ECMO therapy in COVID‐19: An experience from Zurich

Abstract

Background The current coronavirus disease 2019 (COVID‐19) pandemic has a huge impact on society and the economy and represents one of the biggest challenges for healthcare systems all over the world. Reports from healthcare institutions in different countries show a variety of crisis exit strategies. Methods The following is a review and update of the situation and crisis management in Zürich and Switzerland with a special focus on the impact on the cardiac surgery program and extracorporeal membrane oxygenation (ECMO)‐therapy in COVID‐19. Results Regional and national measures had avoided the collapse of the health system in Switzerland. There was a reduction of over 50% of the surgical and transcatheter caseload during the first wave of the pandemic. Twenty‐three ECMO devices, 150 oxygenators, and more than 300 different cannulas were at our disposal. Between March and May 2020, nine COVID‐19 patients were treated by us with ECMO‐therapy. Three patients were transported by us from distant institutions. Median age at ECMO implantation was 59 years. Two patients died on support. Conclusions Measures to prevent a collapse of the healthcare system were effective. Our local ECMO‐Program on the ongoing COVID‐19 pandemic has proven to be a useful tool to control mortality and organ failure in critically ill patients.

Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis

“…Seven studies reported data on COVID-19 patients suffering from two and more comorbidities (Figure 3). [18][19][20][21][22][23][24] COVID-19 patients requiring ECMO support with less than two comorbidities had lower mortality (23% vs 31%; OR 0.55; 95% CI 0.34-0.90; I 2 = 0%; P = .02) than those with two and more comorbidities. 12 cohorts contained comparative body mass index (BMI) data for COVID-19 survivors and nonsurvivors receiving ECMO support (Figure 2).…”

“…[16][17][18][19][20][21][22][23][24][28][29][30][31] In 13 cohorts, the total duration of ECMO support received by COVID-19 patients was similar (mean 15.39 vs 16.62 days; SMD − 0.07; 95% CI [ − 0.30, 0.15];I 2 = 15%; P = .51) between survivors and nonsurvivors (Figure 4). [17][18][19][20][21][22][23][24][25][26][28][29][30] Respiratory Parameters Within 24 h Before ECMO Support Initiation…”

Extracorporeal membrane oxygenation for respiratory failure in phases of COVID‐19 variants

“… 3 The use of extracorporeal membrane oxygenation (ECMO) for patients with severe acute respiratory distress syndrome (ARDS) from COVID‐19 who have failed conventional mechanical ventilatory strategies has been described in multiple studies throughout the course of the pandemic. 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 Besides limited reports in Europe that have described conflicting trends of patient outcomes on ECMO for COVID‐19 ARDS over the course of the pandemic, 12 , 13 , 14 little is known about the characteristics or trends between the eras of SARS‐CoV‐2 variants at their peak prevalence in the United States. The goal of this study is to describe the outcomes of patients who were placed on ECMO for severe COVID‐19 during different variants phases within a single healthcare system.…”

Extracorporeal membrane oxygenation in the forensic setting: A series of 19 forensic cases

“…Thus, the popularity of this topic is undoubtedly linked to the frequency of its clinical application. Further adding to the recent surge in the clinical literature is the trialing and adoption of ECMO as a therapy in some cases of severe Coronavirus disease 2019 (COVID-19) as a result of SARS-CoV2 infection [7][8][9]. Despite the increasing usage of ECMO, studies about ECMO are notably absent in the forensic literature.…”