Effect of heparin on viscoelastic parameters of COVID-19 critically ill patients. A Viscoelastic Coagulation Monitor (VCM) analysis

Introduction: We evaluated the outcomes of Venovenous-extracorporeal membrane oxygenation (VV-ECMO) in patients with COVID-19 compared to patients with non-COVID viral infections Methods: We retrospectively reviewed all adult VV-ECMO patients admitted from 8/2014-8/2020 for viral etiology Data were analyzed with parametric and non-parametric statistics as indicated to compare COVID and non-COVID patients Results: 89 patients were included (35 COVID-19 vs 54 non-COVID) 40 (74%) of the non-COVID patients had influenza virus Prior to cannulation, COVID-19 patients had longer ventilator duration (3 vs 1 days, p=0 003), higher PaCO2 (64 vs 53 mmHg, p=0 012), and white blood cell count (14 vs 9 x103/uL, p=0 004) There was no difference in pre-cannulation pH, P/F ratio, lactate, ventilator parameters, and RESP score between the two groups Overall in-hospital mortality was 33 3% (n=30) COVID-19 patients had a higher mortality (49% vs 24%, p=0 017) when compared to non-COVID patients COVID-19 patients also had a longer median ECMO duration (654 [514, 1092] vs 394 [280, 713] hours, p=0 002) and a similar median hospital length of stay (HLOS) (48 [30, 59] days vs 41 [22, 57], p=0 334) COVID-19 survivors had longer median time on ECMO than non-COVID survivors (585 vs 395 hours p=0 03) but had a similar HLOS Conclusion: Overall, VV-ECMO supported COVID-19 patients had a higher mortality While COVID-19 survivors had significantly longer VV-ECMO runs than non-COVID survivors, both had similar HLOS A potentially modifiable clinical factor that may improve outcomes is earlier cannulation, as COVID-19 patients had a significantly longer duration of pre-cannulation ventilator support