PULMONARY PERFUSION IN LONG-TERM SURVIVORS OF COVID-19 RELATED SEVERE ARDS TREATED BY EXTRACORPOREAL MEMBRANE OXYGENATION

Pulmonary perfusion in long-term survivors of COVID-19 related severe ARDS treated by extracorporeal membrane oxygenation

Introduction. COVID-19 is considered to be a hypercoagulant state with an increased risk of developing venous thromboembolic events (VTE). Whether severe COVID-19 infection requiring ECMO support leads to chronic pulmonary perfusion abnormalities and chronic thromboembolic pulmonary disease/hypertension remains unclear.
Purpose. To evaluate chronic pulmonary perfusion abnormalities in long-term survivors of COVID-19 related severe ARDS treated by ECMO. The incidence of VTE during the acute phase was assessed.
Methods. At least 3 months after ECMO explantation, pulmonary perfusion was examined by V/Q SPECT or V/Q planar scintigraphy.
Results. There were 172 COVID-19 patients treated by ECMO at General University Hospital in Prague between March 2020 and November 2021 and only 80 of them were successfully explanted. We enrolled 37 patients after ECMO explantation (27 % female, mean age 52 years). The median duration of ECMO support was 12 days. In 24 (65 %) patients in the acute phase, VTE was recorded (23 patients developed ECMO cannula-related DVT, 5 of them also had a pulmonary embolism and 1 central catheter-associated DVT). Acute pulmonary embolism was verified by CT angiography in 2 patients before ECMO implantation, in 2 patients during ECMO, and in 1 after ECMO explantation. The median duration between ECMO explantation and assessment of pulmonary perfusion was 420 days. No segmental or larger mismatched perfusion defects have been detected in any of the patients.
Conclusion. In long-term survivors of COVID-19 related severe ARDS treated by ECMO, despite frequent acute VTE, no sequelae suggesting chronic pulmonary perfusion abnormalities were detected.