Tocilizumab Accelerates Recovery in Patients With Severe COVID-19 Pneumonia on Venovenous Extracorporeal Membrane Oxygenation
Abstract
Tocilizumab is known to improve outcomes in patients with severe coronavirus disease 2019 (COVID-19) pneumonia. However, little is known about its utility in patients with COVID-19 who require respiratory support with venovenous extracorporeal membrane oxygenation (V-V ECMO). We performed an observational cohort study of adult patients with COVID-19 admitted between March 1 and April 24, 2020 who required support with V-V ECMO due to acute respiratory failure. Patients who received tocilizumab 400 mg intravenous given once in addition to standard of care were compared to those who received standard of care alone. The primary outcome was time to hospital discharge. Twenty-nine patients with severe COVID-19 supported with V-V ECMO were evaluated, 22 of whom received tocilizumab and 7 who did not. Pneumothorax (18% vs. 86%, p = 0.007) and need for a thoracostomy tube (23% vs. 71%, p = 0.03), were significantly lower in the tocilizumab group. There was no difference in secondary bacterial infections between groups (73% vs. 100%, p = 0.25). The median length of ECMO support (16 vs. 64 days, p = 0.04), mechanical ventilation (36 vs. 127 days, p = 0.02), and hospital length of stay (40 vs. 138 days, p = 0.008) were all significantly reduced in patients who received tocilizumab (Table 3). Survival to hospital discharge did not differ between groups (95% vs. 86%, p = 0.43). Tocilizumab therapy was associated with significantly decreased hospital length of stay in patients on V-V ECMO. More data on COVID-19 targeted therapies in patients on V-V ECMO are needed.