Outcomes of ECMO for Critical COVID-19 disease

Abstract

Background: In August 2020, the Mongolian government initiated preparations for addressing the new COVID-19 pandemic by acquiring the first ECMO machine for the First Central Hospital of Mongolia (FCHM). Since then, the number has grown to four machines. During the pandemic, the first successful treatment commenced in February 2021 at the National Center for Communicable Disease (NCCD), in collaboration with the ECMO team at FCHM. Despite the initiation of ECMO treatment during the COVID-19 pandemic, there is still a lack of studies on mortality rates and complications, prompting our investigation. Aim: The objective of this study is to assess the outcomes of ECMO treatment in severe cases of COVID-19 and to identify external factors influencing the mortality rate. Materials and Methods: The study included 25 severe COVID-19 cases treated with ECMO and 61 non-ECMO patients at the First Central Hospital of Mongolia (FCHM), National Center for Communicable Disease (NCCD), and Central Military Hospital (CMH) from February 2021 to October 2023. Patient laboratory results, diagnostic procedures, and medical notes were analyzed in a retrospective cross-sectional study. Results: The average age of the patients was 57±11.9 (23-84), with a gender ratio of 55.8% male (48) and 44.2% female (38). Vaccination status revealed 11.2% (10) with the first dose, 58.1% (50) fully vaccinated, 7.0% with an additional dose, 3.5% (3) with a fourth dose, and 30.2% (26) unvaccinated. The overall survival rate was 12.8% (11), while the mortality rate was 81.2% (75). Non-ECMO-treated patients had a survival rate of 4.9% (3) and a mortality rate of 95.1% (58). Among those who received ECMO treatment, the survival rate was 32.0% (8), and the mortality rate was 68.0% (18). In the multivariable study (OR 0.296, 95% CI 0.156-0.558, P < 0.001), ECMO treatment was found to significantly reduce the mortality rate of the patients. Conclusion: In severe cases of COVID-19, ECMO treatment demonstrated a reduction in patient mortality. Factors such as high BMI, diabetes, and a high qSOFA score were associated with increased mortality rates.