Outcome of acute respiratory distress syndrome requiring extracorporeal membrane oxygenation in Covid-19 or influenza: A single-center registry study

Abstract

Veno-venous extracorporeal membrane oxygenation (V-V ECMO) is used to sustain blood oxygenation and decarboxylation in severe acute respiratory distress syndrome (ARDS). It is under debate if V-V ECMO is as appropriate for coronavirus disease 2019 (Covid-19) ARDS as it is for influenza. In this retrospective study, we analyzed all patients with confirmed SARS-CoV-2 or influenza A/B infection, ARDS and V-V ECMO, treated at our medical intensive care unit (ICU) between October 2010 and June 2020. Baseline and procedural characteristics as well as survival 30 days after ECMO cannulation were analyzed. A total of 62 V-V ECMO patients were included (15 with Covid-19 and 47 with influenza). Both groups had similar baseline characteristics at cannulation. Thirty days after ECMO cannulation, 13.3% of all patients with Covid-19 were discharged alive from our ICU compared to 44.7% with influenza (P = .03). Patients with Covid-19 had fewer ECMO-free days (0 (0-9.7) days vs. 13.2 (0-22.1) days; P = .05). Cumulative incidences of 30-day-survival showed no significant differences (48.6% in Covid-19 patients, 63.7% in influenza patients; P = .23). ICU treatment duration was significantly longer in ARDS patients with V-V ECMO for Covid-19 compared to influenza. Thirty-day mortality was higher in Covid-19, but not significant.

Keywords: acute respiratory distress syndrome; coronavirus disease 2019; extracorporeal membrane oxygenation; influenza; severe acute respiratory syndrome coronavirus 2.

FIGURE 1

Baseline and procedural characteristics at V‐V ECMO cannulation and outcome in Covid‐19 and influenza patients with acute respiratory failure. (A) Shows baseline and procedural characteristics (median + IQR), (B) outcome data (median + IQR or fraction of patients) [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Cumulative incidence of mortality at 30 days in Covid‐19 and influenza patients with V‐V ECMO. Influenza: 36.34%; Covid‐19:51.38%; P = .234 [Color figure can be viewed at wileyonlinelibrary.com]