Relationships Among Select Comorbidities, Duration of Mechanical Ventilation, Treatment Modalities, and Patient Survival in Patients with COVID-19 who Require Extracorporeal Membrane Oxygenation (ECMO)

Background: Up to 12% of patients with COVID-19 develop multisystem problems and require ICU admission commonly due to ARDS and need for mechanical ventilation.In some cases, the acute hypoxic respiratory failure (AHRF) is refractory to standard therapies and requires initiation of venovenous extracorporeal membrane oxygenation (VV ECMO).Several comorbidities may be associated with poorer outcomes.The purpose of this single site retrospective chart review was to evaluate the relationships among select comorbidities (hypertension, diabetes, obesity, and asthma) in relation to patient outcomes of time on ECMO and survival Methods: A retrospective chart review in two adult ICUs of a tertiary academic medical center in the southeast between March 24, 2020 and June 30, 2020 was conducted.Adult patients with refractory AHRF who tested positive for COVID-19 and required VV ECMO were evaluated.Results: The ages of the 60 patients ranged from 20 to 65 years.The number of comorbidities ranged from 0 to 4. The most common comorbidity was hypertension.Of the 60 patients, 43 survived their ICU admission.The number of days on ECMO ranged from 2 to 108 (median 14 days).Ventilation days ranged from 1 to 48 days.Significant findings included a shorter period on ECMO in those with higher PaO 2 /FiO 2 ratios, which was also associated with a shorter LOS.Anticipated predictors of outcome, such as SOFA score, age, and comorbidities were not found to impact mortality in these patients.Conclusions: VV ECMO was found to reduce mortality despite presence of significant pre-COVID illness.