55: Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) in Covid-19 pneumonia-Related ARDS: observational prospective cohort study

Introduction: COVID-19, caused by SARS-CoV-2, has led to widespread respiratory failure, with many patients developing ARDS requiring mechanical ventilation. In severe cases unresponsive to conventional therapy, veno-venous extracorporeal membrane oxygenation (VV ECMO) provides extracorporeal oxygenation, allowing lung rest and recovery. Its role in COVID-19-related ARDS remains debated due to mixed outcomes across studies. This study evaluates outcomes in patients managed with conventional ventilation versus VV ECMO at a high-volume center. Objectives: Primary: Compare in-hospital mortality in COVID-19 ARDS patients treated with VV ECMO vs. conventional ventilation. Secondary: Compare baseline characteristics, complications, and supportive interventions. Literature Review: COVID-19-induced ARDS is characterized by severe hypoxemia and alveolar damage. Mechanical ventilation is standard but often insufficient in severe cases. ECMO has shown mixed results across studies; outcome variability may reflect differences in center expertise and patient selection. Methodology: A prospective cohort study was conducted at a regional ECMO center. Adults ≥18 with confirmed COVID-19, ARDS by Berlin definition, and on mechanical ventilation were included. Data collected included demographics, severity scores, ventilatory parameters, and outcomes. VV ECMO was applied using standardized protocols. Statistical analysis included t-tests, Chi-square, and Cox regression. Results: Of 123 admitted patients, 24 met inclusion criteria; 13 received VV ECMO, 11 did not. ECMO patients were younger, with similar illness severity. Mortality was lower in the ECMO group. Kaplan-Meier curves showed improved survival; age and respiratory acidosis predicted higher mortality. Discussion: VV ECMO was associated with improved survival in well-selected patients. Benefits include enhanced gas exchange and reduced ventilator-induced injury. Results align with prior influenza-related ARDS studies but contrast with studies showing no ECMO benefit, highlighting the role of center experience. Conclusion: VV ECMO may improve survival in younger patients with severe COVID-19 ARDS when used early at experienced centers. Standardized protocols and multicenter trials are recommended.