Treating Respiratory Failure in Patients With COVID-19

Treatment shows promise for patients whose lungs are so injured that a ventilator is unable to deliver enough oxygen.

A study conducted at Beth Israel Deaconess Medical Center (BIDMC) and Brigham and Women's Hospital (BWH) has provided new evidence that demonstrates extracorporeal membrane oxygenation (ECMO) increases the odds of survival for those with a severe case of the coronavirus disease 2019 (COVID-19). The findings from the study were published in the journal Intensive Care Medicine.

"ECMO gives patients' lungs time to heal when we've exhausted every other aspect of care for these patients -- it can be a bridge to recovery," Shahzad Shaefi, a corresponding author on the study said. "But ECMO's efficacy in the context of COVID-19 remains unclear. This work sheds new light on that question in the most robust way possible during the COVID-19 pandemic."

Investigators gathered and analyzed data from the multicenter cohort study called the “Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID).” STOP-COVID included over 5,000 participants from 68 hospitals who were critically ill, collecting 800 individual data elements from each of the patients.

"This was a remarkable grassroots effort involving more than 400 research assistants, medical students, residents, fellows, and attendings across the United States collecting this data manually during the height of the pandemic," David E. Leaf, an Assistant Professor of Medicine at Harvard Medical School said. "People were highly motivated to get this database assembled, as it represents the best data we have about critically ill patients with COVID-19 in this country."

Findings showed that of the 5,122 patients, 190 (3%) of them were admitted to the intensive care unit (ICU) and received treatment with ECMO. Of those 190, nearly 70% survived for at least 60 days following ICU admission. Additionally, the investigators found that those who were treated with ECMO within the first 7 days of ICU admission had a significantly reduced chance of mortality compared to those with similar illness not receiving ECMO.

"The real question with ECMO is, are we saving lives, or -- candidly -- are we prolonging poor outcomes and death," Shaefi said "The benefit of ECMO prevailed across all of our analyses. In the absence of a randomized controlled trial, which traditionally been very difficult to cleanly do in ECMO, this work represents perhaps the best current evidence we have of the role of ECMO in treating select critically ill COVID 19 patients."