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Outcomes of Extracorporeal Membrane Oxygenation in Influenza vs. COVID-19 During 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

Purpose: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as COVID-19). We conducted this study to compare the outcomes of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19. Materials and Methods: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV -ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed. Results: 28 COVID-19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p=0.04). 30-day survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p=0.13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 days vs. 12 days, p=0.025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy prior to ECMO initiation (p<0.001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%, p=0.03) and bacterial pneumonia (36% vs 6%, p=0.024). Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.

Peer review status:UNDER REVIEW

24 May 2021Submitted to Journal of Cardiac Surgery
25 May 2021Submission Checks Completed
25 May 2021Assigned to Editor
27 May 2021Review(s) Completed, Editorial Evaluation Pending
29 May 2021Editorial Decision: Revise Minor
04 Jun 20211st Revision Received
08 Jun 2021Submission Checks Completed
08 Jun 2021Assigned to Editor
12 Jun 2021Review(s) Completed, Editorial Evaluation Pending