• Benjamin E Garfield, Paolo Bianchi, Deepa J Arachchillage, Francisca Caetano, Sujal Desai, James Doyle, Clara Hernandez Caballero, Anne-Marie Doyle, Sachin Mehta, Alexander Law, Sian Jaggar, Maria Kokosi, Philip L Molyneaux, Maurizio Passariello, Meena Naja, Carole Ridge, Joana Alçada, Brijesh Patel, Suveer Singh, and Stephane Ledot.
• Department of Adult Intensive Care, Royal Brompton & Harefield Hospitals, part of Guy's and St Thomas's NHS Foundation Trust, London, United Kingdom.
• Crit. Care Med. 2023 Aug 1; 51 (8): 106410731064-1073.

ObjectivesEarly studies of venovenous extracorporeal membrane oxygenation (ECMO) in COVID-19 have revealed similar outcomes to historical cohorts. Changes in the disease and treatments have led to differences in the patients supported on venovenous ECMO in the first and second waves. We aimed to compare these two groups in both the acute and follow-up phase.DesignRetrospective single-center cohort study comparing mortality at censoring date (November 30, 2021) and decannulation, patient characteristics, complications and lung function and quality of life (QOL-by European Quality of Life 5 Dimensions 3 Level Version) at first follow-up in patients supported on venovenous ECMO between wave 1 and wave 2 of the COVID-19 pandemic.SettingCritical care department of a severe acute respiratory failure service.PatientsPatients supported on ECMO for COVID-19 between wave 1 (March 17, 2020, to August 31, 2020) and wave 2 (January 9, 2020, to May 25, 2021).InterventionsNone.Measurements And Main ResultsOne hundred twenty-three patients were included in our analysis. Survival at censoring date (χ 2 , 6.35; p = 0.012) and decannulation (90.4% vs 70.0%; p < 0.001) was significantly lower in the second wave, while duration of ECMO run was longer (12.0 d [18.0-30.0 d] vs 29.5 d [15.5-58.3 d]; p = 0.005). Wave 2 patients had longer application of noninvasive ventilation (NIV) prior to ECMO and a higher frequency of barotrauma. Patient age and NIV use were independently associated with increased mortality (odds ratio 1.07 [1.01-1.14]; p = 0.025 and 3.37 [1.12-12.60]; p = 0.043, respectively). QOL and lung function apart from transfer coefficient of carbon monoxide corrected for hemoglobin was similar at follow-up across the waves.ConclusionsMost patients with COVID-19 supported on ECMO in both waves survived in the short and longer term. At follow-up patients had similar lung function and QOL across the two waves. This suggests that ECMO has an ongoing role in the management of a carefully selected group of patients with COVID-19.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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