Extracorporeal membrane oxygenation outcomes in COVID‐19 patients: Case series from the Brazilian COVID‐19 Registry

  1. Daniela Ponce
  2. Rafael Lima Rodrigues de Carvalho
  3. Magda Carvalho Pires
  4. Heloisa Reniers Vianna
  5. Matheus Carvalho Alves Nogueira
  6. Fernando Antonio Botoni
  7. Fernando Graça Aranha
  8. André Soares de Moura Costa
  9. Giovanna Grunewald Vietta
  10. Felipe Ferraz Martins Graça Aranha
  11. Virginia Mara Reis Gomes
  12. Ana Paula Beck da Silva Etges
  13. Antonio Tolentino Nogueira de Sá
  14. Polianna Delfino Pereira
  15. Milena Soriano Marcolino

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Abstract

Around 5% of coronavirus disease 2019 (COVID‐19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to describe the clinical characteristics and in‐hospital outcomes of COVID‐19 patients with ARDS refractory to lung‐protective ventilation and prone positioning on ECMO support, as well as to review the available literature on ECMO use and COVID‐19 patients’ outcome. Patients from this case series were selected from the Brazilian COVID‐19 Registry. From the 7646 patients included in the registry, only eight received ECMO support (0.1%), in four hospitals. The median age of the entire sample was 59 (interquartile range 54.2–64.4) years old and 87.5% were male. Hypertension (50.0%), diabetes mellitus (50.0%) and obesity (37.5%) were the most frequent comorbidities. The indications for ECMO were PaO 2 /FiO 2 ratio <80 mm Hg for more than 6 h or PaO 2 /FiO 2 ratio <60 mm Hg for more than 3 h. The mortality rate was 87.5%. In conclusion, in this case series of COVID‐19 patients with ARDS refractory to conventional therapy who received ECMO support, a very high mortality was observed. Our findings are not different from previous studies including a small number of patients; however, there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for improvement.

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  1. Version published to 10.1111/aor.14136
  2. ScreenIT

    SciScore for 10.1101/2021.05.05.21256475: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has limitations. First, it was not a randomised controlled trial and thus we cannot draw any definitive conclusions as to whether ECMO should be used in patients with COVID-19 and severe respiratory failure. However, our results are consistent with previously reported survival rates in acute hypoxaemic respiratory failure, supporting current ELSO recommendations that centres experienced in ECMO should withhold its use in refractory COVID-19-related respiratory failure in situations of healthcare system collapse. The ECMO may be demanding from both resource and ethical points. In a crisis scenario, the allocation of resources, whether human or financial, is challenging. Stricter selection criteria are recommended in order to use this resource for patients with greater chances of recovery. ECMO is recommended for the largest and certified centers only and it is not recommended when the system is overwhelmed[24]. A lot of research is still needed to show the role of ECMO support in COVID19 patients’ survival. In Brazil, in the second phase of the pandemic those centers may have improved ECMO procedures, as they established protocols and tried to avoid delayed indication, when it might have been too late to be of any benefit. We therefore hypothesize that future analyzes of data from a second phase of the pandemic might provide more encouraging mortality outcomes than those found in the first phase of lesser expertise with ECMO in patients with COVID-19 and even less k...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a protocol registration statement.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.05.05.21256475 on medRxiv