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A certain approach to extracorporeal membrane oxygenation (ECMO) in COVID-19 patients showed a high success rate at two centers in Chicago, researchers reported.

Of 40 recipients, 29 (73%) were discharged from the hospital without any further need for oxygen, Antone J. Tatooles, MD, of Advocate Christ Medical Center in Oak Lawn, Illinois, and colleagues .

All went off ventilator support, and 80% were no longer on ECMO by July 17. Six of the patients died (15%).

"Complications have been minimal, with no ischemic strokes, inotropic support, or tracheostomies," they noted.

Pooled analysis of early reports had suggested , with mortality averaging 94.1%, although not significantly lower for other COVID-19 acute respiratory distress syndrome patients at 70.9%.

Tatooles's study included consecutive patients treated with ECMO for severe respiratory failure from PCR-confirmed COVID-19 at two tertiary medical centers in Chicago from March 17 to July 17, 2020. Patient selection largely followed the 's protocol. Guidelines for ECMO use in the setting of COVID-19 have emphasized having clear criteria ahead of time for patient selection.

In the current study cohort, ECMO was done via a single-access, dual-stage right atrium-to-pulmonary artery cannula, which offered the following advantages, according to the researchers:

• Direct pulmonary artery flow for better oxygenation and ventilation
• Early mobility once off the ventilator
• Minimal cannula-associated complications or revisions
• Support of the right side of the heart in case of right ventricular dysfunction

"Given the higher prevalence of and associated mortality with acute cor pulmonale in patients with COVID-19, protecting the right side of the heart was critically important," the group noted. All patients got systemic anticoagulation.

After cannula placement, ventilation was discontinued. Ten patients needed to be temporarily reintubated after ECMO.

Patients took a mean of 4 days from initial intubation to progress to ECMO; they averaged 13 days from ECMO initiation to extubation.

"While this study has limitations because it is still an early, retrospective report on 40 patients, single-access, dual-stage venovenous ECMO with early extubation appears to be safe and effective in patients with COVID-19 respiratory failure," Tatooles and colleagues concluded. "Ongoing studies are required, however, to further define the long-term outcomes of this approach."

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