Venovenous extracorporeal membrane oxygenation for severe COVID-19 pneumonitis: case series from a Hungarian tertiary centre

Background: Venovenous extracorporeal membrane oxygenation (V-V ECMO) is recommended for the support of patients with severe COVID-19 pneumonitis. In this study we report the characteristics and outcome of COVID-19 patients treated with V-V ECMO in a Hungarian centre. Methods: We retrospectively collected data on all patients admitted with proven SARS CoV-2 infection who received V-V ECMO support between March 2021 and May 2022. Results: Eighteen patients were included in the analysis (5 women, age 44±10 years, APACHE II score 12 (IQR 10-14.5)). The patients had their first positive SARS-CoV-2 PCR test 9 (7-15) days before admission and were already hospitalised for 6 (4-11) days. Fifteen patients received non-invasive ventilation for 4 (2-8) days, two patients high flow nasal oxygen therapy each for one day. They were intubated 2.5 (1-6) days prior to ECMO initiation. Prone position was applied in 15 cases. The Lung Injury Score was 3.25 (3-3.26), the PaO2/FiO2 ratio was 71±19 mmHg. The duration of V-V ECMO support was 26±20 days, and the longest run lasted 70 days. Patients were mechanically ventilated for 34±23 days. Intensive care unit and hospital length of stay were 40±28 days and 45±31 days, respectively. 11 patients were successfully weaned from ECMO. ICU survival rate was 56%, in-hospital survival was 50%. All patients who were discharged from hospital reported a good health-related quality of life at the 5-16 month follow-up. Conclusions: We achieved comparable survival rate to that reported by the European Chapter of the Extracorporeal Life Support Organisation COVID-19 Survey.