Veno-Arterial ECMO for Circulatory Failure in COVID-19 Patients: Insights from the ECMOSARS Registry

ECMOSARS registry data was used to describe the characteristics and outcomes of COVID-19 patients undergoing either veno-arterial (VA) or veno-arterial venous (VAV) extracorporeal membrane oxygenation (ECMO). The authors concentrated on forty-seven patients, with a median age of forty-nine years, supported with VA or VAV-ECMO for refractory cardiogenic shock. Fourteen percent had a previous heart failure diagnosis. The two most common causes of cardiogenic shock were acute pulmonary embolism (30 percent) and myocarditis (28 percent). Thirty-eight percent of the patients underwent extracorporeal cardiopulmonary resuscitation (eCPR). In-hospital survival in the whole group was 28 percent (43 percent if eCPR patients were excluded). One day after ECMO cannulation, nonsurvivors had significantly more severe acidosis and higher FiO2. Several other factors were associated with death.
 
The authors concluded that VA-ECMO is a viable rescue therapy in carefully selected patients and suggested that eCPR is not a reasonable indication for ECMO in this group.