Purpose: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as COVID-19). We conducted this study to compare the outcomes of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19. Materials and Methods: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV -ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed. Results: 28 COVID-19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p=0.04). 30-day survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p=0.13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 days vs. 12 days, p=0.025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy prior to ECMO initiation (p<0.001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%, p=0.03) and bacterial pneumonia (36% vs 6%, p=0.024). Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.

Introduction: Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to COVID-19, but there has been little evidence of its efficacy. We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID-19. Methods: All adult patients who were placed on ECMO for ARDS due to COVID -19 between April 2020 and June 2020 (during the first wave of COVID-19) were identified. The clinical characteristics and outcomes of these patients were analyzed with a specific focus on the differences between patients who survived to hospital discharge and those who did not. Results: 20 COVID-19 patients were included in this study. All patients were placed on veno-veno ECMO. Comparing between survivors and non-survivors, older age was associated with hospital mortality (p=0.02). The following complications were observed: renal failure requiring renal replacement therapy (35%, n=7), bacteremia during ECMO (20%, n=4),coinfection with bacterial pneumonia (15%, n=3), cannula site bleeding (15%, n=3), stroke (10%, n=2), gastrointestinal bleeding (10%, n=2), and liver failure (5%, n=1). The complications associated with patient mortality were culture positive septic shock (p=0.01), culture-negative systemic inflammatory response syndrome (p=0.01), and renal failure (p=0.01). The causes of death were septic shock (44%, n=4), culture-negative systemic inflammatory response syndrome (44%, n=4), and stroke (11%, n=1). Conclusions: Based on our experience, ECMO can improve refractory ARDS due to COVID-19 in select patients. Proper control of bacterial infections during COVID-19 immunomodulation therapy may be critical to improving survival.