The role and needs of extracorporeal membrane oxygenation (ECMO) at a population-level during the COVID-19 pandemic have not been completely established.
To identify the cumulative incidence for ECMO use in the first pandemic wave and to describe the Nationwide Chilean cohort of ECMO-supported COVID-19 patients.
We conducted a population-based study from March 3 to August 31, 2020, using linked data from National agencies. Cumulative incidence of ECMO use and mortality risk of ECMO-supported patients were calculated and age-standardized. Additionally, a retrospective cohort was performed. Outcomes were 90-days mortality after ECMO initiation, ECMO-associated complications and hospital length of stay (LOS). Cox regression models were used to explore risk factors for mortality in a time-to-event analysis.
94 COVID-19 patients were supported with ECMO (0.42:100,000 population, 14.89:100,000 positive cases, and 1.2% of COVID-19 intubated patients); 85 were included in the cohort analysis: age 48 [41-55] years, 83.5% men, 42.4% obese. Pre-ECMO intubation days were 4 [2-7], PaO2:FiO2 86.8 [64-99] mmHg, 91.8% were prone-positioned; 14 had refractory respiratory acidosis. Main complications were infections (70.6%), bleeding (38.8%) and thromboembolism (22.4%); 52 patients were discharged home and 33 died. Hospital LOS was 50 [24-69] days. Lower respiratory system compliance and higher driving pressure before ECMO onset were associated with increased mortality. Duration of pre-ECMO intubation ≥10 days was not associated with mortality.
Documenting nationwide ECMO needs may help planning ECMO provision for future COVID-19 pandemic waves. The 90-days mortality of the Chilean cohort of ECMO-supported COVID-19 patients (38.8%) is comparable to previous reports. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).