Introduction: The onset of COVID-19 pandemic overwhelmed hospital resources with a high admission rate to critical care units. In patients experiencing progressive respiratory failure despite conventional therapies such as mechanical ventilation and prone positioning, venovenous extracorporeal membrane oxygenation (VV-ECMO) offered the only hope for survival. The VV-ECMO duration for COVID-19 is often described as longer than other respiratory illnesses. The outcome of these cases varies from country to country. As the literature available on the outcome of prolonged ECMO in an Indian setting is sparse, we planned to study the same.
Methods: This retrospective study included all adult patients who had undergone VV-ECMO of more than 30 days for COVID-19 illness at Medica Medica Superspecialty Hospital, Kolkata, West Bengal, India between 1 April 2020 and 31 March 2022. Patients who were still in the hospital at the end of the study period were excluded from the study. Data on total ECMO days, in-hospital mortality, age, sex, BMI, symptom onset to ECMO duration, intubation to ECMO duration, mechanical complications such as oxygenator failure or pump failure, patient complications such as major hemorrhage, ischemic stroke, liver/renal dysfunction, thrombocytopenia, culture-proven infection and use of prone position ventilation were collected from an electronic database. Patients who were discharged from the hospital were followed up at 6 months. The data were analyzed using the statistical package for the social sciences (SPSS) software, version 26 (IBM, Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation (SD) and evaluated using Student's t-test. Categorical data were expressed as frequency (in %) and evaluated using the Chi-square test or Fischer's exact t-test as applicable.
Observation: Twenty patients who had prolonged ECMO (>30 days) were found eligible for the study. The average ECMO days and in-hospital mortality were 54.75 ± 33.14 and 60%, respectively. An early decision to ECMO after symptom onset and prone positioning during ECMO were factors associated with a favorable outcome. The requirement of renal replacement therapy (RRT) for renal failure was a poor prognostic factor.
Conclusion: Prolonged ECMO for COVID-19 poses many challenges in terms of thrombotic and bleeding complications, major organ dysfunction, and high mortality. However, this remains the only survival hope for sick COVID-19 acute respiratory distress syndrome (ARDS) patients.
Biancari F, Mariscalco G, Dalén M, et al. Six-month survival after extracorporeal membrane oxygenation for severe COVID-19. J Cardiothorac Vasc Anesth 2021;35(7):1999–2006. DOI: 10.1053/j.jvca.2021.01.027.
Macedo A, Gonçalves N, Febra C. COVID-19 fatality rates in hospitalized patients: Systematic review and meta-analysis. Ann Epidemiol 2021;57:14–21. DOI: 10.1016/j.annepidem.2021.02.012.
Barbaro RP, MacLaren G, Boonstra PS, et al. Extracorporeal membrane oxygenation for COVID-19: Evolving outcomes from the international extracorporeal life support organization registry. Lancet 2021;398(10307):1230–1238. DOI: 10.1016/S0140-6736(21)01960-7.
Ling RR, Ramanathan K, Sim JJL, et al. Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: A systematic review and meta-analysis. Crit Care 2022;26(1):147. DOI: 10.1186/s13054-022-04011-2.
Ramanathan K, Shekar K, Ling RR, et al. Extracorporeal membrane oxygenation for COVID-19: A systematic review and meta-analysis. Crit Care 2021;25(1):211. DOI: 10.1186/s13054-021-03634-1.
Kurihara C, Manerikar A, Gao CA, et al. Outcomes after extracorporeal membrane oxygenation support in COVID-19 and non-COVID-19 patients. Artif Organs 2022;46(4):688–696. DOI: 10.1111/aor.14090.
Schmidt M, Hajage D, Lebreton G, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study. Lancet Respir Med 2020;8(11):1121–1131. DOI: 10.1016/S2213-2600(20)30328-3.
Shih E, DiMaio JM, Squiers JJ, et al. Extracorporeal membrane oxygenation for respiratory failure in phases of COVID-19 variants. J Card Surg 2022;37(10):2972–2979. DOI: 10.1111/jocs.16563.
Nesseler N, Fadel G, Mansour A, et al. Extracorporeal membrane oxygenation for respiratory failure related to COVID-19: A nationwide cohort study. Anesthesiology 2022;136(5):732–748. DOI: 10.1097/ALN.0000000000004168.
Urner M, Barnett AG, Bassi GL, et al. Venovenous extracorporeal membrane oxygenation in patients with acute COVID-19 associated respiratory failure: Comparative effectiveness study. BMJ 2022;377:e068723. DOI: 10.1136/bmj-2021-068723.
Whebell S, Zhang J, Lewis R, et al. Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: A multi-centre-matched cohort study. Intensive Care Med 2022;48(4):467–478. DOI: 10.1007/s00134-022-06645-w.
Dreier E, Malfertheiner MV, Dienemann T, et al. ECMO in COVID-19-prolonged therapy needed? A retrospective analysis of outcome and prognostic factors. Perfusion 2021;36(6):582–591.
Shaefi S, Brenner SK, Gupta S, et al. Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19. Intensive Care Med 2021;47(2):208–221. DOI: 10.1007/s00134-020-06331-9.
Daviet F, Guilloux P, Hraiech S, et al. Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: Results from an ambispective observational cohort. Ann Intensive Care 2021;11(1):157. DOI: 10.1186/s13613-021-00943-0.
Vigneshwar NG, Masood MF, Vasic I, et al. Venovenous extracorporeal membrane oxygenation support in patients with COVID-19 respiratory failure: A multicenter study. JTCVS Open 2022;12:211–220. DOI: 10.1016/j.xjon.2022.08.007.
Davido B, Seang S, Tubiana R, et al. Post-COVID-19 chronic symptoms: A postinfectious entity? Clin Microbiol Infect 2020;26(11):1448–1449. DOI: 10.1016/j.cmi.2020.07.028.
Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: A cohort study. Lancet 2021;397(10270):220–232. DOI: 10.1016/S0140-6736(20)32656-8.