Comparison of clinical characteristics and outcomes of patients requiring extracorporeal membrane oxygenation due to severe acute respiratory distress syndrome related to COVID-19 or influenza

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Background Extracorporeal membrane oxygenation (ECMO) represents a viable therapy option for patients with refractory acute respiratory distress syndrome (ARDS). In recent years ECMO was frequently used in patients suffering from influenza or coronavirus disease 2019 (COVID-19). However, data on comparison of clinical characteristics and outcome of patients with COVID-19 and influenza related severe ARDS requiring ECMO is scarce. Material & Methods This is a retrospective analysis of all consecutive patients treated with ECMO between 01/2009 – 01/2021 at the University Medical Centre Hamburg-Eppendorf (Germany). All patients with confirmed COVID-19 or influenza were included. Patient characteristics, parameters related to ICU- and ECMO as well as clinical outcomes were compared. Mortality was assessed up to 90 days after ECMO initiation. Results Overall 113 patients were included – of those 52 (46%) had COVID-19 and 61 (54%) had influenza. The median age of patients with COVID-19 and influenza was 58 (IQR 53 – 64) and 52 (39 – 58) years (p < 0.001), 35% and 31% (p = 0.695) were female, respectively. The median SAPS II score pre-ECMO was 27 (24 – 36) vs 32 (28 – 41) points (p = 0.009), and the SOFA score was 13 (11 – 14) vs 12 (8 – 15) points (p = 0.853) respectively. Median P/F-Ratio pre-ECMO was 64 (46 – 78) and 73 (56 – 104) (p = 0.089), pH was 7.20 (7.16 – 7.29) and 7.26 (7.18 – 7.33) (p = 0.166). The median duration of ECMO was 17 (7 – 27) and 11 (7 – 20) (p = 0.295), respectively. Renal replacement therapy was used in 71% and 69% (p = 0.790). 94% of patients with COVID-19 and 77% with influenza experienced ECMO associated bleeding events (p = 0.004). Overall, 34% and 55% were successfully weaned from ECMO (p = 0.025). 90-day mortality was 65% and 57% in patients with COVID-19 and influenza, respectively (p = 0.156). Median length of ICU stay was 24 (13 – 44) and 28 (16 – 14) days (p = 0.470), respectively. Conclusion Despite similar disease severity the use of ECMO in ARDS related to COVID-19 and influenza resulted in similar outcome at 90-days. A significant higher rate of bleeding complications and thrombosis was observed in patients with COVID-19. Publication History Article published online: 11 May 2022 © 2022. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

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