89% of eligible COVID-19 patients who didn't receive ECMO died at US hospital

Most (89.1 percent) adult COVID-19 patients who were eligible for but didn't receive extracorporeal membrane oxygenation owing to a lack of resources during the peak of the pandemic died in the hospital, even though they were young and had few underlying health issues, according to findings published Feb. 24 by the American Journal of Respiratory and Critical Care Medicine.

Researchers from Nashville, Tenn.-based Vanderbilt University analyzed Jan. 1 to Aug. 31, 2021, data from all COVID-19 patients referred to a single center for ECMO, a last-resort therapy for severely ill COVID-19 patients. Patients qualified for ECMO if they were younger than 60, had a body mass index less than 55 kg/m2, had received mechanical ventilation for more than seven days, or had irreversible neurologic injury, chronic lung disease, cancer or advanced multi-organ dysfunction. An assessment of the health system's resources to provide ECMO (equipment, staffing and intensive care unit bed availability) was conducted. If resources were available, patients were started on ECMO and then transferred to an ECMO center.  

 Four things to know: 

1. Among 240 COVID-19 patients referred for ECMO, 10.8 percent didn't complete the referral evaluation, 18.3 percent didn't meet lung injury severity criteria, 33.3 percent had contraindications to treatment, and 37.5 percent were eligible for ECMO. 

2. Of eligible patients, 61.1 percent didn't receive ECMO because of a shortage of resources. Nearly 90 percent of these patients died in the hospital, compared to 42.9 percent of patients who received ECMO.

3. "Even when saving ECMO for the youngest, healthiest and sickest patients, we could only provide it to a fraction of patients who qualified for it," Whitney Gannon, MSN, RN, lead study author, said in a Feb. 25 news release. "I hope these data encourage hospitals and federal authorities to invest in the capacity to provide ECMO to more patients."

4. "This data suggests that, on average, providing ECMO to two patients will save a life and give a young person the potential to live for decades," said Jonathan Casey, MD, senior study author.


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