Outcomes of Extracorporeal Membrane Oxygenation in Influenza vs.
COVID-19 During the First Wave of COVID-19
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