Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease: indications, timing, and implementation

Li, Min; Gu, Si Chao; Wu, Xihan; Xia, Jin; Zhang, Yi; Zhan, Qing Yuan

doi:10.1097/cm9.0000000000000778

Cited by 20 publications

(18 citation statements)

References 15 publications

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“…In this particular case, a V-V ECMO is indicated and the criteria to follow for its implantation are PaO2/FiO2 < 100 mmHg and/or arterial blood PH < 7.2 and PaCO2 > 60 mmHg [9]. Additional parameters to take into account may be mechanical ventilation < 7 days, age < 65 years old, ventilator frequency < 35 breath per minute (bpm), and plateau pressure > 30 cm H 2 O [10]. Some studies showed that an early use of V-V ECMO in respiratory distress may minimize respiratory-driven pressure and reduce pulmonary and systemic inflammation as well as severe multiorgan dysfunction [11,12].…”

Section: Covid-related Severe Respiratory Impairment and V-v Ecmomentioning

confidence: 99%

COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review

et al. 2020

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Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has presently become a rapidly spreading and devastating global pandemic. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as life-saving rescue therapy for refractory respiratory failure in the setting of acute respiratory compromise such as that induced by SARS-CoV-2. While still little is known on the true efficacy of ECMO in this setting, the natural resemblance of seasonal influenza's characteristics with respect to acute onset, initial symptoms, and some complications prompt to ECMO implantation in most severe, pulmonary decompensated patients. The present review summarizes the evidence on ECMO management of severe ARDS in light of recent COVID-19 pandemic, at the same time focusing on differences and similarities between SARS-CoV-2 and ECMO in terms of hematological and inflammatory interplay when these two settings merge.

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Section: Covid-related Severe Respiratory Impairment and V-v Ecmomentioning

confidence: 99%

COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review

et al. 2020

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“…In addition to the ELSO guidelines we utilize the RESP score developed by ELSO to determine optimal candidates for ECMO intervention. on the early experience with the pandemic in China [22,23]. As the pandemic spreads and resources (such as ECMO circuits) become limited, we advocate potentially limiting ECMO to those patients who have the best predicted outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

Firstenberg

Stahel

Hanna

et al. 2020

Preprint

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Background: The value of extracorporeal membrane oxygenation (ECMO) for patients suffering from novel coronavirus disease 2019 (COVID-19) as a rescue therapy for respiratory failure remains controversial and associated with high mortality rates of 50% to 82% in early reports from Wuhan, China. We hypothesized that patient outcomes would be improved at our tertiary cardiothoracic surgery referral center with a protocolized team-approach for ECMO treatment of patients with severe COVID-19 disease. Case Presentation: A 51-year-old healthy female developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) bilateral pneumonia while vacationing in Colorado with her family. She was transferred to our facility for a higher level of care. Her respiratory status continued to deteriorate despite maximized critical care, including prone positioning ventilation and nitric oxide inhalation therapy. Veno-venous ECMO was initiated on hospital day 7 in conjunction with a 10-day course of compassionate use antiviral treatment with remdesivir. The patient’s condition improved significantly and she was decannulated from ECMO on hospital day 17 (ECMO day 11). She was successfully extubated and eventually discharged to rehabilitation on hospital day 28.Conclusion: This case report demonstrates that the judicious application of ECMO for respiratory failure due to SARS-CoV-2 pneumonia in conjunction with compassionate use antiviral treatment (remdesivir) resulted in a positive outcome in a young patient with a high predicted mortality from COVID-19. Future prospective multi-center studies are needed to validate these findings in a larger cohort of patients.

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“…Contraindications to ECMO include concerns for acute neurologic insults, such as anoxic brain injury, contraindications to anticoagulation, and baseline comorbidities that predict either futility of ECMO or limited 2-year survival [9,20,21]. Current indications for ECMO in COVID-19 patients were recently proposed based on the early experience with the pandemic in China [22,23]. As the pandemic spreads and resources (such as ECMO circuits) become limited, we advocate potentially limiting ECMO to those patients who have the best predicted outcomes.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

Background: The value of extracorporeal membrane oxygenation (ECMO) for patients suffering from novel coronavirus disease 2019 (COVID-19) as a rescue therapy for respiratory failure remains controversial and associated with high mortality rates of 50 to 82% in early reports from Wuhan, China. We hypothesized that patient outcomes would be improved at our tertiary cardiothoracic surgery referral center with a protocolized team-approach for ECMO treatment of patients with severe COVID-19 disease. Case presentation: A 51-year-old healthy female developed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) bilateral pneumonia while vacationing in Colorado with her family. She was transferred to our facility for a higher level of care. Her respiratory status continued to deteriorate despite maximized critical care, including prone positioning ventilation and nitric oxide inhalation therapy. Veno-venous ECMO was initiated on hospital day 7 in conjunction with a 10-day course of compassionate use antiviral treatment with remdesivir. The patient's condition improved significantly and she was decannulated from ECMO on hospital day 17 (ECMO day 11). She was successfully extubated and eventually discharged to rehabilitation on hospital day 28. Conclusion: This case report demonstrates a positive outcome in a young patient with COVID-19 treated by the judicious application of ECMO in conjunction with compassionate use antiviral treatment (remdesivir). Future prospective multi-center studies are needed to validate these findings in a larger cohort of patients.

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Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease: indications, timing, and implementation

Cited by 20 publications

References 15 publications

COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review

COVID-19 and ECMO: the interplay between coagulation and inflammation—a narrative review

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

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

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