• Omar Saeed, Antone J Tatooles, Muhammad Farooq, Gary Schwartz, Duc T Pham, Asif K Mustafa, David D'Alessandro, Sunil Abrol, Ulrich P Jorde, Igor D Gregoric, Rajko Radovancevic, Brian Lima, Benjamin S Bryner, Ashwin Ravichandran, Christopher T Salerno, Philip Spencer, Patricia Friedmann, Scott Silvestry, Daniel J Goldstein, and COVID-19 ECMO Working Group.
• Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. Electronic address: osaeed@montefiore.org.
• J. Thorac. Cardiovasc. Surg. 2022 Jun 1; 163 (6): 21072116.e62107-2116.e6.

ObjectiveTo determine characteristics, outcomes, and clinical factors associated with death in patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) support.MethodsA multicenter, retrospective cohort study was conducted. The cohort consisted of adult patients (18 years of age and older) requiring ECMO in the period from March 1, 2020, to September 30, 2020. The primary outcome was in-hospital mortality after ECMO initiation assessed with a time to event analysis at 90 days. Multivariable Cox proportional regression was used to determine factors associated with in-hospital mortality.ResultsOverall, 292 patients from 17 centers comprised the study cohort. Patients were 49 (interquartile range, 39-57) years old and 81 (28%) were female. At the end of the follow-up period, 19 (6%) patients were still receiving ECMO, 25 (9%) were discontinued from ECMO but remained hospitalized, 135 (46%) were discharged or transferred alive, and 113 (39%) died during the hospitalization. The cumulative in-hospital mortality at 90 days was 42% (95% confidence interval [CI], 36%-47%). Factors associated with in-hospital mortality were age (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.06-1.61 per 10 years), renal dysfunction measured according to serum creatinine level (aHR, 1.21; 95% CI, 1.01-1.45), and cardiopulmonary resuscitation before ECMO placement (aHR, 1.87; 95% CI, 1.01-3.46).ConclusionsIn patients with severe COVID-19 necessitating ECMO support, in-hospital mortality occurred in fewer than half of the cases. ECMO might serve as a viable modality for terminally ill patients with refractory COVID-19.Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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