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Outcomes of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome due to COVID-19, lessons learned from the first wave of COVID 19
  • Cameron Blazoski,
  • Michael Baram,
  • Hitoshi Hirose
Cameron Blazoski
Thomas Jefferson University Hospital
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Michael Baram
Thomas Jefferson University Hospital
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Hitoshi Hirose
Thomas Jefferson University Hospital
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Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to COVID-19, but there has been little evidence of its efficacy. We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID-19. Methods: All adult patients who were placed on ECMO for ARDS due to COVID -19 between April 2020 and June 2020 (during the first wave of COVID-19) were identified. The clinical characteristics and outcomes of these patients were analyzed with a specific focus on the differences between patients who survived to hospital discharge and those who did not. Results: 20 COVID-19 patients were included in this study. All patients were placed on veno-veno ECMO. Comparing between survivors and non-survivors, older age was associated with hospital mortality (p=0.02). The following complications were observed: renal failure requiring renal replacement therapy (35%, n=7), bacteremia during ECMO (20%, n=4),coinfection with bacterial pneumonia (15%, n=3), cannula site bleeding (15%, n=3), stroke (10%, n=2), gastrointestinal bleeding (10%, n=2), and liver failure (5%, n=1). The complications associated with patient mortality were culture positive septic shock (p=0.01), culture-negative systemic inflammatory response syndrome (p=0.01), and renal failure (p=0.01). The causes of death were septic shock (44%, n=4), culture-negative systemic inflammatory response syndrome (44%, n=4), and stroke (11%, n=1). Conclusions: Based on our experience, ECMO can improve refractory ARDS due to COVID-19 in select patients. Proper control of bacterial infections during COVID-19 immunomodulation therapy may be critical to improving survival.

Peer review status:ACCEPTED

31 Dec 2020Submitted to Journal of Cardiac Surgery
02 Jan 2021Submission Checks Completed
02 Jan 2021Assigned to Editor
10 Jan 2021Review(s) Completed, Editorial Evaluation Pending
10 Jan 2021Editorial Decision: Revise Major
11 Jan 20211st Revision Received
11 Jan 2021Assigned to Editor
11 Jan 2021Submission Checks Completed
04 Feb 2021Review(s) Completed, Editorial Evaluation Pending
04 Feb 2021Editorial Decision: Revise Major
08 Feb 20212nd Revision Received
08 Feb 2021Submission Checks Completed
08 Feb 2021Assigned to Editor
08 Feb 2021Review(s) Completed, Editorial Evaluation Pending
20 Feb 2021Editorial Decision: Accept