Aim: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or COVID-19, infection resulting in acute respiratory distress syndrome (ARDS) requiring veno-venous or veno-arterial extracorporeal membrane oxygenation (VV or VA-ECMO) support is a life-threatening disease process that requires prolonged intubation and has a high risk of mortality. 

Methods: In this retrospective, observational, single-center cohort study, we attempt to better understand the role of extubation in the course of treatment by dichotomizing groups into those extubated early while remaining on ECMO treatment (group A), compared to patients who remained intubated for the entirety of their ECMO treatment (group B). 

Results: The data indicate that early extubation of patients with COVID-19-associated ARDS requiring ECMO support leads to improved survival rates for group A (93%) compared to prolonged intubation (group B) throughout the course of ECMO therapy (64%) (p = 0.13). Additionally, patients extubated earlier (19 days vs. 59 days; p = 0.012) required significantly fewer vasoactive drugs (norepinephrine dosing: 0.03 mcg/kg/min vs. 0.093 mcg/kg/min; p = 0.04), and were less likely to require a tracheostomy (0 vs. 4, p = 0.026). 

Conclusions: Although the utility of ECMO in severe ARDS patients remains a contentious topic, early extubation seems to increase survival rates and overall patient outcomes in patients with COVID-19-associated ARDS requiring ECMO support.

Amit Prasad is an Associate Professor of Anesthesiology and Perioperative Medicine at the Penn State Milton S Hershey Medical Center which is the academic hospital for Penn State Health. He is both a general anesthesiologist and an intensivist in the cardiac care unit which is apart of the Heart and Vascular Critical Care Unit, specializing in adult mechanical circulatory support and heart failure patients. He is also the Medical Director of the cardiac care unit and the Director of the Adult ECMO program in the Heart and Vascular Institute at Penn State Health. Furthermore, He also associate vice chair of education for the Heart and Vascular Institute and am academically responsible for residents and fellows that rotate through the Heart and Vascular Cardiac Care Unit.