Outcomes of Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Acute Respiratory Failure: An Analysis of US Academic Centers
Perisa Ruhi-Williams*2, Jeffry Nahmias2, Fabio Sagebin2, Reza Fazl Alizadeh2, Kishore Gadde2, Alpesh Amin1, Ninh T. Nguyen2
1Medicine, University of California Irvine Medical Center, Orange, CA; 2Surgery, University of California Irvine Medical Center, Orange, CA
Objective: V-V ECMO has been utilized for COVID-19 patients with acute respiratory failure since the beginning of the pandemic. Survival for ECMO in COVID-19 compared to ECMO support for non-COVID acute respiratory failure is unknown. We aimed to compare the characteristics and outcomes of venovenous (V-V) extracorporeal membrane oxygenation (ECMO) for acute respiratory failure from COVID-19 versus non-COVID causes during the same period.
Methods: This retrospective cohort study compared characteristics and outcomes of patients who underwent V-V ECMO for COVID-19 versus non-COVID acute respiratory failure between 3/2020 and 9/2022 at Vizient participating US academic centers. The primary outcome was in-hospital mortality. Secondary outcome measures included length of stay and direct hospitalization cost.
Results: Of the 6,720 patients who underwent ECMO for COVID, 5,976 (89.0%) had V-V ECMO. Of the 17,413 patients who underwent ECMO for non-COVID causes during the same period, 5,895 (33.9%) had V-V ECMO. Compared to ECMO for non-COVID, ECMO for COVID had a higher proportion of male (67.8% vs 62.2%, P<0.01); lower proportion of Caucasians (52.9% vs. 61.4%, P<0.01) and African Americans (15.5%, vs. 19.2%, P<0.01); and less patients ≥65 year-old (3.4% vs 18.6%, P<0.01). Compared to patients who underwent ECMO for non-COVID causes, patients who underwent ECMO for COVID had increased in-hospital mortality (47.6% vs 34.4%, P<0.01), mean length of stay (46.4 ± 39.6 vs. 41.6 ± 47.0 days, P<0.01), direct hospitalization cost ($206,859 ± 200,784 vs. $202,983 ± 212,503, P<0.01), and rate of discharge to a facility for further care (86.3% vs 68.4%, P<0.01). Notably, hospital mortality for V-V ECMO for COVID-19 improved (50.6% in 2020, 48.4% in 2021, and 37.0% in 2022) between 2020-2022. However, the in-hospital mortality after ECMO for COVID-19 was consistently higher than that for non-COVID acute respiratory failure across all different patient ages, gender, and race (Table).
Conclusions: In this nationwide analysis of critically ill acute respiratory failure patients requiring ECMO support, there was increased mortality, length of stay and cost for patients who underwent V-V ECMO for COVID-19 compared to non-COVID etiologies.
ECMO in-hospital mortality for Covid ARF vs. Non-covid ARF
| ECMO in-hospital mortality for COVID ARF N=5976 | ECMO in-hospital mortality for Non-COVID ARF n=5895 | P Value | |
| Age group | |||
| ≤30 yrs | 29.6% | 27.7% | <0.01 |
| 31-50 yrs | 43.9% | 25.6% | <0.01 |
| 51-64 yrs | 58.7% | 36.6% | <0.01 |
| ≥65 yrs | 70.2% | 45.4% | <0.01 |
| Gender group | |||
| Male | 51.1% | 35.3% | <0.01 |
| Female | 40.4% | 32.9% | <0.01 |
| Race group | |||
| Caucasian | 47.0% | 33.1% | <0.01 |
| Black | 47.7% | 33.3% | <0.01 |
| Hispanic | 46.4% | 31.3% | <0.01 |
ARF: acute respiratory failure
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