Explore the link between hypertension and the need for Extracorporeal membrane oxygenation (ECMO) support in COVID-19 patients: A Retrospective study

Abstract

Introduction: Hypertension is a major risk factor for severe COVID-19. Extracorporeal membrane oxygenation (ECMO) is a form of life support used in critical COVID-19 cases, but the relationship between hypertension and need for ECMO is not well understood. This study aims to investigate if hypertension is associated with increased likelihood of requiring ECMO support among hospitalized COVID-19 patients.
Methods: A retrospective study was conducted using medical record data from 1,491 adult COVID-19 patients admitted to 26 intensive care units (ICUs) in Saudi Arabia between September 2020 and December 2020. Patient demographic characteristics, comorbidities including hypertension status, illness severity markers, and need for ECMO support were collected. Hypertension was defined as previous diagnosis or use of antihypertensive medications. Statistical analysis included chi-square tests to examine the association between hypertension and ECMO requirement. One-way ANOVA and independent t-tests were used to compare means.
Results: Of 1,491 patients included, 1,099 (75.5%) had hypertension. Patients requiring ECMO (n=90) had significantly higher mean systolic blood pressure (428.5 mmHg vs 0 mmHg, p<0.001) compared to those not receiving ECMO support. Hypertension was also significantly associated with ECMO need according to chi-square test results (p<0.001). Men were more likely to receive ECMO than women after adjusting for age and hypertension status using multivariable regression.
Conclusion: This large retrospective study found a significant positive association between pre-existing hypertension and need for life-saving ECMO support among hospitalized adult COVID-19 patients. Hypertensive COVID-19 patients appeared to have more severe clinical presentations requiring advanced organ support interventions like ECMO. Timely blood pressure management in hypertensive COVID-19 patients may help reduce disease progression and need for lifesaving interventions. Further prospective studies are still needed to establish the exact mechanisms linking hypertension to COVID-19 severity.