Background: Growing reports argue the value of extracorporeal membrane oxygenation (ECMO) support on COVID-19 survival. The earliest studies reported ridiculously high mortality in small cohorts. International medical organizations still recommended, early in the pandemic, that ECMO should be considered if conventional treatment was not successful.
Aim of the study: To evaluate the impact of add-on ECMO on the outcome of critically ill COVID-19 patients.
Patients and methods: An observational study recruited critically ill COVID-19 patients necessitating ECMO support during their stay in governmental hospitals of Kuwait from March 2020 to December 2021. Socio-demographic characters, clinical-laboratory parameters (days of mechanical ventilation before ECMO, routine investigations, LDH, ferritin, D-dimer, arterial blood gases & and reporting any positive cultures; sputum, blood &/or others), chest radiological findings, and different lines of management (steroids, antivirals, antibiotics, biological therapy and anticoagulants) were recorded. Moreover, various complications and acute events during ECMO were reported in addition to the outcome.
Results: Most of the patients (n=135) were males (61.48%), and non-smokers (80%) in their middle age (41.28±9.88 years). DM was the most prevalent comorbidity (24%). The survival rate was 58.5%. Non-survivors were older (43.6± 8.7 vs. 38.92 ±8.75 years, p=0.01), predominantly males (p=0.046), had higher mean platelet volume (21.78±7.55 vs. 13.47±8.19, p=0.02), median D-dimer (4312±2146 vs. 2795±1545, p=0.04) and mean CO2 (65.1±25.69 vs. 52.45±24.05, p=0.01). Most of the non-survivors (56.9%) had computed tomography (CT) chest findings consistent with COVID-19 (vs. 35.7% among COVID-19 unmatched CT, p=0.028). Moreover, non-survivors were more likely to be shocked and supported with vasopressors (50 out of 56 patients) or developed AKI while on ECMO (44 out of 56 patients) (p <0.001, 0.012 respectively). Most patients who were managed by biological agents survived compared to those who did not receive it (75% vs. 49.5% respectively, p=0.038). We found a significant positive correlation between ECMO duration, age (p=0.012), and LDH (p=0.041); a significant positive correlation between LDH and ICU stay (p<0.001); a significant positive correlation between D-dimer, CRP (p=0.006) and PaC02 (p=0.015). We found that post-discharge ventilatory support among survivors was needed in 48.1% and 11.4% (as O2 supplementation or CPAP, respectively).
Conclusion: Earlier ECMO should be considered for critically ill COVID-19 patients who develop refractory respiratory failure despite standard care.