Extracorporeal membrane oxygenation for respiratory failure in COVID-19 patients: outcome and time-course of clinical and biological parameters

Huette, Pierre; Beyls, Christophe; Guilbart, Mathieu; Coquet, Alexandre; Berna, Pascal; Haye, Guillaume; Roger, Pierre-Alexandre; Besserve, Patricia; Bernasinski, Michaël; Dupont, Hervé; Abou-Arab, Osama; Mahjoub, Yazine

doi:10.1007/s12630-020-01727-z

Cited by 14 publications

(22 citation statements)

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“…Our results T A B L E 4 Demographic, biological, ventilatory, hemodynamic, and therapeutic parameters in survivors and non-survivors of the patients implanted with VV-ECMO show a transient drop in the lymphocyte count the day after ECMO insertion, with a return to normal values at day 3. This result is consistent with the results published in a case series of 12 ECMO COVID-19 patients showing the same results (Huette et al, 2020). However, the authors found that most severe COVID-19 cases had persistently low lymphocyte counts, which our study failed to show.…”

Section: Post-intubationsupporting

confidence: 94%

Timing of VV‐ECMO therapy implementation influences prognosis of COVID‐19 patients

et al. 2021

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Introduction Current knowledge on the use of extracorporeal membrane oxygenation (ECMO) in COVID‐19 remains limited to small series and registry data. In the present retrospective monocentric study, we report on our experience, our basic principles, and our results in establishing and managing ECMO in critically ill COVID‐19 patients. Methods A cohort study was conducted in patients with severe acute respiratory distress syndrome (ARDS) related to COVID‐19 pneumonia admitted to the ICU of the Geneva University Hospitals and supported by VV‐ECMO from March 14 to May 31. The VV‐ECMO implementation criteria were defined according to an institutional algorithm validated by the local crisis unit and the Swiss Society of Intensive Care Medicine. Results Out of 137 ARDS patients admitted to our ICU, 10 patients (age 57 ± 4 years, BMI 31.5 ± 5 kg/m2, and SAPS II score 56 ± 3) were put on VV‐ECMO. The mean duration of mechanical ventilation before ECMO and mean time under ECMO were 7 ± 3 days and 19 ± 11 days, respectively. The ICU and hospital length of stay were 26 ± 11 and 35 ± 10 days, respectively. The survival rate for patients on ECMO was 40%. The comparative analysis between survivors and non‐survivors highlighted that survivors had a significantly shorter mechanical ventilation duration before ECMO (4 ± 2 days vs. 9 ± 2 days, p = 0.01). All the patients who had more than 150 h of mechanical ventilation before the application of ECMO ultimately died. Conclusion The present results suggest that VV‐ECMO can be safely utilized in appropriately selected COVID‐19 patients with refractory hypoxemia. The main information for clinicians is that late VV‐ECMO therapy (i.e., beyond the seventh day of mechanical ventilation) seems futile.

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Section: Post-intubationsupporting

confidence: 94%

Timing of VV‐ECMO therapy implementation influences prognosis of COVID‐19 patients

et al. 2021

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“…Similar to the subsequent positive reports that demonstrated the effectiveness of V-V ECMO in COVID-19 associated pneumonia. [17][18][19] In this study, the presence of lower PaO 2 /FiO 2 ratio, lower C RS , and high driving pressure is consistent with previously described pathophysiology of COVID-19 pneumonia. 20 Previous studies have confirmed the association of lower C RS as well as high driving pressure with poor outcome.…”

Section: Discussionsupporting

confidence: 91%

Extracorporeal membrane oxygenation for COVID-19 induced hypoxia: Single-center study

et al. 2020

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Introduction: The pandemic of the coronavirus disease 2019 (COVID-19) and associated pneumonia represent a clinical and scientific challenge. The role of Extracorporeal Membrane Oxygenation (ECMO) in such a crisis remains unclear. Methods: We examined COVID-19 patients who were supported for acute respiratory failure by both conventional mechanical ventilation (MV) and ECMO at a tertiary care institution in Washington DC. The study period extended from March 23 to April 29. We identified 59 patients who required invasive mechanical ventilation. Of those, 13 patients required ECMO. Results: Nine out of 13 ECMO (69.2%) patients were decannulated from ECMO. All-cause ICU mortality was comparable between both ECMO and MV groups (6 patients [46.15%] vs. 22 patients [47.82 %], p = 0.92). ECMO non-survivors vs survivors had elevated D-dimer (9.740 mcg/ml [4.84-20.00] vs. 3.800 mcg/ml [2.19-9.11], p = 0.05), LDH (1158 ± 344.5 units/L vs. 575.9 ± 124.0 units/L, p = 0.001), and troponin (0.4315 ± 0.465 ng/ml vs. 0.034 ± 0.043 ng/ml, p = 0.04). Time on MV as expected was significantly longer in ECMO groups (563.3 hours [422.1-613.9] vs. 247.9 hours [101.8-479] in MV group, p = 0.0009) as well as ICU length of stay 576.2 hours [457.5-652.8] in ECMO group vs. 322.2 hours [120.6-569.3] in MV group, p = 0.012). Conclusion: ECMO is a supportive intervention for COVID-19 associated pneumonia that could be considered if the optimum mechanical ventilation is deemed ineffective. Biomarkers such as D-dimer, LDH, and troponin could help with discerning the clinical prognosis in patients with COVID-19 pneumonia.

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“…Zeng et al [ 22 ] reported 12 critically ill patients requiring ECMO, where half of them died from septic shock and multi-organ failure. However, Huette et al [ 23 ] reported outcomes from 12 patients on ECMO where 10 of 12 patients were weaned from ECMO, 9 patients were weaned from mechanical ventilation, and 8 patients were discharged from the hospital. Patients weaned from ECMO demonstrated an increase in their lymphocyte count and a decrease in their fibrinogen levels[ 23 ].…”

Section: Special Considerations For Ecmo Use In Covid-19 Patientsmentioning

confidence: 99%

“…However, Huette et al [ 23 ] reported outcomes from 12 patients on ECMO where 10 of 12 patients were weaned from ECMO, 9 patients were weaned from mechanical ventilation, and 8 patients were discharged from the hospital. Patients weaned from ECMO demonstrated an increase in their lymphocyte count and a decrease in their fibrinogen levels[ 23 ]. There was also an increase in the PaO 2 /FiO 2 ratio in these patients[ 23 ].…”

Section: Special Considerations For Ecmo Use In Covid-19 Patientsmentioning

confidence: 99%

“…Patients weaned from ECMO demonstrated an increase in their lymphocyte count and a decrease in their fibrinogen levels[ 23 ]. There was also an increase in the PaO 2 /FiO 2 ratio in these patients[ 23 ]. A larger systematic review of 331 reported cases of COVID-19 patients receiving ECMO found a mortality rate of 46%[ 24 ].…”

Section: Special Considerations For Ecmo Use In Covid-19 Patientsmentioning

confidence: 99%

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Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic

Kichloo

Kumar

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et al. 2021

WJCCM

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Extracorporeal membrane oxygenation for respiratory failure in COVID-19 patients: outcome and time-course of clinical and biological parameters

Abstract: z) contains supplementary material, which is available to authorized users.

Cited by 14 publications

References 10 publications

Timing of VV‐ECMO therapy implementation influences prognosis of COVID‐19 patients

Timing of VV‐ECMO therapy implementation influences prognosis of COVID‐19 patients

Extracorporeal membrane oxygenation for COVID-19 induced hypoxia: Single-center study

Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic

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