Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in COVID-19: Experience with 32 patients

As COVID-19 cases surge worldwide, an urgent need exists to enhance our understanding of the role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with COVID-19 who develop acute respiratory and cardiac compromise refractory to conventional therapy. The purpose of this manuscript is to review our initial clinical experience in 32 patients with confirmed COVID-19 treated with ECMO.

A multi-institutional registry and database was created and utilized to assess all patients who were supported with ECMO provided by SpecialtyCare. Data captured included patient characteristics, pre-COVID-19 risk factors and comorbidities, confirmation of COVID-19 diagnosis, features of ECMO support, specific medications utilized to treat COVID-19, and short-term outcomes through hospital discharge. This analysis includes all of our patients with COVID-19 supported with ECMO, with an analytic window starting March 17, 2020 when our first COVID-19 patient was placed on ECMO, and ending April 9, 2020.

During the 24 days of this study, 32 consecutive patients with COVID-19 were placed on ECMO at 9 different hospitals. As of the time of analysis, 17 remain on ECMO, 10 died prior to or shortly after decannulation, and 5 are alive and extubated after removal from ECMO, with one of these 5 discharged from the hospital. Adjunctive medication in the surviving patients while on ECMO was as follows: 4 of 5 survivors received intravenous steroids, 3 of 5 survivors received antiviral medications (Remdesivir), 2 of 5 survivors were treated with anti-interleukin-6-receptor monoclonal antibodies (Tocilizumab or Sarilumab), and 1 of 5 survivors received hydroxychloroquine.

An analysis of 32 COVID-19 patients with severe pulmonary compromise supported with ECMO suggests that ECMO may play a useful role in salvaging select critically ill patients with COVID-19. Additional patient experience and associated clinical and laboratory data must be obtained to further define the optimal role of ECMO in patients with COVID-19 and ARDS. These initial data may provide useful information to help define the best strategies to care for these challenging patients, and may also provide a framework for much-needed future research about the use of ECMO to treat patients with COVID-19.