Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry
Abstract
The severity of COVID-19-related acute hypoxaemic respiratory failure1,2 and clinical evidence supporting extracorporeal membrane oxygenation (ECMO) in the acute respiratory distress syndrome (ARDS)3-5 prompted several international organisations including the World Health Organization (WHO),6 Surviving Sepsis Campaign,7 and Extracorporeal Life Support Organization (ELSO)8 to consider a role for ECMO support during the current pandemic.9 WHO recommended that expert centres with sufficient ECMO volume to maintain proficiency consider ECMO support in COVID-19-related ARDS with refractory hypoxaemia if lung protective mechanical ventilation10 was insufficient to support the patient.6 Despite such optimism for a possible role for ECMO in both acute respiratory and cardiac failure, early reports of patients with COVID-19 requiring ECMO suggested that mortality could be greater than 90%.11 ELSO is an international organisation that maintains a registry of ECMO cases among its member centres. In March, 2020, the ELSO Registry augmented its data capture with an addendum designed for ECMO-supported patients with COVID-19 to obtain additional information on these patients.12 In this study, we used data from the ELSO Registry to report the epidemiology, treatment, outcomes, and hospital characteristics of patients receiving ECMO with a confirmed diagnosis of COVID-19.
Additionally, we examined whether patient factors and historical hospital ECMO case volume were associated with in-hospital mortality