Researchers Reveal Late-Breaking Findings on ECMO and COVID-19

STS 2021, Day 2 — Today during STS 2021, researchers will reveal new findings, identify trends, and discuss cost implications in extracorporeal membrane oxygenation (ECMO)—including the latest data on the use of ECMO in patients with COVID-19.

Today during STS 2021, researchers will reveal new findings, identify trends, and discuss cost implications in extracorporeal membrane oxygenation (ECMO)—including the latest data on the use of ECMO in patients with COVID-19.

Attendees can expect ample opportunities to ask live questions during the session, moderated by Errol L. Bush, MD, surgical director of the Advanced Lung Disease and Lung Transplant Program at The Johns Hopkins Comprehensive Transplant Center in Baltimore, Maryland, and Pablo G. Sanchez, MD, PhD, chief of the Division of Lung Transplant and Lung Failure and surgical director of lung transplantation and ECMO at the University of Pittsburgh in Pennsylvania.

“This session highlights that while we are facile in ECMO deployment for adjunctive or salvage indications, we are still unclear which patients will benefit most, if there are cannulation strategies that are associated with improved or worsened outcomes, or even what’s the most efficient composition of professionals to monitor patients once they are on ECMO,” Dr. Bush said. “Despite our various institutions having varying degrees of resources, this session highlights that universally ECMO is a resource-intensive tool that we have successfully demonstrated our ability to use a priori during crisis or salvage, but we still need to understand when and how it is best utilized.”

For patients undergoing lung transplantation, ECMO may be a viable replacement to cardiopulmonary bypass, which has been associated with causing inflammatory cascades and possibly leading to primary graft dysfunction, explained Arvind S. Bussetty, BS, from the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania.

Bussetty and colleagues performed a retrospective study to compare the survival outcomes among patients who were supported with ECMO versus outcomes in those supported with cardiopulmonary bypass and those who were maintained off-pump during transplant. Attendees will see data from 742 patients who received lung transplants between February 2012 and March 2020 that suggest ECMO may be superior to cardiopulmonary bypass and comparable to the off-pump strategy.

Jeffrey P. Jacobs, MD, from the University of Florida in Gainesville, will present new findings on the outcomes and trends over time in 189 patients with COVID-19 and severe pulmonary compromise who were treated with ECMO. Over time, a multi-institutional database was created and utilized to assess all patients with confirmed COVID-19 who were supported with ECMO at 20 hospitals, Dr. Jacobs explained. The data revealed that 98 of the patients died while on ECMO or within 24 hours of decannulation and 12 more patients died beyond 24 hours of decannulation, while 79 patients currently survive—with 70 discharged home from the ECMO-providing hospital.

Most of the patients had pre-COVID comorbidities, including asthma, cancer, renal failure, diabetes, heart disease, hypertension, and obesity, but no significant difference related to the comorbidities was found in survivors versus non-survivors. The researchers found that the patients who survived tended to be younger and were intubated sooner. In addition to viewing these data, participants will have the opportunity to see outcomes in patients who received adjunctive therapies, including antiviral medications like remdesivir, convalescent plasma, hydroxychloroquine, interleukin six blockers, prostaglandin, and steroids.

The use of ECMO has grown substantially—increasing 360% in cases from 2008 to 2014, said Jahnavi Kakuturu, MD, from West Virginia University in Morgantown, who will present outcomes findings in patients who required ECMO for post-cardiotomy shock. Dr. Kakuturu’s team performed a retrospective analysis of the National (Nationwide) Inpatient Sample (NIS) database, including 5,885 patients who required ECMO. The majority of the patients underwent isolated valvular procedures, she said. The researchers found the strongest predictor of mortality to be postoperative acute injury requiring dialysis. Among the notable findings was that socioeconomic status seemed to have played a role in survival—patients who weren’t covered by private insurance and received “charity care” had twice the risk for mortality.

Indeed, the cost for delivery and the charges incurred for hospitalizations requiring ECMO are incredibly steep, said presenter Ankit Dhamija, MD, from West Virginia University. Dr. Dhamija noted that for each hospitalization, the costs are estimated at more than $700,000 and, when ECMO is used as a bridge to heart or lung transplantation, can exceed $1.4 million.

ECMO is fast becoming a first line of defense and has seen increased use with the 2009 influenza A pandemic and now the COVID-19 pandemic. To be cost-conscious custodians of this resource-intensive modality, those in the medical field should continue to work on reducing costs without limiting quality, said Dr. Dhamija. He will present results that suggest a nurse-led specialist model could optimize the break-even costs.

The ECMO/COVID-19 session begins this afternoon at 3:30 p.m. ET. Following each presentation, participants have the opportunity to ask live questions and afterward can join a roundtable discussion hosted by expert panelists.