Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-support system that provides cardiopulmonary support. With recent advances, the duration of ECMO has increased but data on the outcomes of prolonged V-V ECMO are limited and inconsistent.
Materials and methods: It is a retrospective observational study done at a tertiary care center in Kolkata to study the outcome of patients receiving prolonged V-V ECMO defined as >14 days.
Observation: A total of 22 patients received prolonged ECMO support. Fifteen patients (68.2%) had severe coronavirus disease-2019 (COVID-19). The mean duration of invasive mechanical ventilation (IMV) before ECMO was 5 days. Baseline PaO2/FiO2 (p/f) ratio was 82 and Murray score was 3.5. The mean duration of ECMO support was 27.18 days (SD: 11.59). Five patients (22.7%) had minor bleeding and one patient had oxygenator failure. Survival at hospital discharge was seven patients (31.8%).
Conclusion: Duration of ECMO support alone should not represent a basis for decision making to decide futility or continuation of ECMO support. Prolonged ECMO in acute respiratory distress syndrome (ARDS) has minor complications and can lead to recovery in almost one-third of the patients.
Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: A systematic review and meta-analysis. Lancet Respir Med 2019;7(2):163–172. DOI: 10.1016/S2213-2600(18)30452-1.
Tonna JE, Abrams D, Brodie D, Greenwood JC, RUBIO Mateo-Sidron JA, Usman A, et al. Management of adult patients supported with venovenous extracorporeal membrane oxygenation (VV ECMO): Guideline from the extracorporeal life support organization (ELSO). ASAIO J 2021;67(6):601. DOI: 10.1097/MAT.0000000000001432.
Makdisi G, Wang IW. Extra corporeal membrane oxygenation (ECMO) review of a lifesaving technology. J Thorac Dis 2015;7(7): E166–176. DOI: 10.3978/j.issn.2072-1439.2015.07.17.
Akoumianaki E, Jonkman A, Sklar MC, Georgopoulos D, Brochard L. A rational approach on the use of extracorporeal membrane oxygenation in severe hypoxemia: Advanced technology is not a panacea. Ann Intensive Care 2021;11(1):107. DOI: 10.1186/s13613-021-00897-3.
Na SJ, Jung JS, Hong SB, Cho WH, Lee SM, Cho YJ, et al. Clinical outcomes of patients receiving prolonged extracorporeal membrane oxygenation for respiratory support. Ther Adv Respir Dis 2019;13:1753466619848941. DOI: 10.1177/1753466619848941.
Posluszny J, Rycus PT, Bartlett RH, Engoren M, Haft JW, Lynch WR, et al. Outcome of adult respiratory failure patients receiving prolonged (≥14 days) ECMO. Ann Surg 2016;263(3):573–581. DOI: 10.1097/SLA.0000000000001176.
Rabie AA, Asiri A, Rajab M, Mufti HN, Alsherbiny M, Azzam MH, et al. Beyond frontiers: Feasibility and outcomes of prolonged veno-venous extracorporeal membrane oxygenation in severe acute respiratory distress syndrome. ASAIO J Am Soc Artif Intern Organs 1992 2021;67(3):339–344. DOI: 10.1097/MAT.0000000000001367.
Mariappan R, Kumar M, Ramakrishnan N, Mani AK, Kumar S, Chandrasekaran V. Practice patterns and outcome of extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome in Indian ICUs. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med 2021;25(11):1263–1268. DOI: 10.5005/jp-journals-10071-23928.
Kakar V, North A, Bajwa G, Raposo N, Kumar PG. Long runs and higher incidence of bleeding complications in COVID-19 patients requiring venovenous extracorporeal membrane oxygenation: A case series from the United Arab Emirates. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med 2021;25(12):1452–1458. DOI: 10.5005/jp-journals-10071-24054.
Posluszny J, Engoren M, Napolitano LM, Rycus PT, Bartlett RH, ELSO member centers. Predicting survival of adult respiratory failure patients receiving prolonged (≥14 days) extracorporeal membrane oxygenation. ASAIO J Am Soc Artif Intern Organs 1992 2020;66(7):825–833. DOI: 10.1097/MAT.0000000000001067.
Lee EH, Lee KH, Lee SJ, Kim J, Baek YJ, Ahn JY, et al. Clinical and microbiological characteristics of and risk factors for bloodstream infections among patients with extracorporeal membrane oxygenation: A single-center retrospective cohort study. Sci Rep 2022;12(1):15059. DOI: 10.1038/s41598-022-19405-z.
Yaqoob H, Greenberg D, Huang L, Henson T, Pitaktong A, Peneyra D, et al. Extracorporeal membrane oxygenation in COVID-19 compared to other etiologies of acute respiratory failure: A single-center experience. Heart Lung 2023;57:243–249. DOI: 10.1016/j.hrtlng.2022.10.003.
Blazoski CM, Baram M, Yang Q, Hirose H. Outcomes of extracorporeal membrane oxygenation in influenza versus COVID-19 during the first wave of COVID-19. J Card Surg 2021;36(10):3740–3746. DOI: 10.1111/jocs.15888.