Prospective Evaluation after 3 Years on Survival Quality of Life and Functional Outcomes in COVID-19 Patients with Severe Acute Respiratory Distress Syndrome Managed with Veno-venous ECMO

Rationale: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19 unresponsive to conventional therapy, but uncertainty remains about the determinants of in-hospital mortality, and data on post-discharge outcomes are scarce.Studies suggest that ECMO can provide a survival benefit for these patients.Long-term functional outcomes post-ECMO are still under investigation, with some studies indicating that patients may experience ongoing health challenges after discharge.Continuous research and long-term follow-up are essential to fully understand the efficacy of ECMO and optimize post-discharge care for these patients.Objectives: To assess the clinical outcomes, quality of life, and functional status of COVID-19 patients who underwent ECMO for refractory acute respiratory distress syndrome (ARDS) and to form evidence-based guidelines for managing severe COVID-19 cases and mitigating their long-term impacts.Materials and methods: In our center, we provided ECMO support to 185 COVID-19 patients with severe ARDS between March 2020 and August 2021.This single-center, retrospective, observational study included adult patients (over 18 years) admitted to the ICU during the aforesaid period, diagnosed with COVID-19-related ARDS refractory to conventional therapies, eventually supported with extracorporeal life support (ECLS), and who survived to discharge.We collected data retrospectively, encompassing demographics, comorbidities, clinical characteristics, treatment modalities prior to ECMO, respiratory parameters, ECMO support details, and post-discharge follow-up information.Results: Among the study population, 78.4% were male, with a mean age, weight, and height of 46.51 9.03, 60 10.96, and 165 6.79, respectively.The most common comorbidity was hypertension, 54.1% were referred from outside hospitals, and 43.2% were already in an intubated state.Proning was tried in 18.9% of patients pre-ECMO and 40.5% of patients post-ECMO.Patients received several therapies such as corticosteroids, antivirals, vasopressors, and renal replacement therapy (RRT), and almost 89.2% of the patients were tracheostomized.The mean duration of ECMO was 21.40 13.34 days, with the longest being 150 days.The most common complication among the survivors during ECMO was hypercoagulability and clot formation in the circuits or oxygenator, and post-discharge, 86.2% of patients needed oxygen at home for almost 2.5 months.Though many patients suffered from stress disorders and psychiatric problems post-discharge, most patients were able to live independently and returned to their previous work after 6 months of discharge.Conclusion: Extracorporeal membrane oxygenation was a salvage therapy in refractory ARDS related to COVID-19.Though it may have postdischarge challenges of post-acute COVID-19 syndrome (PACS) along with its effect on the physical and functional abilities of the patient, the long-term outcome is positive, though further studies are required to establish standardized strategies.