PMID- 34494893 OWN - NLM STAT- MEDLINE DCOM- 20211203 LR - 20211214 IS - 1557-8674 (Electronic) IS - 1096-2964 (Linking) VI - 22 IP - 10 DP - 2021 Dec TI - Risk Factors of Mortality for Patients Receiving Venovenous Extracorporeal Membrane Oxygenation for COVID-19 Acute Respiratory Distress Syndrome. PG - 1086-1092 LID - 10.1089/sur.2021.114 [doi] AB - Background: Venovenous extracorporeal membrane oxygenation (VV-ECMO) for select adults with severe acute respiratory distress syndrome (ARDS) cause by coronavirus disease 2019 (COVID-19) infection is a guideline-supported therapy with associated hospital survival of 62%-74%, similar to expected survival with VV-ECMO for other indications. However, ECMO is a resource-heavy intervention, and these patients often require long ECMO runs and prolonged intensive care unit (ICU) care. Identifying factors associated with mortality in VV-ECMO patients with COVID-19 infection can inform the evaluation of ECMO candidates as well as prognostication for those patients on prolonged VV-ECMO. Patients and Methods: This was a retrospective cohort study that included all patients who received either VV- or venoarteriovenous (VAV)-ECMO at one of four ECMO Centers of Excellence in the state of Minnesota between March 1, 2020 and November 1, 2020. The primary outcome was 60-day survival. Secondary outcomes were hospital complications, infectious complications, and complications from ECMO. Results: There were 46 patients who met criteria during this study period and 30 survived to 60-day follow-up (65.2%). Prior to cannulation, older patient age (55.5 in non-survivors vs. 49.1 years in survivors; p = 0.03), lower P/F ratio (62.1 vs. 76.2; p = 0.04), and higher sequential organ failure assessment (SOFA) score (8.1 vs. 6.6; p = 0.02) were identified as risk factors for mortality. After ECMO cannulation, increased mortality was associated with increased number of antibiotic days (25.9 vs. 14.5; p = 0.04), increased number of transfusions (23.9 vs. 9.9; p = 0.03), elevated white blood cell (WBC) count at post-ECMO days one through three, elevated D-dimer at post-ECMO day 21-27, and decreased platelet count from post-ECMO days 14 and onward using univariable analysis. Conclusions: Multiple markers of infection including leukocytosis, thrombocytopenia, and increased antibiotic days are associated with increased mortality in patients placed on VV-ECMO for COVID-19 infection and subsequent ARDS. Knowledge of these factors may assist with determining appropriate candidates for this limited resource as well as direct goals of care in prolonged ECMO courses. FAU - Bergman, Zachary R AU - Bergman ZR AD - Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. FAU - Wothe, Jillian K AU - Wothe JK AD - University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA. FAU - Alwan, Fatima S AU - Alwan FS AD - University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA. FAU - Lofrano, Arianna E AU - Lofrano AE AD - Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA. FAU - Tointon, Kelly M AU - Tointon KM AD - Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. FAU - Doucette, Melissa AU - Doucette M AD - Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. FAU - Bohman, John K AU - Bohman JK AD - Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA. FAU - Saavedra-Romero, Ramiro AU - Saavedra-Romero R AD - Department of Critical Care Medicine, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA. FAU - Prekker, Matthew E AU - Prekker ME AD - Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA. AD - Department of Internal Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA. FAU - Lusczek, Elizabeth R AU - Lusczek ER AD - Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. FAU - Beilman, Greg AU - Beilman G AD - Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. FAU - Brunsvold, Melissa E AU - Brunsvold ME AD - Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. LA - eng PT - Journal Article DEP - 20210906 PL - United States TA - Surg Infect (Larchmt) JT - Surgical infections JID - 9815642 SB - IM MH - *COVID-19 MH - *Extracorporeal Membrane Oxygenation/adverse effects MH - Humans MH - *Respiratory Distress Syndrome/therapy MH - Retrospective Studies MH - Risk Factors MH - SARS-CoV-2 OTO - NOTNLM OT - ARDS OT - COVID-19 OT - ECMO OT - mortality OT - venovenous EDAT- 2021/09/09 06:00 MHDA- 2021/12/15 06:00 CRDT- 2021/09/08 12:15 PHST- 2021/09/09 06:00 [pubmed] PHST- 2021/12/15 06:00 [medline] PHST- 2021/09/08 12:15 [entrez] AID - 10.1089/sur.2021.114 [doi] PST - ppublish SO - Surg Infect (Larchmt). 2021 Dec;22(10):1086-1092. doi: 10.1089/sur.2021.114. Epub 2021 Sep 6.