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• W4387249932 abstract "SESSION TITLE: Critical Care Posters 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: The current medical literature demonstrates a wide discrepancy when evaluating mortality of COVID patients on extracorporeal membrane oxygenation (ECMO). Although randomized control trials have been conducted establishing a survival benefit for ARDS patients on ECMO, no such trials have been performed on a COVID patient population. We set out to conduct the largest retrospective study to date that compares the efficacy of ECMO on COVID patients to those on conventional mechanical ventilation (MV). METHODS: This retrospective observational cohort study uses the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) 2020 database. We included all adult patients who were admitted to the hospital with COVID-19 as the primary diagnosis. Patient demographics were directly obtained from the NIS data. We generated patient comorbidities using ICD-10 codes. The primary outcome was all-cause inpatient mortality. Secondary outcomes were the length of stay and disposition on discharge. RESULTS: We identified 1,048,025 hospital admissions with COVID-19 as the primary diagnosis. 98,528 of the admissions were on MV, and only 1.8% (1770) underwent ECMO. The overall in-hospital mortality for COVID-19 ECMO patients was 49%, compared to 59% in the MV group (p < 0.001). ECMO was associated with a decreased risk of mortality (HR= 0.67, p < 0.0001, 95% CI 0.59–0.82). Patients on ECMO were admitted for an average of 34 days or 16 days longer than MV patients at 18 days. ECMO patients were more likely to be discharged to an acute rehabilitation hospital (ARH) or skilled nursing facility (SNF), 16% and 23% respectfully, compared to MV patients at 8% and 18%. ECMO patients were younger than MV patients, 49.5 to 65 years. ECMO patients were disproportionately obese compared to MV patients, 43% to 29%. Female gender had a protective effect on mortality (HR 0.91, p < 0.001, CI 0.87-0.94). Obese patients and those with chronic pulmonary disease were found to have no increased risk of mortality (HR 0.98, p < 0.36, CI 0.94-1.02; HR 0.99, p < 0.85, CI 0.95-1.04). Patients with CKD, CAD, CHF, and active smokers were found to be at a higher mortality risk (HR 1.24, p < 0.001, CI 1.18-1.30; HR 1.22; p < 0.001, CI 1.16-1.27; HR 1.07, p = 0.007, CI 1.02-1.12; HR 1.08, p = 0.002, CI 1.03-1.13). CONCLUSIONS: ECMO offers a survival benefit over conventional management for patients with severe COVID disease. Patients on ECMO had a prolonged hospital course due to severity of disease and extended survival time, and were more likely to be discharged to an ARH or SNF. ECMO was utilized in a population significantly younger than those treated exclusively with MV. Patients who are male or obese are disproportionately likely to have severe disease. ECMO eliminates any increased risk of mortality for patients with obesity or chronic pulmonary disease. ECMO does not eliminate the gender disparity in mortality. CLINICAL IMPLICATIONS: ECMO should be offered to COVID patients with severe disease not responsive to MV. Younger patients with independent risk factors of male gender and obesity should be considered for early evaluation due to significant survival benefit. DISCLOSURES: No relevant relationships by Andrew Abrahamian No disclosure on file for Rami Ahmad No disclosure on file for Ragheb Assaly No relevant relationships by Zachary Holtzapple No relevant relationships by Rayna Patel No relevant relationships by Fadi Safi No relevant relationships by Ayman Salih" @default.
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• W4387249932 date "2023-10-01" @default.
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• W4387249932 title "COMPARING EXTRACORPOREAL MEMBRANE OXYGENATION TO CONVENTIONAL MECHANICAL VENTILATION: A NATIONAL RETROSPECTIVE COHORT STUDY" @default.
• W4387249932 doi "https://doi.org/10.1016/j.chest.2023.07.1129" @default.
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