COVID-19 can trigger severe, fast-progressing, and treatment-resistant ARDS. Evidence-based guidelines for using ECMO as a supportive treatment to improve outcomes are lacking. Initial ECMO fatality rates for ARDS in COVID-19 were significant, leading some to doubt the therapy’s usefulness in treating this virus. Experience has led to better results. However, the optimal cannula recipient, cannulation window, and post-cannulation care plan have yet to be determined. From April 1, 2020, to July 31, 2020, researchers looked back at the first 25 patients at their institution to get V-V ECMO for COVID-19-related acute respiratory distress syndrome. 

They compared the characteristics of those who survived until hospital discharge with those of those who did not. Adjusted risk factors for death were modeled using a form of Poisson regression called the modified Poisson model. The hospital discharged 44 patients (about 11%) who were initially admitted. There were no significant variations in mean body mass index, diabetes prevalence, or PaO2 between cohorts, but survivors were younger (40.5 years vs. 53.1 years; P<0.001). FiO2 minus at the time of cannulation. The median time from the onset of symptoms to cannulation was 12.5 days for survivors compared to 19.9 days for non-survivors (P = 0.028), and the median time spent in the ICU prior to cannulation was 5.6 days for survivors and 11.7 days for non-survivors (P = 0.045). 

The adjusted risk of death was 4% higher for each day that passed between ICU admission and cannulation and 6% higher for each additional year of age. When COVID-19 causes severe, refractory ARDS, ECMO may be useful. The increasing patient age and length of time since ICU admission were risk factors for mortality and should be taken into account when making treatment decisions. There is a need for more research to determine optimal V-V ECMO procedures for COVID-19.

Source: journals.lww.com/annalsofsurgery/Abstract/2022/12000/Time_to_Cannulation_after_ICU_Admission_Increases.23.aspx