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. 2021 Dec;112(6):1983-1989.
doi: 10.1016/j.athoracsur.2020.12.050. Epub 2021 Jan 21.

Mortality Risk Assessment in COVID-19 Venovenous Extracorporeal Membrane Oxygenation

Ali Tabatabai  1 , Mira H Ghneim  2 , David J Kaczorowski  3 , Aakash Shah  4 , Sagar Dave  5 , Daniel J Haase  6 , Roumen Vesselinov  7 , Kristopher B Deatrick  3 , Joseph Rabin  2 , Ronald P Rabinowitz  8 , Samuel Galvagno Jr  9 , James V O'Connor  2 , Jay Menaker  2 , Daniel L Herr  2 , James S Gammie  3 , Thomas M Scalea  2 , Ronson J Madathil  3
Affiliations

Mortality Risk Assessment in COVID-19 Venovenous Extracorporeal Membrane Oxygenation

Ali Tabatabai et al. Ann Thorac Surg. 2021 Dec.

Abstract

Background: A life-threatening complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS) refractory to conventional management. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) (VV-ECMO) is used to support patients with ARDS in whom conventional management fails. Scoring systems to predict mortality in VV-ECMO remain unvalidated in COVID-19 ARDS. This report describes a large single-center experience with VV-ECMO in COVID-19 and assesses the utility of standard risk calculators.

Methods: A retrospective review of a prospective database of all patients with COVID-19 who underwent VV-ECMO cannulation between March 15 and June 27, 2020 at a single academic center was performed. Demographic, clinical, and ECMO characteristics were collected. The primary outcome was in-hospital mortality; survivor and nonsurvivor cohorts were compared by using univariate and bivariate analyses.

Results: Forty patients who had COVID-19 and underwent ECMO were identified. Of the 33 patients (82.5%) in whom ECMO had been discontinued at the time of analysis, 18 patients (54.5%) survived to hospital discharge, and 15 (45.5%) died during ECMO. Nonsurvivors presented with a statistically significant higher Prediction of Survival on ECMO Therapy (PRESET)-Score (mean ± SD, 8.33 ± 0.8 vs 6.17 ± 1.8; P = .001). The PRESET score demonstrated accurate mortality prediction. All patients with a PRESET-Score of 6 or lowers survived, and a score of 7 or higher was associated with a dramatic increase in mortality.

Conclusions: These results suggest that favorable outcomes are possible in patients with COVID-19 who undergo ECMO at high-volume centers. This study demonstrated an association between the PRESET-Score and survival in patients with COVID-19 who underwent VV-ECMO. Standard risk calculators may aid in appropriate selection of patients with COVID-19 ARDS for ECMO.

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Figures

Figure 1
Figure 1
Number of bleeding complications in patients with COVID-19 treated with extracorporeal membrane oxygenation (ECMO). Total n = 40. Musculoskeletal bleeding included upper or lower extremity hematoma. Intraabdominal bleeding was retroperitoneal hematoma. Genitourinary bleeding was hematuria. Gastrointestinal included upper or lower gastrointestinal bleeding. Cardiac bleeding was a mediastinal hematoma. Pulmonary complications included hemothorax and tube thoracostomy site or tracheostomy site bleeding. Some patients had more than 1 episode or type of bleeding complication, and all occurrences were included in all relevant categories.
Figure 2
Figure 2
Prediction of Survival on ECMO Therapy Score (PRESET-Score) and mortality. Patients with a PRESET-Score of 2 (n = 1), 4 (n = 3), 5 (n = 1), and 6 (n = 4) had a 0% mortality. Patients with a PRESET-Score of 7 (n = 9) had a mortality of 33.3%. Patients with a PRESET-Score of 8 (n = 5) and 9 (n = 10) had a mortality of 80%. Overall mortality for patients with a PRESET-Score of 7 or higher was 62.5%. Nonsurvivors had a higher PRESET-Score (mean ± SD, 8.33 ± 0.8 vs 6.17 ± 1.8; P = .001).
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