Extracorporeal Membrane Oxygenation for COVID-19-Associated Acute Respiratory Distress Syndrome: A Nationwide Analysis

Authors

Atsuyuki Watanabe, Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York, USA.
Aaqib Malik, Department of Medicine, Division of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
Tadao Aikawa, Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan.
Alexandros Briasoulis, Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, Iowa, USA.
Toshiki Kuno, Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York, USA.

Author Type(s)

Faculty

Journal Title

Journal of Medical Virology

First Page

e28961

Document Type

Article

Publication Date

7-1-2023

Department

Medicine

Abstract

Extracorporeal membrane oxygenation (ECMO) has been used for COVID-19-associated acute respiratory distress syndrome (ARDS). We aimed to elucidate the association between ECMO and mortality in patients with COVID-19-associated ARDS in the nationwide setting. United States National Inpatient Sample was used to identify mechanically ventilated adults for COVID-19 with ARDS. We divided them into three groups according to the use of ECMO (i.e., no-ECMO, venovenous [VV]-ECMO, and venoarterial [VA]-ECMO). The primary outcome was in-hospital mortality, while the secondary outcomes included the length of hospital stay (LOS) and the total costs during hospitalization. We performed a stepwise logistic regression, adjusting for baseline characteristics, comorbidities, and severity. We included 68 795 (mean age [SD]: 63.5 [0.1]), 3280 (mean age [SD]: 48.7 [0.5]), and 340 (mean age [SD]: 43.3 [2.1]) patients who received no-, VV-, and VA-ECMO, respectively. The logistic regression analysis did not show significant associations between the use of VV-/VA-ECMO and mortality (adjusted odds ratio with no-ECMO as reference [95% confidence interval]: 1.03 [0.86-1.24] and 1.18 [0.64-2.15], respectively). While LOS was longest with VV-ECMO, the total costs were highest with VA-ECMO. In conclusion, our study found no association between the use of ECMO and mortality of COVID-19-associated ARDS in the nationwide setting.

Recommended Citation

Watanabe, A., Malik, A., Aikawa, T., Briasoulis, A., & Kuno, T. (2023). Extracorporeal Membrane Oxygenation for COVID-19-Associated Acute Respiratory Distress Syndrome: A Nationwide Analysis. Journal of Medical Virology, 95 (7), e28961. https://doi.org/10.1002/jmv.28961