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. 2024 Jan 8;24(1):19.
doi: 10.1186/s12890-023-02836-3.

Potential for recovery after extremely prolonged VV-ECMO support in well-selected severe COVID-19 patients: a retrospective cohort study

Jean-Marc de Walque  1   2 , Christophe de Terwangne  1 , Raphaël Jungers  3 , Sophie Pierard  1   4 , Christophe Beauloye  1   4 , Fatima Laarbaui  1 , Melanie Dechamps #  1   4 , Luc Marie Jacquet #  5   6
Affiliations

Potential for recovery after extremely prolonged VV-ECMO support in well-selected severe COVID-19 patients: a retrospective cohort study

Jean-Marc de Walque et al. BMC Pulm Med. .

Abstract

Background: VenoVenous ExtraCorporeal Membrane Oxygenation (VV-ECMO) has been widely used as supportive therapy for severe respiratory failure related to Acute Respiratory Distress Syndrome (ARDS) due to coronavirus 2019 (COVID-19). Only a few data describe the maximum time under VV-ECMO during which pulmonary recovery remains possible. The main objective of this study is to describe the outcomes of prolonged VV-ECMO in patients with COVID-19-related ARDS.

Methods: This retrospective study was conducted at a tertiary ECMO center in Brussels, Belgium, between March 2020 and April 2022. All adult patients with ARDS due to COVID-19 who were managed with ECMO therapy for more than 50 days as a bridge to recovery were included.

Results: Fourteen patients met the inclusion criteria. The mean duration of VV-ECMO was 87 ± 29 days. Ten (71%) patients were discharged alive from the hospital. The 90-day survival was 86%, and the one-year survival was 71%. The evolution of the patients was characterized by very impaired pulmonary compliance that started to improve slowly and progressively on day 53 (± 25) after the start of ECMO. Of note, four patients improved substantially after a second course of steroids.

Conclusions: There is potential for recovery in patients with very severe ARDS due to COVID-19 supported by VV-ECMO for up to 151 days.

Keywords: Acute respiratory distress syndrome (ARDS); COVID-19; COVID-19 related ARDS; Extracorporeal membrane oxygenation ( ECMO); Prolonged ECMO.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Timeline describing main steps of patients’ hospital stay and their respective durations. Values are means with standard deviations. Abbreviations: ECMO: Extra Corporeal Life Support, FdO2: fraction delivered oxygen (in ECMO sweep gas), ICU: Intensive care unit, MV: Mechanical Ventilation
Fig. 2
Fig. 2
Evolution of tidal Volume (Vt) and Fraction of Delivered Oxygen (FD02) during the VV-ECMO course. Illustrates the significant decrease in Vt promptly after ECMO initiation, followed by a gradual but persistent improvement over weeks, accompanied by a decline in FDO2 requirement. Abbreviations: Vt: Tidal Volume, FD02: Fraction of Delivered Oxygen in ECMO sweep gas. The blue curves represent the mean Vt over time (left y-axis), while the red curve represents the mean FDO2 over time (right y-axis)
Fig. 3
Fig. 3
Tidal volume (Vt) evolution in four patients treated with a second course of steroids. The blue curves represent the mean Vt over time (left y-axis), while the red curve represents the mean FDO2 over time (right y-axis). Arrows represent the start of the second course of steroids. Abbreviations: Vt: Tidal Volume. FD02: Fraction of Delivered Oxygen in ECMO sweep gas
See this image and copyright information in PMC

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