Nationwide Experience of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19 Patients in Israel: A Multicenter Analysis

Eitan Keizman ¹ Maged Makhoul ² Eilon Ram ¹ Uri Carmi ³ Ori Galante ⁴ Eduard Ilgiyaev ⁵ Udi Karni ⁶ Reut Kassif-Lerner ⁷ Sigal Sviri ⁸ Arieh Eden ⁹ Leonid Sternik ¹ Yigal Kassif ¹

¹Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
²Department of Cardiac Surgery, Rambam Medical Center, Haifa, Israel
³Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
⁴Intensive Care Unit, Faculty of Health Ben Gurion University, Soroka Medical center, Beer-Sheva, Israel
⁵Intensive Care Unit, Shamir Medical Center, Zerifin, Israel. Affiliated to Sackler Faculty of Medicine University of Tel Aviv, Israel
⁶Department of Cardiac Surgery, The Baruch Padeh Medical Center, Poriya, Israel
⁷Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital Sheba Medical Center, Ramat Gan, Israel
⁸Division of Anesthesia and Critical Care, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
⁹Department of Anesthesiology Critical Care and Pain Medicine, Carmel Lady Davis Medical Center, Haifa, Israel

Background:

COVID-19 was announced a global pandemic in March 2020. The first COVID-19 patient was connected to ECMO on March 20th. Since then, three major COVID-19 “waves” occurred in Israel, and altogether, more than 200 patients required ECMO support. We have conducted a nationwide multicenter data collection with the aim to gather information that might allow us to improve our understanding of the clinical course and help in future decision making and management of COVID-19 patients.

Methods:

This is a retrospective multicenter study from nine out of twelve ECMO centers in Israel. From March 2020 to February 28, 2021, more than 200 patients were connected to ECMO due to respiratory and/or cardiac failure as a consequence of COVID-19 infection. The data includes: patients’ characteristics, comorbidities, procedural data, adverse events, and outcomes. Patients were divided based on their cannulation date into three groups: the first “wave”, from March 20, 2020 to June 31, 2020; the second from July 1, 2020 to November 31, and; the third from December 1, 2020 to February 28, 2021.

Results:

The results (table 1) are still being processed. Nonetheless, from the presented data it is evident that more patients needed ECMO during the second and third waves of COVID-19. The most prominent differences among the waves are: more complications and longer pre-cannulation ventilation period during the first wave, and; higher prevalence of female in the third wave. It is too early to summarize survival rates.

Conclusions:

Confronting with a new disease, it is inevitable that part of the management is evidence based. The data presented here sheds light on some of our clinical impression during the last year. As such, it is evident that as the year progressed, the patients needing ECMO were: slightly younger; cannulated earlier, and; had less adverse events. Nonetheless, after a year of gaining more experience, the outcomes are still poor. Further analysis and better understanding of the results are required.