Background: Predicting whether extracorporeal membrane oxygenation (ECMO) treatment duration affects prognosis is important both medically and economically. We conducted a retrospective, multicenter study to better understand the outcomes of patients treated with VV ECMO for a prolonged duration, analyzing data from the Israel ECMO registry. The study included all adult patients treated with VV-ECMO due to COVID-19-induced respiratory failure. The primary outcomes were survival rates up to 180 days from cannulation. Results: One hundred and eighty-eight patients were included in the study. The median age was 50 years (IQR 42, 50) and 69% were male. Patients were mechanically ventilated for a median of 2.5 days before cannulation (IQR 0.5, 5). The mean ECMO support duration was 29.9 days, with a maximal duration of 189.9 days. Survival rate for 180 days was 56%. We found no change in survival for patients on ECMO for 14, 28, or 56 days. Every day of mechanical ventilation before cannulation correlated with an 11% greater risk for prolonged ECMO treatment (p=0.01). Conclusions: For COVID-19-induced ARDS patients treated with VV-ECMO, ECMO treatment duration did not affect mortality. The longer the duration of mechanical ventilation before ECMO cannulation, the higher the risk for prolonged ECMO treatment.

Background: The COVID-19 pandemic markedly increased the number of patients with infection-related acute respiratory distress syndrome who required extracorporeal membrane oxygenation (ECMO) and multiple blood transfusions. This study aimed to assess a potential correlation between the daily rate of transfused blood products and the intensive care unit (ICU) outcome of ECMO-supported COVID-19 patients. Methods: Data were retrieved from the electronic databases of three Israeli tertiary care centers. All COVID-19 patients treated with ECMO for >3 days in these centers between July 2020 and November 2021 were included in the analysis. Results: The study incorporated 106 patients [median age 49 (17–73) years]. The median numbers of ECMO days and daily transfused packed red blood cell (PRBC) units were 20.5 (4–240) and 0.61 (0–2.82), respectively. In multivariate analysis, age ≥50 years was an independent factor for ICU mortality [odds ratio (OR) 4.47). In ECMO-supported patients for <38 days, transfusion of ≥0.85 units/day was associated with higher ICU mortality compared to that observed in patients transfused with <0.85 PRBC units/day (OR = 5.43; p < 0.004). Transfusion of ≥0.5 units/day combined with ECMO support of ≥38 days (OR = 17.9; p < 0.001) conferred the highest mortality risk. Conclusions: Three-quarters of patients <50 years old and half of patients ≥50 years were successfully discharged from ICU. Higher daily transfusion rates were associated with significantly increased ICU mortality, irrespective of ECMO duration. Reduced blood transfusion may improve the survival of these patients. This approach could also contribute to the measures taken to address the challenges of blood shortages occurring during pandemics and other global or national emergencies.

Background: Veno-venous extra-corporeal membrane oxygenation (ECMO) cannulations are mostly performed while patients are heavily sedated and mechanically ventilated. For patients with acute respiratory distress syndrome (ARDS), cannulating for ECMO while awake and spontaneously breathing, as well as treating without sedation and mechanical ventilation, has potential advantages. This study aimed to compare clinical outcomes between patients cannulated for ECMO while awake and patients cannulated while sedated and mechanically ventilated. Methods: A retrospective multicenter study. Data were accessed from the Israeli ECMO registry of patients with COVID-19-induced ARDS treated at eight ECMO centers in Israel. The study group comprised 24 patients who were cannulated while awake and spontaneously breathing. A control group comprised 96 patients who were cannulated after sedation and mechanical ventilation, matched 1:4 by age, sex, and body mass index. The primary outcome was six-month survival. Secondary outcomes were: the duration of ECMO therapy, the duration of invasive mechanical ventilation-free ECMO therapy, and the duration of invasive mechanical ventilation. Results: The mean age was 52 + 11 years; 78% were males. Fifteen patients (63%) in the study group were eventually intubated. The mean durations on ECMO and in the intensive care unit did not differ between the groups. The study group had a higher six-month survival (75% vs. 49%, p = 0.02) and fewer infectious complications such as pneumonia or bacteremia (21% vs. 40%, p < 0.001) compared to the control group. After adjusting for PO₂/FiO₂ ratio and for the COVID-19 variant, the hazard ratio was 0.45 (C.I 0.19–1.06, p = 0.069). Conclusions: Awake VV-ECMO cannulation in COVID-19-induced ARDS is feasible in selected patients and was associated with higher survival in unadjusted analyses. However, after adjustment for key covariates, this association was attenuated and did not reach statistical significance.

Objective: Veno-venous extra-corporeal membrane oxygenation (ECMO) cannulations are mostly done while patients are heavily sedated and mechanically ventilated. For patients with acute respiratory distress syndrome (ARDS), cannulating for ECMO while awake and spontaneously breathing, and treating without sedation and mechanical ventilation has potential advantages. This study aimed to compare clinical outcomes between patients cannulated for ECMO while awake and patients cannulated while sedated and mechanically ventilated. Design: A retrospective multicenter study. Setting: Data were accessed from the Israeli ECMO registry of patients with COVID-19-induced ARDS treated at eight ECMO centers in Israel. Patients: The study group comprised 24 patients who were cannulated while awake and spontaneously breathing. A control group comprised 96 patients who were cannulated after sedation and mechanical ventilation, matched 1:4 by age, sex, and body mass index. Interventions: None. Measurements: The primary outcome was six-month survival. Secondary outcomes were: the duration of ECMO therapy, the duration of invasive mechanical ventilation-free ECMO therapy, and the duration of invasive mechanical ventilation. Main Results: The mean age was 52 + 11 years; 78% were males. Fifteen (63%) of the study group were eventually intubated. The mean durations on ECMO and in the intensive care unit did not differ between the groups. The study group had a higher six-month survival (75% vs 49%, p=0.02), and fewer infectious complications such as ventilatory-induced pneumonia or bacteremia (21% vs 40%, p<0.001) compared to the control group. Conclusions: In patients with severe COVID-19-induced ARDS, awake cannulation for veno-venous ECMO may improve six-month survival compared to cannulation while sedated and mechanically ventilated.