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

doi:10.1016/j.jtcvs.2021.11.099

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 language	English
Pages (from-to)	842-851.e1
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	166
Issue number	3
DOIs	https://doi.org/10.1016/j.jtcvs.2021.11.099
State	Published - Sep 2023

Bibliographical note

Publisher Copyright:
© 2022

Funding

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).

Funders	Funder number
Department of Medicine, University of Colorado Anschutz Medical Campus
Department of Neurology and Critical Care
Joseph A. Hippensteel
University of Kentucky
The Johns Hopkins University
University of Virginia
Department of Medicine, Georgetown University

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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10.1016/j.jtcvs.2021.11.099

Cite this

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title = "Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19",

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.",

keywords = "ECMO, coronavirus, critical illness, long-term outcomes",

author = "Taylor, {Lauren J.} and Jolley, {Sarah E.} and Chintan Ramani and Mayer, {Kirby P.} and Etchill, {Eric W.} and Mart, {Matthew F.} and Shoaib Fakhri and Skyler Peterson and Kathryn Colborn and Sevin, {Carla M.} and Alexandra Kadl and Kyle Enfield and Whitman, {Glenn J.R.} and Zwischenberger, {Joseph B.} and Rove, {Jessica Y.} and Montgomery-Yates, {Ashley A.} and Parker, {Ann M.} and Teman, {Nicholas R.} and Jordan Hoffman and Karsten Bartels and Kim, {Bo Soo} and Cho, {Sung Min} and Hippensteel, {Joseph A.}",

note = "Publisher Copyright: {\textcopyright} 2022",

year = "2023",

month = sep,

doi = "10.1016/j.jtcvs.2021.11.099",

language = "English",

volume = "166",

pages = "842--851.e1",

number = "3",

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T1 - Early posthospitalization recovery after extracorporeal membrane oxygenation in survivors of COVID-19

AU - Taylor, Lauren J.

AU - Jolley, Sarah E.

AU - Ramani, Chintan

AU - Mayer, Kirby P.

AU - Etchill, Eric W.

AU - Mart, Matthew F.

AU - Fakhri, Shoaib

AU - Peterson, Skyler

AU - Colborn, Kathryn

AU - Sevin, Carla M.

AU - Kadl, Alexandra

AU - Enfield, Kyle

AU - Whitman, Glenn J.R.

AU - Zwischenberger, Joseph B.

AU - Rove, Jessica Y.

AU - Montgomery-Yates, Ashley A.

AU - Parker, Ann M.

AU - Teman, Nicholas R.

AU - Hoffman, Jordan

AU - Bartels, Karsten

AU - Kim, Bo Soo

AU - Cho, Sung Min

AU - Hippensteel, Joseph A.

PY - 2023/9

Y1 - 2023/9

N2 - 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.

AB - 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.

KW - ECMO

KW - coronavirus

KW - critical illness

KW - long-term outcomes

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

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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