Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure

Bartlett, Robert H.; Ogino, Mieko; Brodie, Daniel; McMullan, D. Michael; Lorusso, Roberto; MacLaren, Graeme; Stead, Christine; Rycus, Peter; Fraser, John F.; Bělohlávek, Jan; Salazar, Leonardo; Mehta, Yatin; Raman, Lakshmi; Paden, Matthew L.

doi:10.1097/mat.0000000000001173

Cited by 283 publications

(342 citation statements)

References 4 publications

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“…Second, complications such as myocarditis (8-10) acute myocardial infarction (11), arrhythmias (9), thromboembolic events (12)(13)(14), and heart failure (11,14), have been linked to COVID-19 infection. In some cases, these complications engendered treatment with ECMO (15)(16)(17). Third, reports on cardiovascular side effects of COVID-19 therapies have been published (18)(19)(20), and lastly, the pandemic's consequences regarding non-COVID-19 cardiovascular patients.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic on Cardiac Surgery in Israel

Keizman

Ram

Kachel

et al. 2020

Preprint

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Background: Ever since the coronavirus disease 2019 (COVID-19) has become a pandemic, worldwide efforts are being made to “flatten the curve”. Israel was amongst the first countries to impose significant restrictions. As a result, cardiac surgeons have been required to scale down their routine practice, resulting in a significant reduction in the number of cardiac surgeries. The aim of this study is to characterize the impact of COVID-19 on cardiac surgery in Israel. Methods: This is a retrospective observational study performed in two cardiac surgery departments in Israel and includes all patients who underwent cardiac surgery in March and April during the years 2019 and 2020. The patient cohort was divided into two groups based on the year of operation. Analysis of the patients’ baseline characteristics, operative data, and postoperative outcome, was performed. Results: The 2019 group (n=173), and the 2020 group (n=108) were similar regarding their baseline characteristics, previous medical history, and rates of previous revascularization interventions. However, compared to the 2019 group, patients in the 2020 group were found to be more symptomatic (NYHA class IV; 2.4% vs. 6.2%, p=0.007). While all patients underwent similar procedures, patients in the 2020 group had significantly longer procedural time (p<0.001). In-hospital mortality rate was found to be significantly higher in group 2020 (13% vs. 5.2%, p=0.037). Conclusions: While the number of patients undergoing cardiac surgery declined during the outbreak period, the rate of surgical mortality increased. One explanation for this might be delayed hospital arrival.

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Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 Pandemic on Cardiac Surgery in Israel

Keizman

Ram

Kachel

et al. 2020

Preprint

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“…The application of VA-ECMO is indicated when inadequate tissue perfusion has manifested as hypotension and low cardiac output despite adequate intravascular volume [ 5 ]. Bartlett et al [ 6 ] reported ECMO is considered when the situation presenting PaO 2 /FiO 2 <80 lasts longer than 6 h. Our patient suffered from PaO 2 /FiO 2 <78 on FiO 2 290% for 12 h and had a Murray score of 3.5. The patient developed oliguria and her BP decreased below 90/60 mmHg despite the administration of norepinephrine.…”

Section: Discussionmentioning

confidence: 73%

Veno-Arterial-Venous Extracorporeal Membrane Oxygenation in a Critically Ill Patient with Coronavirus Disease 2019

et al. 2020

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Patients with cardiopulmonary failure may not be fully supported with typical configurations of extracorporeal membrane oxygenation (ECMO), either veno-arterial (VA) or veno-venous (VV). Veno-arterial-venous (VAV)-ECMO is a technique used to support the cardiopulmonary systems during periods of inadequate gas exchange and perfusion. In the severe case of coronavirus disease 2019 (COVID-19), which simultaneously affects the heart and lung, VAV-ECMO may improve a patient’s recovery potential. We report the case of a 72-year-old woman with acute respiratory distress syndrome and circulatory failure following COVID-19, who was treated with VAV-ECMO.

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“…The risks and benefits should be weighed to prevent or reduce additional complications, such as the ECLS circuit‐related thrombosis or bleeding that results from the potentially negative interplay between COVID‐19 and extracorporeal devices. However, appropriate patient selection criteria that was addressed by experts and scientific organizations, such as ELSO, may provide significant help with difficult decision‐making 136 . Because it remains a bridging strategy to buy the time toward recovery, ECLS cannot act as the ultimate treatment for the underlying COVID‐19 disease (Figure 4).…”

Section: Perspectives After the Pandemic: “The Aftermath Of The Pandementioning

confidence: 99%

Artificial lungs––Where are we going with the lung replacement therapy?

et al. 2020

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Lung transplantation may be a final destination therapy in lung failure, but limited donor organ availability creates a need for alternative management, including artificial lung technology. This invited review discusses ongoing developments and future research pathways for respiratory assist devices and tissue engineering to treat advanced and refractory lung disease. An overview is also given on the aftermath of the coronavirus disease 2019 pandemic and lessons learned as the world comes out of this situation. The first order of business in the future of lung support is solving the problems with existing mechanical devices. Interestingly, challenges identified during the early days of development persist today. These challenges include device‐related infection, bleeding, thrombosis, cost, and patient quality of life. The main approaches of the future directions are to repair, restore, replace, or regenerate the lungs. Engineering improvements to hollow fiber membrane gas exchangers are enabling longer term wearable systems and can be used to bridge lung failure patients to transplantation. Progress in the development of microchannel‐based devices has provided the concept of biomimetic devices that may even enable intracorporeal implantation. Tissue engineering and cell‐based technologies have provided the concept of bioartificial lungs with properties similar to the native organ. Recent progress in artificial lung technologies includes continued advances in both engineering and biology. The final goal is to achieve a truly implantable and durable artificial lung that is applicable to destination therapy.

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Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure

Cited by 283 publications

References 4 publications

The Impact of COVID-19 Pandemic on Cardiac Surgery in Israel

The Impact of COVID-19 Pandemic on Cardiac Surgery in Israel

Veno-Arterial-Venous Extracorporeal Membrane Oxygenation in a Critically Ill Patient with Coronavirus Disease 2019

Artificial lungs––Where are we going with the lung replacement therapy?

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