Experience with ECMO therapy for acute respiratory distress syndrome treatment throughout the COVID-19 pandemic

Objective

To analyze our experience with extracorporeal membrane oxygenation (ECMO) therapy for acute respiratory distress syndrome (ARDS) treatment during the COVID-19 pandemic.

Design

Retrospective, observational, single center study.

Setting

Third-level hospital in Spain.

Patients

Adult patients with COVID-19 ARDS treated with an ECMO system in our center between March 2020 and March 2023.

Interventions

Retrospective collection of variables during hospital admission and follow-up.

Main Variables of Interest

Demographic variables, clinical history, variables related to ECMO therapy, COVID-19 wave number, in-hospital mortality, adverse events, ICU and hospital length of stay, and functional status at follow-up were collected.

Results

Eighty-one patients were included. Of these, 61 patients (75%) died during hospitalization. Patients who died were older and had more comorbidities. During the second, third, and sixth waves, mortality was higher. In the multivariate analysis, the only independent predictor of mortality was age (OR 1.24 95% CI (1.027–1.5, P = 0.025). After discharge, 40% of patients had difficulties returning to normal life due to respiratory failure requiring oxygen and arthropathies.

Conclusion

In-hospital mortality increased during the pandemic. Older age was the only independent predictor of mortality. After discharge, no deaths were recorded during the first 18 months of follow-up, although 40% of surviving patients had respiratory and motor sequelae making it difficult for them to return to a normal life.