Outcomes of Extracorporeal Membrane Oxygenation in Patients with COVID-19 and Pulmonary Hypertension: An ELSO Registry Analysis.

Abstract

Objective: To describe the characteristics and outcomes of patients with COVID-19 infection with acute or chronic pulmonary hypertension (PH) supported by extracorporeal membrane oxygenation (ECMO). It was hypothesized that patients with acute or chronic PH supported by ECMO would have higher mortality rates compared to those without a diagnosis of PH.

Design: A retrospective analysis of the Extracorporeal Life Support Organization registry.

Setting: Global registry data from patients who received ECMO support for severe COVID-19 between 2020 and 2021.

Participants: Patients with COVID-19 who required ECMO support, categorized into those with acute PH (177 patients), chronic PH (147 patients), and no PH (7465 patients).

Interventions: None (retrospective study).

Measurements & main results: Overall, there were no statistically significant differences in mortality among the 3 groups (52.2% for No-PH v 52.0% for Acute-PH v 61.9% for Chronic-PH; p = 0.07). Venoarterial ECMO was used most frequently in Acute-PH (17.5%, compared to 5.2% for No-PH and 6.8% for Chronic-PH; p < 0.001). Patients with chronic PH had more liver disease (26.5%, compared to 3.0% for No-PH and 4.0% for Chronic-PH; p < 0.0001). Patients with chronic PH had the highest overall complication rate (84.4%, compared to 70.0% for No-PH and 78.5% for Acute-PH; p < 0.0001), although the Acute-PH group had the highest incidences of limb ischemia and neurologic complications.

Conclusions: Patients with acute or chronic PH who required ECMO for severe COVID-19 had higher risk profiles compared to those without PH. While outcomes for patients with acute PH were similar to those for patients without PH, the complication rate was significantly higher in acute PH. Chronic PH was associated with significantly higher, (although nonprohibitive) mortality and a higher risk of complications. Thoughtful patient selection is important for optimal outcomes in this high-risk population.