Racial disparities among patients on venovenous extracorporeal membrane oxygenation in the pre-Coronavirus Disease 2019 and Coronavirus Disease 2019 eras: A retrospective registry review

Zachary Obinna Enumah; Eric W Etchill; Bo Soo Kim; Katherine A Giuliano; Andrew Kalra; Sung-Min Cho; Glenn J R Whitman; Jinny S Ha; Chun Woo Choi; Robert S D Higgins; Errol L Bush

doi:10.1016/j.xjon.2023.12.008

Racial disparities among patients on venovenous extracorporeal membrane oxygenation in the pre-Coronavirus Disease 2019 and Coronavirus Disease 2019 eras: A retrospective registry review

JTCVS Open. 2023 Dec 23:17:162-171. doi: 10.1016/j.xjon.2023.12.008. eCollection 2024 Feb.

Authors

Affiliations

¹ Department of Surgery, Johns Hopkins Hospital, Baltimore, Md.
² Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Md.
³ Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
⁴ Neurocritical Care, Johns Hopkins Hospital, Baltimore, Md.
⁵ Brigham and Women's Hospital, Boston, Mass.

Abstract

Objectives: Although many studies have addressed such disparities caused by COVID-19, to our knowledge, no study has focused on the association of race on outcomes for patients with COVID-19 requiring venovenous extracorporeal membrane oxygenation support. The goal of this study was to assess association of race on death and duration on venovenous extracorporeal membrane oxygenation in both the pre-COVID-19 and COVID-19 eras.

Methods: We retrospectively reviewed the Extracorporeal Life Support Organization registry and included adults (≥18 years) who required venovenous extracorporeal membrane oxygenation between January 2019 and April 2021. We performed descriptive statistics and multivariable logistic regression. Our primary outcomes were death and extracorporeal membrane oxygenation duration.

Results: A total of 7477 patients were included after excluding 340 patients (4.3%) who were missing race data. In the COVID-19 era, 1474 of 2777 COVID-19-positive patients (53.1%) died. Our regression model suggested somewhat of a protective effect on death for Black and multiple race patients. Additionally, a diagnosis of COVID-19 and patients in the COVID-19 era in general, irrespective of COVID-19 diagnosis, had higher odds of death. Hispanic patients had the longest average venovenous extracorporeal membrane oxygenation run times.

Conclusions: Our study using data from the international Extracorporeal Life Support Organization Registry provides updated data on patients supported with venovenous extracorporeal membrane oxygenation in the pre-COVID-19 and COVID-19 eras between 2019 and 2021 with a focus on race. Patients in the COVID-19 era group also had higher mortality compared with those in the pre-COVID-19 era even after being adjusted for COVID-19 diagnosis. Black and multiple races appeared somewhat protective in terms of death. Hispanic race was associated with longer venovenous extracorporeal membrane oxygenation duration.

Keywords: COVID-19; VV-ECMO; race; racial disparities; venovenous extracorporeal membrane oxygenation.

Abstract

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