(538) Outcomes in Severe ARDS: Care at a Community Hospital or Transfer to an ECMO Center

Introduction: The transfer of patients with severe acute respiratory distress syndrome (ARDS) to extracorporeal membrane oxygenation (ECMO) capable centers is a prevalent practice, however, outcomes comparing transferred patients and those who remain in a community setting have never been compared when standardized care is delivered. Our aim was to compare in-hospital-mortality in these two patient populations.

Methods: Adult patients admitted to a community health system with SARS-CoV2 infection requiring invasive mechanical ventilation (IMV) between Feb. 2020 & July 2022 were identified. We performed univariate and multivariable logistic regression (adjusting for demographics and severity of illness). Categorical data are presented as percentages and continuous data as medians [25-75% interquartile range].

Results: 397 patients were identified with COVID-19 requiring IMV, of those 29 were transferred to the ECMO center. Compared to transferred patients, non-transferred patients were older: 64[56-73] vs 48 [40-55], p< 0.001, and had a higher proportion of comorbid conditions: COPD (14% vs 0%), diabetes (37% vs 17%) and hypertension (57% vs 17%). Both groups had similar initial P/F ratios but there was a trend toward a lower P/F in the transferred group at 24 hours after IMV: 121 [88-167] vs 105 [75-132], p=0.083. The SOFA score was lower in transferred patients 0[0-1] vs 1[0-2], p=0.007. 282 patients (71.2%) at the community health system died. Among those referred to the tertiary care center, 21 (72.4%) were not supported with ECMO and 9 (42.9%) died. Of the 8 patients supported with ECMO, 3 (37.5%) died. Transfer to the tertiary care center was associated with a reduced risk of death (OR: 0.25; 95% CI: 0.11-0.55, p-value=0.001). This finding persisted when adjusted for age, P/F ratio, & organ-specific SOFA scores (OR: 0.34; 95% CI: 0.15-0.80, p-value=0.013).

Conclusions: Patients with severe ARDS have a reduction in mortality when transferred to an ECMO capable center despite providing similar medical care in both settings. An emphasis on correct patient selection is important, specifically focusing on ECMO-eligible patients. More research is needed to identify which variables impact mortality in these two patient populations.