Demographics and Outcomes of Extracorporeal Membrane Oxygenation in COVID-19 Patients: National Database Analysis.

INTRODUCTION: The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been variable. To gain a better insight, we examined the outcomes of ECMO in COVID-19 patients using data from the 2020 National Inpatient Sample database. METHODS: We analyzed data from adult hospital admissions where COVID-19 was the primary diagnosis. The primary outcome was all-cause inpatient mortality. Secondary outcomes were length of stay (LOS), cost, and discharge disposition. RESULTS: We identified 1,048,025 COVID-19 admissions, of which 98,528 were on mechanical ventilation (MV), and only 1.8% received ECMO. In-hospital mortality of mechanically ventilated patients who received ECMO was 49%, compared to 59% with no ECMO (p < 0.001). ECMO treatment was associated with a reduced risk of mortality (HR = 0.67, p < 0.0001, CI 0.57-0.79) even after adjustment for confounders and other comorbidities. Patients on ECMO had significantly extended hospital stays and were more likely to be discharged to an acute care facility. Younger and male patients were more likely to receive ECMO treatment. Females had a lower mortality risk, while race and obesity were not associated with an increased risk of death. CONCLUSION: ECMO treatment may offer survival benefits in severe COVID-19. Based on our findings, we suggest early ECMO treatment for patients with a high mortality risk.

Does a Starting Positive End-Expiratory Pressure of 8 cmH2O Decrease the Probability of a Ventilator-Associated Event?

Introduction: Ventilator-associated events (VAEs) are objective measures as defined by the Centers for Disease Control and Prevention (CDC). To reduce VAEs, some hospitals have started patients on higher baseline positive end-expiratory pressure (PEEP) to avoid triggering VAE criteria due to respiratory fluctuations. Methods: At our institution, VAEs were gathered from January 2014 through December 2019. Using the CDC-defined classifications, VAEs were split into two groups to separate patients with hypoxemia only (VAC) and those with hypoxemia and evidence of inflammation or infection (IVAC-plus). We used the geometric distribution to calculate the daily event probability before and after the protocol implementation. A probability threshold was used to determine if the days between events was exceeded during the post-protocol period. Results: A total of 306 VAEs were collected over the study period. Of those, 155 were VACs and 107 were IVAC-plus events during the pre-protocol period. After implementing the protocol, 24 VACs and 20 IVAC-plus events were reported. There was a non-significant decrease in daily event probabilities in both the VAC and IVAC-plus groups (0.083 vs. 0.068 and 0.057 vs. 0.039, respectively). Conclusion: We concluded a starting PEEP of 8 cmH2O is unlikely to be an effective intervention at reducing the probability of a VAE. Until specific guidelines by the CDC are established, hospitals should consider alternative methods to reduce VAEs.