Risk factors for mortality among patients with COVID-19 needing ECMO: Observational study including 24 patients supported in a high volume center with an ICU-based ECMO program

Background/Hypothesis: With COVID-19 infections rising globally, treatment options continue to evolve Extra-corporeal membrane oxygenation (ECMO) may be an effective supportive therapy for overwhelming COVID-19 infections-but it is not curative As the literature and experience with ECMO and COVID-19 therapies evolve, we hypothesize that outcomes will improve Methods: A review of 156 consecutive patients with confirmed COVID-19 who were treated with ECMO from a national registry was conducted between March 12 and July 28, 2020 from 27 institutions across the United States The patient demographics, COVID-19 therapies, and outcomes of the first 50 (F-50) patients were compared to the most recent 50 (R-50) Results: The F-50 were younger than R-50 (51 9+/-12 4 vs 46 9+/-12 5, p=0 01), but were similar with regards to gender, incidence of cancer, diabetes, heart disease, and asthma (p=NS) The F-50 were more likely to be treated with anti-malarials, but less likely with steroids The use of interlukin-6 antagonists, remdesivir, convalescent plasma, inhaled nitric oxide, and pre-ECMO prone positioning were similar between F-50 and R-50 Time from intubation to ECMO cannulation and duration of ECMO was also similar Hospital mortality (~48% for both) and survivors weaned from mechanical ventilation (52% vs 45%, p=NS) was also similar in both groups Conclusions: Despite growing experience, evolving literature, and therapeutic options, no significant improvement in survival and extubation has been observed in an early cohort of ECMO-COVID patients versus a later cohort This early observation illustrates the need for an aggressive focus on opportunities to improve outcomes