ECMO Support May Save Lives in COVID-19
In patients with severe lung disease caused by viral infections, physicians sometimes turn to ECMO—a life support machine that takes over the functions of the lungs, heart, or both when other support options appear to be failing. But initial reports of ECMO use in patients with COVID-19 described very high mortality, and some physicians recommended against its use.
New data from Columbia University and other ECMO centers throughout the world now show that more than 60% of severe COVID-19 patients who received ECMO have survived.
“The results of this large-scale international registry study, while hardly definitive evidence, provide a real-world understanding of the potential for ECMO to save lives in a highly select population of COVID-19 patients,” says senior author Daniel Brodie, MD, professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and director of the Adult ECMO Program at NewYork-Presbyterian/Columbia University Irving Medical Center.
What is ECMO?
ECMO, which stands for extracorporeal membrane oxygenation, is an advanced life support system that does the work of the patient’s lungs, heart, or both. The patient is connected to the ECMO machine via catheters placed in veins and arteries. The machine pumps the patient’s blood through an artificial lung for gas exchange and back into the patient.
What did the study find?
The study analyzed data from the ELSO registry, including 1,035 patients age 16 years or older with confirmed COVID-19 who had ECMO support initiated in the first four months of 2020 at 213 hospitals in 36 countries. The researchers estimate in-hospital mortality 90 days after the initiation of ECMO was 37.4%.
Why does it matter?
The mortality rate among COVID patients is similar to previous mortality rates published for ECMO-supported patients with acute respiratory distress syndrome and acute respiratory failure from other causes.
“These results are exciting as they suggest that patients with life-threatening COVID-19 can be successfully supported with ECMO. It’s encouraging to know that we have a tool that can help support these critically ill patients to recovery,” said Cara Agerstrand, MD, associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons and director of the Medical ECMO Program at NewYork-Presbyterian/Columbia University Irving Medical Center.
The initial fear that ECMO would be unsuitable for critically ill COVID patients appears, with this new data, to be unsubstantiated.
Instead, the results support the use of ECMO in COVID patients with acute respiratory distress syndrome in experienced centers, although only a randomized clinical trial can provide a definitive answer.
References
More information
Daniel Brodie is president-elect of the Extracorporeal Life Support Organization (ELSO), which organized the study via an international registry of ECMO cases with over 125,000 cases recorded, including an addendum created specifically for COVID-19.
The findings were published Oct. 10 in The Lancet in a paper titled “Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry.”
Other authors: Ryan P. Barbaro (University of Michigan); Graeme MacLaren (National University Health System, Singapore); Philip S Boonstra (University of Michigan); Theodore J. Iwashyna (University of Michigan and Veterans Affairs Center for Clinical Management Research); Arthur S. Slutsky (University of Toronto and St. Michael’s Hospital); Eddy Fan (University of Toronto); Robert H. Bartlett (University of Michigan); Joseph E. Tonna (University of Utah); Robert Hyslop (Children’s Hospital Colorado); Jeffrey J. Fanning (Medical City Children’s Hospital, Dallas, TX); Peter T. Rycus (ELSO); Steve J. Hyer (ELSO); Marc M. Anders (Baylor University); Katarzyna Hryniewicz (Abbott Northwestern Hospital, Minneapolis); Rodrigo Diaz (Clinica Las Condes, Santiago, Chile); Roberto Lorusso (Maastricht University Medical Centre); and Alain Combes (Sorbonne).
See the paper for additional contributors.
Daniel Brodie reports grants from ALung Technologies, a current relationship of medical advisory board with Hemovent, and personal fees from Baxter, Abiomed, and Xenios, all of which are unrelated to the work.