Extracorporeal Membrane Oxygenation for COVID 2019-Acute Respiratory Distress Syndrome: Comparison between First and Second Waves (Stage 2)

We aimed to compare the outcomes of patients under veno-venous extracorporeal membrane oxygenation (V-V ECMO) for COVID-19-Acute Respiratory Distress Syndrome (CARDS) between the first and the second wave. From 1 March 2020 to 30 November 2020, fifty patients requiring a V-V ECMO support for CARDS were included. Patient demographics, pre-ECMO, and day one, three, and seven on-ECMO data and outcomes were collected. The 90-day mortality was 11% higher during the second wave (18/26 (69%)) compared to the first wave (14/24 (58%) (p = 0.423). During the second wave, all of the patients were given steroids compared to 16.7% during the first wave (p < 0.001). The second wave's patients had been on non-invasive ventilation support for a longer period than in the first wave, with the median time from ICU admission to ECMO implantation being significantly higher (14 (11-20) vs. 7.7 (5-12) days; p < 0.001). Mechanical properties of the lung were worsened in the second wave's CARDS patients before ECMO implantation (median static compliance 20 (16-26) vs. 29 (25-37) mL/cmH2O; p < 0.001) and during ECMO days one, three, and seven. More bacterial co-infections before implantation and under ECMO were documented in the second wave group. Despite a better evidence-driven critical care management, we depicted fewer encouraging outcomes during the second wave.

Automated summary

The study aimed to compare outcomes of COVID-19 patients with Acute Respiratory Distress Syndrome treated with V-V ECMO during the first and second waves. While the 90-day mortality did not significantly differ between waves, more patients in the second wave received steroid treatment, had longer non-invasive ventilation support duration, and exhibited poorer lung mechanical properties. The second wave also saw more bacterial co-infections and less encouraging outcomes despite evidence-based critical care management.