Relationship Between Number of Mechanical Ventilation Days Prior to ECMO Initiation and Outcomes in COVID-19 Patients
Year of Publication
Doctor of Nursing Practice
Dr. Sheila Melander
Dr. Aaron Harris
Dr. Melissa Czarapata
Dr. Candice Falls
Background: Since the start of the pandemic, there has been over 16,000 COVID-19 positive patients placed on Extracorporeal Membrane Oxygenation (ECMO). Little is known about the effect of long mechanical ventilation prior to ECMO initiation. Purpose: The first purpose of this project is to evaluate whether a longer mechanical ventilator time (ten or more days) prior to ECMO initiation is associated with increased mortality and longer total lengths of time on ECMO in patients with COVID-19, as opposed to being on a ventilator for under ten days prior to being placed on ECMO. The second purpose is to increase provider awareness and education of COVID-19 ECMO usage at UK Healthcare throughout the pandemic. Methods: A chart review was performed at University of Kentucky Healthcare on COVID-19 positive patients that were placed on ECMO between the dates of February 2020 and August 2022 with documented intubation and cannulation dates. Patients with long mechanical ventilator times (10 days or greater) were compared with patients placed on ECMO prior to their 10th ventilator day. Total length of time on ECMO as well as discharge disposition were assessed and compared between the two groups. Results of the study and a three question pre and posttest were distributed to ECMO providers in the Cardiovascular Intensive Care Unit to evaluate their understanding of ventilator length of time prior to cannulation and the effect on outcomes in COVID-19 ECMO patients. Results: The chart review showed there was no significant difference in outcomes (discharged or deceased, p=.545) and total length of time on ECMO (p=.796) between the patients who were placed on ECMO prior to their tenth intubation day compared to ten or more days of mechanical ventilation. Education within the ECMO providers were significantly increased after the distribution of the results of the study in two of the three questions. Post-education results were increased to 86.4% and 90.9% (p=<0.001). Conclusion: These results indicate that more research is still needed on the use of ECMO throughout the COVID-19 pandemic and the factors that affect mortality. Length of time on mechanical ventilation prior to ECMO initiation was not associated with significant effect on mortality or total length of time on ECMO, while there was a significant increase in provider education on the topic.
Bergman, Brittany, "Relationship Between Number of Mechanical Ventilation Days Prior to ECMO Initiation and Outcomes in COVID-19 Patients" (2023). DNP Projects. 412.