Dr. Keerthana Ramesh
Last-resort life support option helped majority of critically ill COVID-19 patients survive
27 September 2020
It saved lives in past epidemics of lung-damaging viruses. Now, the life-support option known as ECMO appears to be doing the same for many of the critically ill COVID-19 patients who receive it, according to a new international study
The 1,035 patients in the study faced a staggeringly high risk of death, as ventilators and other care failed to support their lungs. But after they were placed on ECMO, their actual death rate was less than 40%. That's similar to the rate for patients treated with ECMO in past outbreaks of lung-damaging viruses, and other severe forms of viral pneumonia.
The new study published in The Lancet provides strong support for the use of ECMO -- short for extracorporeal membrane oxygenation -- in appropriate patients as the pandemic rages on worldwide.
It may help more hospitals that have ECMO capability understand which of their COVID-19 patients might benefit from the technique, which channels blood out of the body and into a circuit of equipment that adds oxygen directly to the blood before pumping it back into regular circulation. Small studies published early in the pandemic had cast doubt on the technique's usefulness.
Still, the international team of authors cautions that patients who show signs of needing advanced life support should receive it at hospitals with experienced ECMO teams, and that hospitals shouldn't try to add ECMO capability mid-pandemic.
Global cooperation to achieve results
The study was made possible by a rapidly created international registry that has given critical care experts near real-time data on the use of ECMO in COVID-19 patients since early in the year
Hosted by the organization called ELSO, for Extracorporeal Life Support Organization, the registry includes data submitted by the 213 hospitals on four continents whose patients were included in the new analysis. The paper includes data on patients age 16 or older who were started on ECMO between January 16 and May 1, and follows them until death, discharge from the hospital, or August 5, whichever occurred first. The team will present the findings at the ELSO Annual Meeting on Sept. 26.
"These results from hospitals experienced in providing ECMO are similar to past reports of ECMO-supported patients, with other forms of acute respiratory distress syndrome or viral pneumonia," says co-lead author Ryan Barbaro, M.D., M.S., of Michigan Medicine, the University of Michigan's academic medical center. "These results support recommendations to consider ECMO in COVID-19 if the ventilator is failing. We hope these findings help hospitals make decisions about this resource-intensive option."
Co-lead author Graeme MacLaren, MBBS, of the National University Health System in Singapore, notes, "Most centers in this study did not need to use ECMO for COVID-19 very often. By bringing data from over 200 international centers together into the same study, ELSO has deepened our knowledge about the use of ECMO for COVID-19 in a way that would be impossible for individual centers to learn on their own."
Insights into patient outcomes
Seventy percent of the patients in the study were transferred to the hospital where they received ECMO. Half of these were actually started on ECMO -- likely by the receiving hospital's team -- before they were transferred. This reinforces the importance of communication between ECMO-capable hospitals and non-ECMO hospitals that might have COVID-19 patients who could benefit from ECMO