Coronavirus 2019 (COVID‐19) venovenous extracorporeal oxygenation: Single community hospital results and insights

Abstract

Background The role of extracorporeal membrane oxygenation (ECMO) for patients with refractory respiratory failure due to coronavirus 2019 (COVID‐19) is still unclear even now over a year into the pandemic. ECMO is becoming more commonplace even at smaller community hospitals. While the advantages of venovenous (VV) ECMO in acute respiratory distress syndrome (ARDS) from COVID‐19 have not been fully determined, we believe the benefits outweighed the risks in our patient population. Here we describe all patients who underwent VV ECMO at our center. Methods All patients placed on ECMO at our center since the beginning of the pandemic, May 5, 2020, until February 20, 2021 were included in our study. All patients placed on ECMO during the time period described above were followed until discharge or death. The primary endpoint was in‐hospital death. Secondary outcomes included discharge disposition, that is, whether patients were sent to a long‐term acute care center (LTAC), inpatient rehabilitation, or went directly home. Results A total of 41 patients were placed on VV ECMO for refractory acute respiratory failure. Survival to discharge, the primary end point, was 63.4% (26/41). Inpatient mortality was 36.6% (15/41). Conclusions We show here that a successful high‐volume VV ECMO program for ARDS is achievable at even a medium‐size community hospital. We think our success can be replicated by most small‐ and medium‐size community hospitals with cardiothoracic surgery programs and intensivist teams.

Extracorporeal Membrane Oxygenation in Children With COVID-19: A Systematic Review and Meta-Analysis*

“…Although some patients with MIS-C recovered promptly and were decannulated within 1 week after venoarterial-ECMO initiation ( 11 , 13 , 29 , 33 , 34 , 39 , 51 , 52 , 54 ), one patient with ARDS remained on venovenous-ECMO for 71 days ( 35 ). It is not uncommon that pulmonary function takes a month or more to recover in adult COVID-19 cases as well ( 67 , 68 ). In the face of critically ill children with COVID-19 necessitating ECMO support, recognizing the difference in possible recovery timelines according to ECMO indications and modes will play a crucial role in assessing the treatment courses appropriately.…”

Extracorporeal membrane oxygenation (ECMO): Can we do it ourselves?

“…Thus, the format of the transfer of care model espoused by the CESAR trial has become flawed due to this sudden change in the ARDS incidence, resulting in a saturation of resources of the specialized referral healthcare systems. West et al, in their study, have nicely shown how high‐quality ECMO can be done beyond the confines of a specialized, large healthcare system, thus meeting this new challenge posed by the COVID‐19 pandemic 3 …”

“…West et al, in their study, have nicely shown how high‐quality ECMO can be done beyond the confines of a specialized, large healthcare system, thus meeting this new challenge posed by the COVID‐19 pandemic. 3 …”

“…West et al, in their study, have nicely shown how high-quality ECMO can be done beyond the confines of a specialized, large healthcare system, thus meeting this new challenge posed by the COVID-19 pandemic. 3 Over 10 months, they placed 41 patients on venovenous ECMO for refractory respiratory failure due to ARDS from COVID-19. They used either a single or a double site cannulation strategy and modified it as per the clinical response from the patient.…”

Extracorporeal Membrane Oxygenation (ECMO): Can we do it ourselves?

“…Thus, the format of the transfer of care model espoused by the CESAR trial has become flawed due to this sudden change in the ARDS incidence, resulting in a saturation of resources of the specialized referral healthcare systems. West and colleagues, in their study, have nicely shown how high-quality ECMO can be done beyond the confines of a specialized, large healthcare system, thus meeting this new challenge posed by the COVID-19 pandemic 3 .…”