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Higher #mortality in #ECMO patients during the #COVID19 #pandemic compared with #H1N1 #influenza: implications for future pandemics

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By G.M.

 


Highlights

-- Higher Mortality in COVID-19 ECMO Patients: COVID-19 patients on ECMO had a significantly higher in-hospital mortality rate (52%) compared to H1N1 patients (6%) (p < 0.0001).

-- Increased Complications in COVID-19: COVID-19 patients had a higher incidence of complications, including:

• Secondary bloodstream infections (OR = 14.3; p = 0.003)

• Neurological complications

• Acute kidney injury requiring renal replacement therapy (RRT)

-- Longer ECMO Duration in COVID-19: COVID-19 patients required longer durations of ECMO support compared to H1N1 patients.

-- Age and Comorbidities Impact Mortality: Even after adjusting for age, BMI, gender, and ECMO duration, COVID-19 conferred a 16-fold higher risk of mortality compared to H1N1 (adjusted OR = 16.8).


Abstract

Background

Veno-venous Extracorporeal Membrane Oxygenation (V-V ECMO) in management of refractory respiratory failure due to viral respiratory infections has increased with recent pandemics.

Aims

The aim was to compare clinical characteristics and outcomes of patients requiring ECMO support during an evolving pandemic with COVID-19, with patients during the H1N1-influenza pandemic and subsequent seasonal epidemics, where adjunct therapy and vaccination was available.

Methods

Medical records of inpatients at an ECMO referral centre diagnosed with COVID-19 between March 2020 and October 2022 and requiring ECMO support were analysed. The clinical characteristics and outcomes of these patients were compared to data from patients with H1N1 influenza requiring ECMO between July 2009 and August 2017, treated at the same centre. The primary outcome of in-hospital mortality was analysed with a multivariate logistic regression model; categorical and continuous variables were compared using Fisher’s exact tests and two-sample T-tests, respectively.

Results

ECMO was used in 27 COVID-19 patients and 32 H1N1 influenza patients. Compared with H1N1 patients, COVID-19 patients were older (49.2±9.0 vs 42.3±11.1 years,p=0.01), and more likely to have comorbidities (59% vs 28%,p=0.02). Mortality was significantly higher for COVID-19 patients (52% vs 6%,p<0.0001), odds ratio 16.8 (95% CI: 1.27 - 221.39,p<0.05). Days on ECMO were longer in the COVID-19 group (20±13.3 vs 10±5.6 days,p<0.001). ECMO-related complication rates were similar between groups, apart from higher rates of secondary blood stream infections in COVID-19 patients (44% vs 6%,p<0.001).

Conclusion

Outcomes in patients with COVID-19 requiring ECMO support were worse than those requiring similar support during H1N1 seasons.

Source: Respiratory Medicine, https://www.resmedjournal.com/article/S0954-6111(25)00374-9/abstract

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