Extracorporeal Membrane Oxygenation in Patients With COVID-19: An International Multicenter Cohort Study

J Intensive Care Med. 2021 Aug;36(8):910-917. doi: 10.1177/08850666211007063. Epub 2021 Apr 7.


Background: To report and compare the characteristics and outcomes of COVID-19 patients on extracorporeal membrane oxygenation (ECMO) to non-COVID-19 acute respiratory distress syndrome (ARDS) patients on ECMO.

Methods: We performed an international retrospective study of COVID-19 patients on ECMO from 13 intensive care units from March 1 to April 30, 2020. Demographic data, ECMO characteristics and clinical outcomes were collected. The primary outcome was to assess the complication rate and 28-day mortality; the secondary outcome was to compare patient and ECMO characteristics between COVID-19 patients on ECMO and non-COVID-19 related ARDS patients on ECMO (non-COVID-19; January 1, 2018 until July 31, 2019).

Results: During the study period 71 COVID-19 patients received ECMO, mostly veno-venous, for a median duration of 13 days (IQR 7-20). ECMO was initiated at 5 days (IQR 3-10) following invasive mechanical ventilation. Median PaO2/FiO2 ratio prior to initiation of ECMO was similar in COVID-19 patients (58 mmHg [IQR 46-76]) and non-COVID-19 patients (53 mmHg [IQR 44-66]), the latter consisting of 48 patients. 28-day mortality was 37% in COVID-19 patients and 27% in non-COVID-19 patients. However, Kaplan-Meier curves showed that after a 100-day follow-up this non-significant difference resolves. Non-surviving COVID-19 patients were more acidotic prior to initiation ECMO, had a shorter ECMO run and fewer received muscle paralysis compared to survivors.

Conclusions: No significant differences in outcomes were found between COVID-19 patients on ECMO and non-COVID-19 ARDS patients on ECMO. This suggests that ECMO could be considered as a supportive therapy in case of refractory respiratory failure in COVID-19.

Keywords: ARDS; COVID-19; ECMO; survival.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • COVID-19* / mortality
  • COVID-19* / therapy
  • Cohort Studies
  • Extracorporeal Membrane Oxygenation*
  • Female
  • Humans
  • Internationality
  • Male
  • Middle Aged
  • Respiratory Distress Syndrome* / mortality
  • Respiratory Distress Syndrome* / therapy
  • Retrospective Studies