#4112 IMPACT OF ADD-ON EXTRACORPOREAL MEMBRANE OXYGENATION ON THE OUTCOME OF CRITICALLY ILL COVID-19 POSITIVE PATIENTS
Authors: Gheith Osama Ashry Ahmed , Abbas Ahmad , Zahab Mohamed Ahmed Abdulkhalek , Hammad Muhammad , Adel Mohamad , Atta Ahmed , Fayad Zohair , Megahad Mohamed , Nair Prasad , Alotaibi Torki , Khalid Mahmoud 
Published: June 2023

Abstract

Background and Aims
Growing reports arguing the value of extracorporeal membrane oxygenation (ECMO) support on COVID-19 survival. The earliest studies reported prohibitively high mortality in small cohorts. International medical organizations still recommended, early in the pandemic, that ECMO should be considered if conventional treatment was not successful. To evaluate the impact of add-on ECMO on the outcome of critically ill COVID-19 patients.

Method
An observational study recruited critically ill COVID-19 patients necessitating ECMO support during their stay in governmental hospitals of Kuwait from March 2020 to December 2021. Socio-demographic characters (age, sex, smoking history, comorbidities), clinico-laboratory parameters (days of mechanical ventilation before ECMO, routine investigations, LDH, ferritin, D-dimer, arterial blood gases &reporting any positive cultures; sputum, blood &/or others), chest radiological findings, and different lines of management (steroids, antivirals, antibiotics, biological therapy and anticoagulants) were recorded for all patients. Moreover, various complications and acute events during ECMO were reported with special stress on bleeding or thrombotic event, RBCs or platelet transfusion in addition to acute kidney injury (AKI) on ECMO. Final outcome was recorded regarding ECMO duration, ICU stay, mortality, and need for ventilatory support post discharge.

Results
Most of the studied patients (n = 135) were males (61.48%), non-smokers (80%) in their middle age (41.28±9.88 years). DM was the most prevalent comorbidity (24%). The reported survival rate was 58.5%. Non-survivors were older (43.6± 8.7 vs. 38.92 ±8.75 years, p = 0.01), predominantly males (p = 0.046), had higher mean platelet volume (21.78±7.55 vs. 13.47±8.19, p = 0.02), median D-dimer (4312±2146 vs. 2795±1545, p = 0.04) and mean CO2 (65.1±25.69 vs. 52.45±24.05, p = 0.01). Most of non-survivors (56.9%) had computed tomography (CT) chest findings consistent with COVID-19 (vs. 35.7% among COVID-19unmatched CT) (p = 0.028). Moreover, non-survivors were more likely to be shocked and supported with vasopressors (50 out of 56 patients) or developed AKI while on ECMO (44 out of 56 patients), (p &lt;0.001, 0.012 respectively). Most patients who were managed by biological agents survived compared to those who did not receive it (75% vs. 49.5% respectively, p = 0.038). We found a significant positive correlation between ECMO duration, age (p = 0.012), and LDH (p = 0.041); a significant positive correlation between LDH and ICU stay (p&lt;0.001); a significant positive correlation between D-dimer, CRP (p = 0.006) and PaC02 (p = 0.015). We found that post-discharge ventilatory support among survivors was needed in 48.1% and 11.4% (as O2 supplementation or CPAP, respectively).

Conclusion
ECMO should be considered for critically ill COVID-19 patients who develop refractory respiratory failure despite standard care.