Pre-ECMO Management-
All patients excluding outside transfers were admitted and managed with lung protective ventilation, NMB, and prone positioning. Twelve of the fifteen patients were managed with lung protective ventilation prior to initiation of ECMO. The three patients that were not treated with lung protective ventilation were patients transferred to our institution from outside hospitals. Of the three transfers, one patient expired peri-cannulation, one patient was decannulated after 17 days and remains on MV, and one patient was successfully decannulated on ECMO day 16 and has been discharged to home. Patients supported on mechanical ventilation without lung protective ventilation remained on ECMO longer than those that only received lung protective ventilation. Neuromuscular blockade was utilized in 14 of 15 patients. The NMB exception was a patient transferred from an outside hospital who expired immediately after cannulation. 14 of 15 patients were placed in the prone position. The exception to prone positioning was due to body habitus limitations (BMI 44). Two patients did not receive inhaled vasodilator therapy prior to ECMO cannulation; seven received inhaled epoprostenol and six received inhaled nitric oxide. From onset of Covid-19 symptoms to initiation of ECMO, the average time was 14 days, with a range of 4 - 29 days. The average duration of mechanical ventilation (MV) prior to ECMO was 4.5 days, with a range of 1-9 days. As expected, all patients had elevated inflammatory markers (d-dimer, CRP, ferritin). The Pre-ECMO characteristics of the patients are listed in Tables 1 & 2.