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Amidst the pandemic, geographical boundaries presented challenges to those in need of higher levels of care from referral centers. Authors sought to evaluate potential predictors of treatment success; assess our transport and remote cannulation process; and identify transport associated complications. Retrospective series of critically ill adults with COVID-19 transferred by our Extracorporeal Membrane Oxygenation (ECMO) team 24 March 2020 through 8 June 2021. Descriptive statistics and associated interquartile ranges (IQR) were used to summarize the data. Sixty-three patients with COVID associated acute respiratory distress syndrome (ARDS) requiring ECMO support were admitted to our ECMO center. Mean age was 44 years old (SD 12; IQR 36–56). 59% ( n = 37) of patients were male. Average body mass index was 39.7 (SD 11.3; IQR 31–48.5). Majority of patients (77.8%; n = 35) had severe ARDS. Predictors of treatment success were not observed. Transport distances ranged from 2.2 to 236 miles (median 22.5 miles; IQR 8.3–79); round trip times from 18 to 476 min (median 83 min; IQR 44–194) . No transport associated complications occurred. Median duration of ECMO support was 17 days (IQR 9.5–34.5). Length of stay in the Intensive Care Unit (median 36 days; IQR 17–49) and hospital (median 39 days; IQR 25–57) varied. Amongst those discharged, 60% survived.

Background: Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date. Methods: We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality. Findings: Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4–40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20–2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6–41·5). Interpretation: In patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or discharge were less than 40%. These data from 213 hospitals worldwide provide a generalisable estimate of ECMO mortality in the setting of COVID-19. Funding: None.

Introduction: Postoperative acute kidney injury (AKI) confers poor outcomes after cardiac surgery. Conventional ultrafiltration (CUF) is performed on cardiopulmonary bypass (CPB) to raise hematocrit, avoid intraoperative blood transfusion, and provide renal protection. These protective effects remain unclear with high CUF volumes, which may cause hypovolemia and renal hypoperfusion. Hypothesis: Higher CUF volumes will be associated with increased AKI and poor outcomes. Methods: Retrospective analysis of 1,791 consecutive patients undergoing cardiac surgery (CABG, CABG/Valve, Valve only) was performed between June 2013 and December 2015. Institutional CPB protocol with CUF was used during all cases. Uni- and multivariable logistic regression analyses determined predictors for AKI. CUF volume analyses were performed, defined by two extreme quartiles or by Youden index derived from ROC analysis, and compared for their effect on AKI rate. Mortality data was acquired from the Social Security Administration’s Death Master File through 1 year after index surgery. Results: CUF volume independently predicted AKI (prd quartile, was > 2,900 ml (OR=1.72, 95% CI 1.25, 2.38) and defined by Youden index, was > 2,239 ml, (OR=1.52, 95% CI 1.22, 1.89). While associated with increased intraoperative blood transfusion volume (p=0.002), CUF volume in AKI patients (N=903) predicted increased ICU (p Conclusions: CUF volume removal during CPB predicted blood transfusion requirements, postoperative AKI, and ICU/Hospital LOS, while AKI predicted 30-day mortality.