Extracorporeal membrane oxygenation instead of invasive ventilation in patients with COVID–19 acute respiratory distress syndrome (ARDS) and pneumomediastinum: a cohort trial

Abstract

Abstract Background Patients with severe respiratory failure due to COVID–19 who are not invasively ventilated may develop severe hypoxemia due to spontaneous pneumomediastinum (PM). These patients might be harmed by invasive ventilation. Alternatively, veno − venous extracorporeal membrane oxygenation (VV–ECMO) may be utilised. The aim of this study was to compare the efficacy of VV–ECMO versus invasive ventilation as the initial advanced respiratory support in COVID–19 patients with acute respiratory failure due to spontaneous PM. Methods This is a retrospective cohort study performed between March 2020 and January 2022. Not invasively ventilated COVID–19 patients presented acute respiratory failure due to spontaneous PM needed invasive ventilation or VV–ECMO support were enrolled in this study. Mortality and intensive care unit (ICU) discharge at 90 days after ICU admission were the primary outcomes. Results Twenty-two patients included in this study. Thirteen patients (59%) were originally treated with invasive ventilation (Invasive ventilation group) and 9 (41%) with VV–ECMO (VV–ECMO group). VV–ECMO strategy was significantly associated with lower mortality 0.33 [95%−CI 0.12 − 0.97], P = 0.04]) (hazard ratio (HR), 0.33 [95%–confidence interval (CI) 0.12 − 0.97], P = 0.04). 5 patients of the VV–ECMO group were intubated and 8 of the invasive ventilation group were needed VV–ECMO support within 30 days. Three patients (33%) in the VV–ECMO group were discharged from ICU within 90 days compared to 1 patient (8%) in the invasive ventilation group (HR 4.71 [95%−CI 0.48 − 45.3], P = 0.18). Conclusions VV–ECMO without invasive ventilation is associated with a higher survival rate but not a reduced ICU length of stay in patients with COVID–19 acute respiratory failure due to spontaneous pneumomediastinum.