Adding another mechanical support system—extracorporeal membrane oxygenation, or ECMO—for patients with 2019 coronavirus disease (COVID-19) on ventilators resulted in 96 percent of patients surviving (4 percent mortality) over a 44-day period, an early study finds. Patients with this severity of disease often die, say the study authors, with another recent report finding the mortality rate to be 88.1 percent among patients with COVID-19 who are intubated.
Led by researchers at NYU Grossman School of Medicine, the study of 27 patients placed on ECMO found the high survival rate at the end of the study period, which ran from March 10 to April 24. Of the 321 patients intubated during that span, 27 were chosen to receive ECMO because the research team judged that it would give them a chance to survive otherwise frequently fatal respiratory failure. While critically ill, the included patients had neither life-threatening complications (such as blood clotting issues) nor the very lowest observed oxygen levels in their arteries (a PaO2/FiO2, or P/F, ratio of less than 60 mmHg).
Published online in The Annals of Thoracic Surgery, the study is the largest published single-center examination of ECMO, a specialized heart–lung bypass machine used when the lungs cannot function by themselves, in patients with severe COVID-19. The technique—which removes blood from the body, infuses it with oxygen, and returns it—is an intricately challenging process to manage, say the authors. Its many risks include bleeding complications and stroke, with only specialized centers having the capability to deliver it safely.
“Our team at NYU Langone has in-depth experience with ECMO and was confident that an early, aggressive approach to this therapy could improve patient survival,” says Zachary N. Kon, MD, associate professor in the Department of Cardiothoracic Surgery, surgical director of lung transplantation at the NYU Langone Transplant Institute, and co-lead author of the study. “This study provides evidence in support of the value of ECMO in patients with COVID-19.”
For the study, a team of cardiothoracic surgeons, pulmonologists, and critical care specialists retrospectively looked at outcomes for all patients referred for ECMO support at NYU Langone’s Tisch Hospital and Kimmel Pavilion in Manhattan during the study period. Of the 27 patients included, 13 patients (48 percent) remained on ECMO support at that end of the study period, while 13 patients (48 percent) had their ventilator removed, and 7 patients (25.9 percent) had been discharged from the hospital. Six patients (22.2 percent) remained in the hospital.
Complications associated with the mechanical support developed in 11 patients, including renal failure and low levels of platelets within the blood.
“Our research found that with early intervention, appropriate patient selection and management, lung recovery is possible,” says Deane E. Smith, MD, assistant professor in the Department of Cardiothoracic Surgery, director of the Adult ECMO Program at NYU Langone, and the other co-lead author. “Our findings should reassure the medical community to offer ECMO to appropriate patients with severe COVID-19.”
“This is the largest single-center study of its kind in the United States, with the best results worldwide,” notes Aubrey C. Galloway, MD, the Seymour Cohn Professor of Cardiothoracic Surgery and chair of the Department of Cardiothoracic Surgery and the study’s senior author. “Our team of physicians, nurses, respiratory therapists, and clinical staff along with assistance from the corporate services across the institution made this intricate treatment a success. What we’ve accomplished is not easily replicated and is made possible by our commitment to provide the best care for our patients.”
Researchers plan on continuing to follow the patients for 90 days with a matched control and additional pulmonary function tests to further confirm the reported benefits of ECMO.
Along with Dr. Kon, Dr. Smith, and Dr. Galloway, authors of the study from NYU Langone were Stephanie H. Chang, MD; Ronald M. Goldenberg, MD; Luis F. Angel, MD; Julius A. Carillo, MD; Travis C. Geraci, MD; Bridget Toy, BSN, RN; Kimberly Sureau, BSN, RN; Brigitte Sullivan, MBA; Daniel H. Sterman, MD; Robert J. Cerfolio, MD, MBA; Robert Montgomery, MD, PhD; and Nader Moazami, MD.