Survival Outcomes and Effects of Cannulation Strategy in Extracorporeal Membrane Oxygenation for COVID-19 Acute Respiratory Distress Syndrome

Document Type

Conference Proceeding

Publication Date

2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Rationale: The COVID-19 pandemic resulted in an increase in acute respiratory distress syndrome and use of veno-venous extracorporeal membrane oxygenation. The Extracorporeal Life Support Organization (ELSO) registry reports an in-hospital mortality of 48%. Previous evaluation on the effects of cannulation site strategies revealed no significant difference in 90-day mortality. We aimed to evaluate our veno-venous ECMO outcomes in COVID-19 and the effects of cannulation site differences on mortality and cardiac function.

Methods. Patients were retrospectively identified via electronic medical record as having a diagnosis of COVID-19 pneumonia diagnosed by nasal polymerase chain reaction testing and requiring veno-venous extracorporeal membrane oxygenation from 3/1/2020-3/1/2021 at a single center institution. Patients were excluded if they were younger than the age of 18. Information regarding patient characteristics, patient outcomes, mechanical ventilation settings, echocardiographic findings and cannulation site were collected and analyzed. Results. Thirty-four patients were identified consisting of 26 males and 8 females, the average age was 41.6 years old. Of our 34 patients, 16 (47.1%) survived to discharge, 2 patients required lung transplant. Average time spent on VV-ECMO was 21 days and patients averaged a total of 34.7 days of mechanical ventilation with 4.6 days of mechanical ventilation prior to VV-ECMO initiation. Common complications included DVT (73.5%), pneumothorax (44.1%), secondary infection (82.4%). We found no significant differences between survivors and deceased. Patients were then stratified by cannulation site, either single site dual lumen (VVDL) catheters vs multisite cannulation. We found that patients were more likely to have abnormal left ventricular function with VVDL cannulation (62.5% vs 77.7%) and more likely to have abnormal right ventricular function with a 2 site cannulation strategy (44.4% vs 75%). No other significant differences were identified.

Conclusion. ECMO support for COVID-19 ARDS remains a viable option and our institutions mortality is near the nationwide average. Patients in our cohort were statistically more likely to have abnormal left ventricular function with single lumen cannulation and patients with a two-site cannulation strategy were more likely to have abnormal RV function. Differences in ECMO flow rates or center specific cannulation strategies may be involved in the observed difference. The effects of cannulation strategy on cardiac function needs more evaluation.

Volume

211

First Page

A3759

Last Page

A3759

Comments

American Thoracic Society International Conference, May 16-25, 2025, San Francisco, CA

DOI

10.1164/ajrccm.2025.211.Abstracts.A3759

ISSN

1535-4970

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