Transition from Simple V-V to V-A and Hybrid ECMO Configurations in COVID-19 ARDS

• Main Authors: Piotr Suwalski, Jakub Staromłyński, Jakub Brączkowski, Maciej Bartczak, Silvia Mariani, Dominik Drobiński, Konstanty Szułdrzyński, Radosław Smoczyński, Marzena Franczyk, Wojciech Sarnowski, Agnieszka Gajewska, Anna Witkowska, Waldemar Wierzba, Artur Zaczyński, Zbigniew Król, Ewa Olek, Michał Pasierski, Justine Mafalda Ravaux, Maria Elena de Piero, Roberto Lorusso, Mariusz Kowalewski
• Format: Article
• Language: English
• Published: MDPI AG 2021-06-01
• Series: Membranes
• Subjects: extracorporeal life support; extracorporeal membrane oxygenation; acute respiratory distress syndrome; cardiogenic shock; COVID-19; SARS-CoV-2
• Online Access: https://www.mdpi.com/2077-0375/11/6/434

In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine (<i>p</i> = 0.007) and a shorter ICU duration (<i>p</i> = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank <i>p</i> = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.