Clinical Characteristics and Outcomes of COVID-19–related ARDS Patients on ECMO Support: A Single Centre Experience from Newly Established ECMO Centre in Surabaya, Indonesia

Abstract* Background Extracorporeal membrane oxygenation (ECMO) serves as a rescue therapy for acute respiratory distress syndrome (ARDS), yet data from low- and middle-income countries (LMICs) remain limited. During the COVID-19 pandemic, several new ECMO centers were established to address rising demand. This study reports and analyzes the clinical characteristics and outcomes of patients with COVID-19–associated ARDS who received ECMO support at a newly established high-volume ECMO center in Indonesia. Methods This single-center retrospective cohort study included all adult patients with confirmed COVID-19 and severe ARDS who underwent ECMO between July 24, 2020, and August 26, 2021. Outcomes evaluated included mortality, ICU length of stay, ECMO duration, and complications. Statistical analyses were conducted using R Studio version 4.2.1. Results Among 26 patients who received ECMO (25 veno-venous [VV] and 1 veno-arterial [VA]), the in-hospital mortality rate was 65.4%, and the 90-day mortality rate reached 69.2%. Non-survivors were more likely to present with hypoalbuminemia (82.4%) and septic shock (58.8%) at ECMO initiation. Mortality was significantly associated with a longer interval from symptom onset to ECMO cannulation (OR 1.36; 95% CI 1.01–1.84; p=0.04), occurrence of multiple organ dysfunction syndrome (MODS) during ECMO (OR 19.20; 95% CI 1.88–>100; p=0.01), and shorter duration from ECMO initiation to death or discharge (OR 0.82; 95% CI 0.69–0.99; p=0.04). No significant differences were found in pre-ECMO mechanical ventilation duration, ECMO support duration, or ICU length of stay between survivors and non-survivors. Conclusions Survival in COVID-19–associated ARDS patients receiving ECMO is influenced by timing of intervention and the occurrence of complications such as MODS. Delayed initiation of ECMO after symptom onset and sepsis-related complications were associated with increased mortality. Optimizing early identification, infection control, and resource allocation, along with ongoing clinical training, are essential to improving outcomes in ECMO centers within resource-limited settings.