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Oktober 21, 2021


INCREASED MORTALITY RATE DURING SECOND WAVE OF PANDEMIC FOR PATIENTS WITH
COVID-19 REQUIRING ECMO


By Ed Susman

VIRTUAL -- October 21, 2021 -- The mortality rate of patients with coronavirus
disease 2019 (COVID-19) who required extracorporeal membrane oxygenation (ECMO)
appeared to increase during the second wave of the pandemic in the United
States, according to a study presented at CHEST 2021, the Annual Meeting of the
American College of CHEST Physicians.

In a single institution study, the mortality rate of 28 patients with COVID-19
requiring ECMO was 32% during the first wave of the COVID-19 pandemic (April
2020 to September 2020), but during the second wave -- between November 2020 and
March 2021 -- the mortality rate was 69% (9 of 13 patients; P = .026).

“Despite improved pre-ECMO treatment, patients with COVID-19 during the second
wave experienced higher mortality on ECMO than patients in the first wave,” said
Rohit Reddy, Thomas Jefferson University, Philadelphia, Pennsylvania. “More
strict inclusion/exclusion criteria for ECMO may be necessary to improve
outcomes.”

The 28 patients in the first wave had an average age of 52 years and 68% were
male. The 13 patients in the second wave had an average age of 45 years and 69%
were male. Comorbidities were not significantly different between the 2 groups.

Pre-ECMO immunomodulators were given more often during the second wave. In the
first wave, 54% of patients were treated with steroids compared with all 13
patients in the second wave (P = .003). Remdesivir was administered to 39% and
85% of patients, respectively (P = .007). While on ECMO, 11% of patients were
placed in a prone position during the first wave compared with 85% of the
patients in the second wave (P < .001). Patients in the first wave spent a
median of 14 days on ECMO compared with 20 days for patients in the second wave.

In the second wave group, 39% experienced acute renal failure, as did 38% of
patients in the first wave group. Sepsis occurred in 32% and 23%, respectively,
and bacterial pneumonia occurred in 11% of the patients in the second wave
compared with 8% of the patients in the first wave.

“As treatment algorithms for COVID-19 evolved, patients were more often
administered pre-ECMO immunomodulation therapy during the second wave that
potentially made these patients more susceptible to bacterial infection,” said
Dr. Reddy. “Sepsis was one of the leading causes of death in this study. Control
of infection for patients on immunomodulation therapy is challenging, but
necessary to improve outcomes in these patients.”

[Presentation title: Outcomes of Extracorporeal Membrane Oxygenation in ARDS Due
to COVID-19: Comparison of the First and the Second Wave]

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