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?:abstract
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Background: The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking We aim to report clinical characteristics, management and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume centre in the UK Methods: Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3 March and 2 May 2020 Clinical management is described Data are reported for survivors and nonsurvivors Results: We describe 43 consecutive patients with COVID-19 who received VV-ECMO Median age was 46 years (interquartile range 35 5–52 5) and 76 7% were male Median time from symptom onset to VV-ECMO was 14 days (interquartile range 11–17 5) All patients underwent computed tomography imaging, revealing extensive pulmonary consolidation in 95 3%, and pulmonary embolus in 27 9% Overall, 79 1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state Vasopressors were used in 86%, and 44 2% received renal replacement therapy Median duration on VV-ECMO was 13 days (interquartile range 8–20) 14 patients died (32 6%) and 29 survived (67 4%) to hospital discharge Nonsurvivors had significantly higher d-dimer (38 2 versus 9 5 mg·L−1, fibrinogen equivalent units;p=0 035) and creatinine (169 versus 73 μmol·L−1;p=0 022) at commencement of VV-ECMO Conclusions: Our data support the use of VV-ECMO in selected COVID-19 patients The cohort was characterised by high degree of alveolar consolidation, systemic inflammation and intravascular thrombosis
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