Use of VV-ECMO in Patients with ARDS due to fungal pneumonia

Author(s):
Jillian Wothe; Danika Evans; Bridget Dillon; Angela Phillips; Kristiana Sather; Matthew Prekker; Ramiro Saavedra-Romero; Melissa E Brunsvold

Background:

Patients with rare fungal pneumonias such as blastomycosis and pneumocystis sometimes progress to acute respiratory distress syndrome (ARDS). Mortality has been reported as high as 50-90% in this group. Venovenous extracorporeal membrane oxygenation (VV-ECMO) can be used to support such patients, however due to the rare nature of these pneumonias, outcomes are not well understood.

Hypothesis:

In this study we report outcomes of patients treated with VV-ECMO for ARDS due to rare fungal pneumonias at three ECMO centers.

Methods:

This was a retrospective study across three ECMO centers in the United States during a period from 2013-2022. Data was extracted from the electronic medical record and stored in a RedCap database. Basic descriptive statistics were performed.

Results:

A total of 22 out of 346 (6%) adult VV-ECMO patients were treated for ARDS due to fungal pneumonia. The majority (68%) were male and the mean age was 45 years (SD 11). By type of fungal infection, 15 (68%) had blastomycosis, 5 (22%) had pneumocystis, 1 (5%) had cryptococcus, and 1 (5%) had Candida krusei infection. The overall survival rate was 73%: 67% for blastomycosis, 80% for pneumocystis, and 100% for Cryptococcus and Candida krusei. Patients with pneumocystis had longer ECMO runs compared to those with blastomycosis, with a median of 30 days (IQR 20-42) and 11 days (IQR 9-12) respectively. These patients also had a longer duration between intubation and cannulation for VV-ECMO, median 10 (IQR 2-12) days for pneumocystis compared to median 3 (IQR 2-5) days for blastomycosis.

Conclusions:

Our findings support the use of VV-ECMO for ARDS due to rare fungal pneumonias. While survival was high, patients with pneumocystis required longer ECMO runs compared to patients with blastomycosis.