Extracorporeal membrane oxygenation for COVID‐19‐associated acute respiratory distress syndrome: A nationwide analysis

Abstract

AbstractExtracorporeal membrane oxygenation (ECMO) has been used for COVID‐19‐associated acute respiratory distress syndrome (ARDS). We aimed to elucidate the association between ECMO and mortality in patients with COVID‐19‐associated ARDS in the nationwide setting. United States National Inpatient Sample was used to identify mechanically ventilated adults for COVID‐19 with ARDS. We divided them into three groups according to the use of ECMO (i.e., no‐ECMO, venovenous [VV]‐ECMO, and venoarterial [VA]‐ECMO). The primary outcome was in‐hospital mortality, while the secondary outcomes included the length of hospital stay (LOS) and the total costs during hospitalization. We performed a stepwise logistic regression, adjusting for baseline characteristics, comorbidities, and severity. We included 68 795 (mean age [SD]: 63.5 [0.1]), 3280 (mean age [SD]: 48.7 [0.5]), and 340 (mean age [SD]: 43.3 [2.1]) patients who received no‐, VV‐, and VA‐ECMO, respectively. The logistic regression analysis did not show significant associations between the use of VV‐/VA‐ECMO and mortality (adjusted odds ratio with no‐ECMO as reference [95% confidence interval]: 1.03 [0.86−1.24] and 1.18 [0.64−2.15], respectively). While LOS was longest with VV‐ECMO, the total costs were highest with VA‐ECMO. In conclusion, our study found no association between the use of ECMO and mortality of COVID‐19‐associated ARDS in the nationwide setting.