Extracorporeal membrane oxygenation (ECMO) reduces mortality in critically ill COVID-19 patients to less than 49%, according to a new study.

Researchers at the University of Michigan (U-M; Ann Arbor, USA), the University of Toronto (Canada), the Extracorporeal Life Support Organization (ELSO; Ann Arbor, MI, USA), and other institutions collated data drawn from the ELSO registry to characterize epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation.

The results showed that 380 of the patients in the study had died in the hospital, with more than 80% of them dying within 24 hours of a proactive decision to discontinue ECMO because of a poor prognosis. Of the remaining patients, 57% were released to their home, to a rehabilitation center, or were discharged to another hospital or long-term acute care center. The remaining patients were still in the hospital, but survived to reach 90 days after start of ECMO. The study was published on September 25, 2020, in The Lancet.

“These results from hospitals experienced in providing ECMO are similar to past reports of ECMO-supported patients, and support recommendations to consider ECMO in COVID-19 if the ventilator is failing,” said study co-lead author Ryan Barbaro, MD, MS, of U-M, who also chairs ELSO. “We hope these findings help hospitals make decisions about this resource-intensive option. All of this knowledge can help centers and families understand what patients might face if they are placed on ECMO.”

ECMO is a form of veno-venous extracorporeal life support (VV ECLS), an emerging therapy designed to provide a higher level of life support by infusing oxygen directly into the blood using an oxygenator that acts as an artificial lung. A tapered cannula provides omni-directional flow, optimizing gas exchange and reducing stress on the right side of the heart.

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