Considering Extracorporeal Membrane Oxygenation for COVID-19-Associated ARDS

If another wave of coronavirus disease 2019 (COVID-19) occurs, the use of extracorporeal membrane oxygenation (ECMO) should be considered at an early stage in patients who develop acute respiratory distress syndrome (ARDS) despite the use of optimized conventional care, including prone positioning, according to the results of a study published in The Lancet Respiratory Medicine.  

Investigators sought to determine the clinical characteristics and outcomes in patients with respiratory failure and COVID-19 who are treated with ECMO. Therefore, they conducted a retrospective cohort study in 5 intensive care units (ICUs) that are part of the Paris-Sorbonne University Hospital Network. Possible patient outcomes over time were categorized into 4 states: state 1, on ECMO; state 2, in the ICU and weaned off ECMO; state 3, alive and out of the ICU; and state 4, death.

Between March 8, 2020, and May 2, 2020, a total of 492 patients with COVID-19 were treated in an ICU within the hospital network. Of the 492 patients, complete 60-day follow-up data were available for 83 individuals who received ECMO. The median patient age was 49 years (range, 41-56 years). Overall, 73% (61 of 83) of the participants were men.

Prior to receiving ECMO, 94% (78 of 83) of the patients had been prone positioned. In these individuals, the median driving pressure was 18 cm H₂O (range, 16-21 cm H₂O) and the median arterial partial pressure of oxygen/fraction of inspired oxygen (PaO₂/FiO₂) was 60 mm Hg (range, 54-68 mm Hg), with these values indicative of extreme ARDS severity.

At 60 days following the initiation of ECMO, the estimated probabilities of occupation in each state were as follows: state 1, 6% (95% CI, 3%-14%); state 2, 18%

(95% CI, 11%-28%); state 3, 45% (95% CI, 35%-56%); state 4, 31% (95% CI, 22%-42%). Overall, 42% (35 of 83) of the patients experienced major bleeding; 5% (4 of 83) of the participants had a hemorrhagic stroke. A total of 30 patients died.

The investigators concluded that longer follow-up of such patients is warranted to evaluate the potential physical, pulmonary, and psychological sequelae of COVID-19.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Schmidt M, Hajage D, Lebreton G, et al; for the Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université and the Paris-Sorbonne ECMO-COVID Investigators. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. Published online August 13, 2020. doi:10.1016/S2213-2600(20)30328-3