Abstract 13383: Extracorporeal Membrane Oxygenation for COVID-19-associated Acute Respiratory Distress Syndrome: A Nationwide Analysis
Atsuyuki Watanabe, Aaqib H Malik, Tadao Aikawa, Alexandros Briasoulis, Toshiki Kuno- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Introduction: While extracorporeal membrane oxygenation (ECMO) has been used for patients with COVID-19-associated acute respiratory distress syndrome (ARDS), its benefit in the nationwide setting is unknown.
Aim: To evaluate the association between the use of ECMO and outcomes of COVID-19-associated ARDS in the nationwide setting.
Methods: Using the United States National Inpatient Sample in 2020, we identified adults hospitalized and mechanically ventilated for COVID-19 with ARDS and 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, and the secondary outcomes were the length of hospital stay (LOS) and the total costs during hospitalization. We applied a multivariable logistic regression model for the primary outcome, adjusting for baseline characteristics and underlying comorbidities.
Results: Of the total of 72,415 included patients, 68,795, 3,280, and 340 patients received no-, VV-, and VA-ECMO, respectively (Table) . The crude mortality was the highest in the no-ECMO group (59.8%; 41,110/68,795), followed by VA-ECMO (47.1%; 160/340), and VV-ECMO groups (44.8%; 1,470/3,280). LOS was the longest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. Similarly, the total costs during hospitalization were the highest in VV-ECMO group, followed by VA-ECMO, and no-ECMO groups. After adjusting for the covariates, VV- or VA-ECMO was not associated with lower mortality compared to no-ECMO (adjusted odds ratio [95% confidence interval]: 0.98 [0.82-1.18] and 1.12 [0.62-2.04], respectively).
Conclusions: In the nationwide setting, ECMO was not associated with improved mortality in patients with COVID-19-associated ARDS but was associated with longer LOS and higher costs. Future studies exploring the characteristics of suitable candidates for ECMO are warranted.