No abstract

We report a higher prevalence of intracranial hemorrhage than has previously been described with high level of neurologically intact survival. Duration of mechanical ventilation and admission fibrinogen, but not exposure to extracorporeal support, are independently associated with intracranial hemorrhage.

The prevalence of deep vein thrombosis following decannulation from extracorporeal membrane oxygenation for severe respiratory failure is clinically significant, and routine venous Doppler ultrasound following decannulation is warranted in this population.

RationaleThe use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from Coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management, and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume UK centre.MethodsPatient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3rd March and 2nd May 2020. Clinical management is described. Data are reported for survivors and non-survivors.ResultsWe describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years [IQR 35.5–52.5], 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days [IQR 11–17.5]. All patients underwent computed tomography imaging, finding extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days [IQR 8–20]. Fourteen patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Non-survivors had significantly higher d-dimer (38.2 versus 9.5 mg·L−1, Fibrinogen Equivalent Units; p=0.035) and creatinine (169 versus 73 umol·L−1; p=0.022) at commencement of ECMO.ConclusionsOur data supports the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation, and intravascular thrombosis.

No abstract