Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai, China

Abstract

Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.

The role of ECMO in COVID‐19: Can it provide rescue therapy in those who are critically ill?

“…The Murray score (Table 2) stratifies the severity of acute lung injury and values of greater than 2 should be considered for transfer to centers with ECMO facilities. Patients with ARDS and a Murray score of 3 to 4 may be suitable candidates for ECMO 6 …”

“…Of these four had died (50%) and three were weaned off ECMO but were still on mechanical ventilation (37.5%). Only one patient had been weaned off ECMO before the 28‐day mark 6 . Zhan et al reported a case of a low‐risk individual who was placed on ECMO therapy within hours of intubation, the clinicians realising early on that mechanical ventilation was insufficient.…”

Successful COVID-19 rescue therapy by extra-corporeal membrane oxygenation (ECMO) for respiratory failure: a case report

“…The role of ECMO for rescue therapy of respiratory failure in critically ill COVID-19 patients remains controversial [10,11,14,15]. In this case report, we present a successful ECMO salvage case in a 51-year-old patient with bilateral SARS-CoV-2 pneumonia and refractory respiratory failure.…”

“…Extra-corporeal membrane oxygenation (ECMO) represents a potentially life-saving modality for patients with terminal respiratory failure [9]. However, early experiences from COVID-19 "hot zones" in China reported a high mortality rate of 50-82% in adult patients with ARDS from SARS-CoV-2 pneumonia [10,11]. In the present case report, we describe the successful rescue treatment of a critically ill patient with respiratory failure due to COVID-19 and discuss the critical variables for effective ECMO therapy in this highly vulnerable patient cohort.…”

Utility of extracorporeal membrane oxygenation in COVID-19

“…There are only a few reports of successful use of venoarterial ECMO in myocarditis secondary to COVID-19. 10 Use of venoarterial ECMO should be based on stringent criteria and subject to scrutiny by ECMO multidisciplinary teams.…”