source/Disclosures

Disclosures:
Smith reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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Patients with severe COVID-19 who received venovenous extracorporeal membrane oxygenation support had “exceptional early survival” to discharge that was sustained 1 year after cannulation, researchers reported in Annals of Thoracic Surgery.

“[With] appropriately selected patients and aggressive management strategies, the use of ECMO support in patients with severe COVID-19 can result in exceptional early survival that, in this cohort, was sustained 1 year after ECMO cannulation,” Deane E Smith, MD, cardiac surgeon in the department of cardiothoracic surgery, director of the ECMO program, co-director of the thoracic aortic disease management program and associate director of heart transplant and mechanical circulatory support at NYU Langone Health, and colleagues wrote.

Source: Adobe Stock.

Smith and colleagues conducted a single-institution, retrospective review of 30 patients (median age, 42 years; 87% men) with severe COVID-19 who were cannulated for venovenous ECMO from March to May 2020 at NYU Langone Health. A multidisciplinary ECMO team evaluated, selected and managed all patients who received ECMO support.

“When we started using ECMO in this patient cohort, very little was known about what that would look like,” Smith told Healio. “We aimed to provide follow-up for this group of patients who were cared for early on in the COVID-19 pandemic, in terms of how many patients survived to discharge. We were able to follow the patients to 1 year.”

Dean E Smith, MD

The primary outcome of the study was survival to discharge. The researchers also reported 1-year follow-up data.

Twenty-eight patients (93.3%) survived venovenous ECMO. Twenty-seven patients (90%) survived to discharge, according to the results. The cause of death in the patient who died before discharge was progressive liver failure complicated by gastrointestinal bleeding. Median length of hospitalization was 45 days and median length of ICU stay was 40 days. Median duration of venovenous support was 19 days.

Nearly all patients were discharged to home or to acute rehabilitation on room air; one patient required supplemental oxygen therapy.

Survival was 86.7% at a median follow-up of 10.8 months after ECMO cannulation, including one patient who underwent lung transplantation, the researchers reported.

Forty-four percent of patients discharged from the hospital had pulmonary function testing data available. Median FEV1 percent predicted was 100%. Fifty-nine percent of survivors completed a 6-minute walk test and had a median walk distance of 350 m.

The researchers noted several limitations of the study, including its retrospective, observational design, selection bias and lack of patients randomized to ECMO vs. medical therapy.

Research into outcomes after venovenous ECMO support in patients with severe COVID-19 will continue.

“A question to still be answered is: What is the tipping point for any one particular patient whereby their likelihood of a better outcome from earlier use of ECMO, where’s that inflection point?” Smith said. “Another question that needs to be answered is: Who was really not a good candidate for ECMO? Or where does offering ECMO support not make sense, given that it’s a limited resource and time-intensive?”

For more information:

Deane E Smith, MD, can be reached at deane.smith@nyulangone.org.

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