Characteristics And Outcomes Of Patients With Covid-19 With Respiratory Failure Requiring Extracorporeal Membrane Oxygenation

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: The novel coronavirus (SARS-CoV-2) has become a global pandemic, with many suffering from resultant severe acute respiratory distress syndrome (ARDS). Initiation of veno-venous extracorporeal membrane oxygenation (ECMO) support, which can restore gas exchange, has been used in patients with refractory ARDS, and is now being trialed in select patients with SARS-CoV-2 infection. However, use of ECMO in ARDS remains controversial, and both its usage and data are limited in SARS-CoV-2 infection. We describe consecutive patients who received ECMO support for refractory COVID-19-related ARDS in our facility. METHODS: We performed a retrospective cohort analysis of the first fourteen COVID-19 patients admitted to Yale New Haven Hospital who required ECMO support between April 6 and May 23, 2020. RESULTS: All 14 subjects were male; median age 50 (range 32-61) years; median BMI 37 (IQR 32-41) kg/m2; the most common ethnicity Hispanic (79%); and most prevalent comorbidities included diabetes and hypertension (36% each). The majority of patients received a trial of prone positioning and neuromuscular blockade (100%), pulmonary vasodilators (71%), and Tocilizumab (93%) prior to initiation of ECMO (Table 1). Patients had higher levels of positive end-expiratory (median 16 cmH2O) and plateau (median 36 cmH2O) pressures, with P/F ratio consistent with severe ARDS category (median 75) at the time of cannulation (Table 2). Bleeding requiring transfusion (86%) and sepsis excluding pneumonia (29%) were the most common complications while on ECMO. Six patients (43%) were successfully de-cannulated, of which two patients were discharged from the hospital. Four patients have died (29%) and another four (29%) continue to receive ECMO support (Table 3). CONCLUSIONS: COVID-19 patients with severe ARDS refractory to invasive mechanical ventilator support, prone positioning, and neuromuscular blockade have significant mortality with limited therapeutic options . Although use of ECMO in such patients has been debated, our experience suggests otherwise. Successful decannulation (43%), mortality (40%), and complications are in keeping with those of all-cause pulmonary failure requiring ECMO support in global registries. CLINICAL IMPLICATIONS: Veno-venous extracorporeal membrane oxygenation should be considered a feasible therapeutic option in restoring gas exchange in COVID-19-related ARDS once standard methods of mechanical ventilation, proning, and paralysis have proven insufficient. DISCLOSURES: No relevant relationships by Pramod Bonde, source=Web Response No relevant relationships by Astha Chichra, source=Web Response Owner/Founder relationship with Vent Multiplexor Please note: $1-$1000 Added 06/01/2020 by Elaine Fajardo, source=Web Response, value=Equity Owner/Founder relationship with prevents Please note: $1-$1000 Added 06/01/2020 by Elaine Fajardo, source=Web Response, value=Intellectual property rights No relevant relationships by Jan Fouad, source=Web Response No relevant relationships by Arnar Geirsson, source=Web Response No relevant relationships by Phillip Joseph, source=Web Response No relevant relationships by Akhil Khosla, source=Web Response No relevant relationships by Andres Oswaldo Razo-Vazquez, source=Web Response No relevant relationships by Jonathan Siner, source=Web Response No relevant relationships by Inderjit Singh, source=Web Response No relevant relationships by Christopher Szabo, source=Web Response No relevant relationships by Hossam Tantawy, source=Web Response