Extracorporeal Membrane Oxygenation for COVID-19 respiratory distress syndrome: an Italian Society for Cardiac Surgery Report

An increased need of Extracorporeal Membrane Oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1st and September 15th, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous (VAV) ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n=26). Main causes of death were multiple organ failure (n=14, 31.1%) and sepsis (n=11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p=0.048), elevated pre-ECMO C-reactive protein level (p=0.048), higher positive end-expiratory pressure on ventilator (p=0.036) and lower lung compliance (p=0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.