ECMO Life-Support Therapy Can Improve Survival of COVID-19 Patients with Severe Respiratory Failure, Suggests Study

Extracorporeal membrane oxygenation (ECMO) may improve the odds of survival for certain patients with severe COVID-19 whose lungs are so injured that even a ventilator is unable to deliver enough oxygen.

A study by physician-researchers at Beth Israel Deaconess Medical Center (BIDMC Boston, MA, USA) and the Brigham and Women’s Hospital (Boston, MA, USA) has provided new evidence that critically ill patients with COVID-19 who were treated with ECMO - which does the work of the lungs by removing carbon dioxide and adding oxygen to blood outside the body - had better odds of survival than those who were not treated with ECMO. The findings represent the only published study to investigate ECMO's efficacy for treatment of critically ill patients with COVID-19.

In the study, the researchers analyzed observational data from Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID), a multicenter cohort study of patients with COVID-19 admitted to intensive care units at 68 hospitals across the US. Overall, the scientists found that 190 of the 5,122 critically ill adults (3%) admitted to the ICU with COVID-19 between March 1 and July 1, 2020, received treatment with ECMO. Among those 190 patients, nearly 70% survived to hospital discharge or at least 60 days following ICU admission.

The team then delved deeper into the data using an analytic technique called target trial emulation, which allows them to use observational data to infer causality when randomized controlled trials are unavailable. By this method, the researchers examined selected patients with severe respiratory failure, defined as those with a very low ratio of oxygen content in their blood divided by the amount of inspired oxygen delivered by the ventilator. They found that patient treated with ECMO in the first seven days of ICU admission had a considerable reduction in mortality compared to those who were similarly ill but who were not treated with ECMO. Specifically, among the 1,297 patients eligible for the target trial emulation, just over a third of the 130 who received ECMO died, compared to nearly half of those who did not receive ECMO.

"These findings are not only statistically significant, but very clinically meaningful," said senior author David E. Leaf, MD, Director of Clinical and Translational Research in Acute Kidney Injury in the Division of Renal Medicine at the Brigham. "They show a considerable magnitude of benefit with ECMO - a 45% reduction in death - among the sickest patients. That's very compelling evidence that ECMO saves lives."

"ECMO gives patients' lungs time to heal when we've exhausted every other aspect of care for these patients - it can be a bridge to recovery," said corresponding author Shahzad Shaefi, MD, Co-Director of the ECMO Program at BIDMC and in the Department of Anesthesia, Critical Care and Pain Medicine. "But ECMO's efficacy in the context of COVID-19 remains unclear. This work sheds new light on that question in the most robust way possible during the COVID-19 pandemic."

Related Links:
Beth Israel Deaconess Medical Center
Brigham and Women’s Hospital