Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19 Induced ARDS Patients

초록

Background: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has been used as rescue therapy in many coronavirus disease 2019 (COVID-19) induced acute respiratory distress syndrome (ARDS) patients. Among patients who survived after VV-ECMO for COVID-19 ARDS, we compared the group that applied VV-ECMO for more than 28 days (prolonged group) and the group that applied less than 28 days (non-prolonged group). Methods: Between March 1, 2020 and May 31, 2022, 320 COVID-19 patients were admitted to medical intensive care unit (ICU), and 43 of them applied VV-ECMO. Data of patients who continued VV-ECMO for survivors were retrospectively collected and analyzed. Results: Of the 43 VV-ECMO patients, 31 patients (72.0%) survived and 6 patients were treated with ECMO for more than 28 days (prolonged group). There were no differences in baseline characteristics such as age (64.3 years vs 58.4 years), BMI (25kg/m2 vs 27.7kg/m2), comorbidity. In the prolonged group, the PaO2/FiO2 was lower before ECMO (81.3 vs 104.3) and the PaCO2 (58.6mmHg vs 49.2mmHg), sequential organ failure assessment (SOFA) score excluding Glasgow coma scale (7.8 vs 5.7) were slightly higher. Cytomegalovirus (CMV) viremia (100% vs 16%), invasive aspergillosis (33.3% vs 8%), ventilator-associated pneumonia (100% vs 40%) were more common in prolonged group. The duration of ECMO application (52.8 days vs 15.6 days), ICU length of stay (85.5 days vs 32.7 days) were longer in the prolonged group. Conclusion: There is a possibility that severity before ECMO or coinfection during ECMO may have affected the ECMO duration, but further studies are needed because the number of patients is too small and the difference is not clear. In addition, the decision on whether ECMO is maintained should be considered not only for ECMO duration but also for other factors.