Outcomes in COVID-19 ARDS: A Cohort Study Comparing Patients Transferred to an ECMO Center and Patients at a Community Hospital

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Sonja Knittel-Hliddal, Adam Green, Abhimanyu Chandel, Awab Khan, Hena Yagnik, Reena Patel, Joshua Levy, Derek Chen, Nishi Parikh, Sydnee Lim, Gregory Felock, Jean-Sebastien Rachoin, Michael Bonk

Published: 01 Aug 2025, Last Modified: 26 May 2026Researchers' Journal of Internal MedicineEveryoneRevisionsCC BY-SA 4.0
Abstract: Introduction The transfer of patients with severe acute respiratory distress syndrome (ARDS) to extracorporeal membrane oxygenation (ECMO) capable centers is a prevalent practice, despite a paucity of data regarding the outcome of transferred patients and those remaining in a community setting with standardized care. Our aim was to compare outcomes in these two patient populations. Methods Adult patients admitted to a community health system with SARS-CoV-2 infection requiring invasive mechanical ventilation (IMV) from February 2020 to 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 median [25-75% Interquartile range]. Results 397 patients were identified with COVID-19 requiring IMV, and 29 were transferred to the ECMO center. Non-transferred patients were older, 64 [56-73] vs. 48 [40-55] (p < 0.001), with a higher proportion of comorbid conditions. Both groups had similar initial P/F ratios, trending towards a lower P/F in the transferred group at 24 hours after IMV: 121 [88-167] vs. 105 [75-132] (p = 0.083). The organ-specific (renal, liver, coagulation) SOFA score was lower in transferred patients, 0 [0-1] vs. 1 [0-2] (p = 0.007). Two hundred eighty-two patients (71.2%) in the community health system died. Among those transferred, 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 a tertiary care center was associated with a reduced risk of death (OR 0.25; 95% CI 0.11-0.55, p = 0.001), which persisted when adjusted for age, P/F ratio, & organ-specific SOFA scores (OR 0.34; 95% CI 0.15-0.80, p = 0.013). Conclusions Patients with severe ARDS have a reduction in mortality when transferred to an ECMO-capable center despite providing similar care in both settings. An emphasis on appropriate patient selection is important, specifically focusing on ECMO-eligible patients. More research is needed to identify the variables impacting mortality in these patient populations.