Extracorporeal membrane oxygenation in COVID-19 compared to other etiologies of acute respiratory failure: A single-center experience.
Hamid Yaqoob, Daniel Greenberg, Lawrence Huang and 12 others
PMID 36274533WHAT IT FOUND
Survival to hospital discharge was 33% in COVID ECMO and 50% in non-COVID ECMO, and did not differ significantly.
COVID patients more often had ECMO longer than 30 days (69% vs 17%).
Key findings
01Survival to hospital discharge was 33% in the COVID ECMO group and 50% in the non-COVID ECMO group, and the difference was not statistically significant.
02ECMO lasting more than 30 days was significantly more common in the COVID ECMO group: 69% vs 17%.
03Median ICU length of stay was significantly greater in the COVID ECMO group: 43.0 days vs 20.5 days.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective, single-center, and included only 36 COVID ECMO patients and 18 non-COVID ECMO patients. The groups were treated in non-overlapping time periods, and pre-ECMO care differed: prone positioning was used in 39% of COVID patients and 0% of non-COVID patients, and neuromuscular blocking agents were used in 81% of COVID patients and 44% of non-COVID patients. ECMO eligibility and cannulation strategy were not protocolized, and cannulation sites differed between groups, with femoral-femoral cannulation in 28% of non-COVID patients and 3% of COVID patients. Many patients were transferred from outside hospitals, so some early clinical course data could not be ascertained. The non-COVID group included 2 patients with ARDS due to trauma, which may not be comparable to COVID ARDS. Thromboembolism was not systematically screened, so its rate was not reported. The primary survival comparison used an unadjusted model because of the small number of patients.
Declared interests
No relevant competing interests were disclosed.
The easy way to misread this
Do not read the 33% versus 50% survival figures as proof that ECMO is less effective in COVID patients. The primary outcome did not reach statistical significance, and the two groups were treated in different time periods with different pre-ECMO management.