Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19

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Abstract

Objective: We sought to determine the influence of venovenous extracorporeal membrane oxygenation (ECMO) on outcomes of mechanically ventilated patients with COVID-19 during the first 120 days after hospital discharge. Methods: Five academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 admitted during March through May 2020. Survivors had access to a multidisciplinary postintensive care recovery clinic. Physical, psychological, and cognitive deficits were measured using validated instruments and compared based on ECMO status. Results: Two hundred sixty two mechanically ventilated patients were compared with 46 patients cannulated for venovenous ECMO. Patients receiving ECMO were younger and traveled farther but there was no significant difference in gender, race, or body mass index. ECMO patients were mechanically ventilated for longer durations (median, 26 days [interquartile range, 19.5-41 days] vs 13 days [interquartile range, 7-20 days]) and were more likely to receive inhaled pulmonary vasodilators, neuromuscular blockade, investigational COVID-19 therapies, blood transfusions, and inotropes. Patients receiving ECMO experienced greater bleeding and clotting events (P < .01). However, survival at discharge was similar (69.6% vs 70.6%). Of the 217 survivors, 65.0% had documented follow-up within 120 days. Overall, 95.5% were residing at home, 25.7% had returned to work or usual activity, and 23.1% were still using supplemental oxygen; these rates did not differ significantly based on ECMO status. Rates of physical, psychological, and cognitive deficits were similar. Conclusions: Our data suggest that COVID-19 survivors experience significant physical, psychological, and cognitive deficits following intensive care unit admission. Despite a more complex critical illness course, longer average duration of mechanical ventilation, and longer average length of stay, patients treated with venovenous ECMO had similar survival at discharge and outcomes within 120 days of discharge.

Original languageEnglish
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - 2022

Bibliographical note

Funding Information:
The authors thank David J. Carter, BS, College of Medicine, University of Kentucky. The ORACLE group includes Ashley A. Montgomery-Yates, MD (Division of Pulmonary, Critical Care and Sleep Medicine, College of Medicine, University of Kentucky), Ann M. Parker, MD, and Bo Soo Kim, MD (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University), Nicholas R. Teman, MD (Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia), Jordan Hoffman, MD (Division of Cardiothoracic Surgery, Department of Surgery, Vanderbilt University), Karsten Bartels, MD, PhD (Department of Anesthesiology, University of Nebraska), Sung-Min Cho, DO, MHS (Department of Neurology and Critical Care, Johns Hopkins University), and Joseph A. Hippensteel, MD (Division of Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado Anschutz Medical Campus).

Publisher Copyright:
© 2022

Keywords

  • ECMO
  • coronavirus
  • critical illness
  • long-term outcomes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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