Abstract:OBJECTIVES
Treatment of severe acute respiratory distress syndrome (ARDS) induced by severe acute respiratory syndrome coronavirus 2 has been heavily debated. Our goal was to describe our findings in patients with severe ARDS due to severe coronavirus disease 2019 (sCOVID-19) treated with venovenous extracorporeal membrane oxygenation (vv-ECMO).
METHODS
We retrospectively examined all patients treated with vv-ECMO for severe … Show more
“…However, due to a relatively small number of patients, we could not establish significant results. 18 In this study, we were able to provide proof that vv-ECMO implantation <48 h after admission was associated with improved survival. To our knowledge, this is the first time that a clear correlation between the time of vv-ECMO implantation and survival has been described.…”
Background Severe acute respiratory distress syndrome (ARDS) due to Coronavirus Disease-19 (COVID-19) is associated with high mortality. Although survival on mechanical circulatory support has improved, determinants for better prognosis are still unclear. Here, we report on the outcome of our patient population with the need for mechanical circulatory support due to severe COVID-19 (sCOVID-19) induced ARDS. Methods All patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS due to sCOVID-19 were analysed. Patients > 18 years of age at the time of initiation of ECMO were included. Pre-existing comorbidities, complications during ECMO implantation, and ECMO runtime were reviewed. The latency to intubation, proning, tracheotomy, and ECMO implantation was analysed. Furthermore, the survival and non-survival population were compared to determine factors in favour of a better outcome. Results In total, 85 patients were treated with veno-venous membrane oxygenation (vv-ECMO) for severe ARDS in our medical centre. The patient population was predominantly male (83.5%) with a mean patient age of 54.9 years. A history of cardiovascular disease ( p = .01), smoking ( p < .05), need for vasopressor- ( p < .05), and renal replacement therapy ( p < .001) was associated with a worse prognosis. Overall survival was 50%. The survival population was significantly younger ( p = .004), had a significantly higher body weight ( p = .02) and body mass index (BMI) ( p = .01). Furthermore, survival was significantly better when vv-ECMO was initiated within 48 h after admission ( p < .001). Conclusions Pre-existing cardiovascular disease, higher age, history of nicotine abuse, and development of renal failure are associated with poor outcome. Early start of vv-ECMO therapy may lead to better survival in sCOVID-19 patients, although complications during ECMO therapy are associated with a worse prognosis.
“…However, due to a relatively small number of patients, we could not establish significant results. 18 In this study, we were able to provide proof that vv-ECMO implantation <48 h after admission was associated with improved survival. To our knowledge, this is the first time that a clear correlation between the time of vv-ECMO implantation and survival has been described.…”
Background Severe acute respiratory distress syndrome (ARDS) due to Coronavirus Disease-19 (COVID-19) is associated with high mortality. Although survival on mechanical circulatory support has improved, determinants for better prognosis are still unclear. Here, we report on the outcome of our patient population with the need for mechanical circulatory support due to severe COVID-19 (sCOVID-19) induced ARDS. Methods All patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS due to sCOVID-19 were analysed. Patients > 18 years of age at the time of initiation of ECMO were included. Pre-existing comorbidities, complications during ECMO implantation, and ECMO runtime were reviewed. The latency to intubation, proning, tracheotomy, and ECMO implantation was analysed. Furthermore, the survival and non-survival population were compared to determine factors in favour of a better outcome. Results In total, 85 patients were treated with veno-venous membrane oxygenation (vv-ECMO) for severe ARDS in our medical centre. The patient population was predominantly male (83.5%) with a mean patient age of 54.9 years. A history of cardiovascular disease ( p = .01), smoking ( p < .05), need for vasopressor- ( p < .05), and renal replacement therapy ( p < .001) was associated with a worse prognosis. Overall survival was 50%. The survival population was significantly younger ( p = .004), had a significantly higher body weight ( p = .02) and body mass index (BMI) ( p = .01). Furthermore, survival was significantly better when vv-ECMO was initiated within 48 h after admission ( p < .001). Conclusions Pre-existing cardiovascular disease, higher age, history of nicotine abuse, and development of renal failure are associated with poor outcome. Early start of vv-ECMO therapy may lead to better survival in sCOVID-19 patients, although complications during ECMO therapy are associated with a worse prognosis.
“…There were 18 studies reporting the events of major bleeding in COVID-19 patients who received ECMO support, 19,20,22,27–29,37–39,43,46,49,50,52,56–58,60 and the incidence of hemorrhage varied from 3.7% to 81.3%. Meta-analysis of proportions found that the pooled incidence rate of bleeding requiring transfusion was 39% (95% CI 28%–52%, I 2 = 76%; Figure 4) in ECMO-assisted patients with COVID-19.Figure 4.Forest plot of the incidence of bleeding requiring transfusion in COVID-19 patients treated with ECMO.…”
Section: Resultsmentioning
confidence: 99%
“…Total 27 studies including 1103 patients with COVID-19 who developed ARDS reported inhospital mortality. [21][22][23][25][26][27][28][29][31][32][33]35,36,39,41,42,[44][45][46][47][48][49][50]52,56,59,60 It varied from 3.7% to 65.6% in an overall hospital setting. Meta-analysis of proportions revealed the pooled incidence rate of in-hospital death was 35% (95% CI 30%-42%, I 2 = 72%; Figure 3) in all hospitalized patients.…”
Section: Primary Outcomementioning
confidence: 99%
“…Total 17 studies reported the incidence of hemorrhagic stroke events in an overall hospital setting, varying from 0% to 41.7%. 20,25,29,[31][32][33][37][38][39]44,46,50,52,[56][57][58]60 The events were observed in 58 out of 527 COVID-19 patients treated with ECMO in hospital. Meta-analysis of proportions revealed a pooled incidence rate of hemorrhagic stroke was 11% (95% CI 9%-14%, I 2 = 42%; Figure 5) in hospitalized COVID-19 patients.…”
Objective Although the application of venovenous extracorporeal membrane oxygenation (VV-ECMO) in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS) is accumulating, the feasibility and safety of this therapy remain controversial. We aimed to evaluate the effect of VV-ECMO in the treatment of these patients. Methods A comprehensive literature search was performed using PubMed, Embase, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2021. According to the inclusion and exclusion criteria, the included studies were screened, and meta-analysis was performed by R software (version 4.0.2). Results Forty-two studies including 2037 COVID-19 patients supported with VV-ECMO due to ARDS were identified. The pooled analysis revealed that 30-, 60-, and 90-day mortality among patients were respectively 46% (95% CI 37%–57%, I2 = 66%), 46% (95% CI 30%–70%, I2 = 93%), and 49% (95% CI 43%–58%, I2 = 52%), and the pooled incidence rate of in-hospital mortality, major bleeding, hemorrhagic stroke, thrombosis, pulmonary embolism, deep venous thrombosis, and renal replacement therapy were respectively 35%, 39%, 11%, 40%, 15%, 21%, and 44%. Conclusion Although COVID-19 patients may have a higher risk of bleeding, hemorrhagic stroke, and acute kidney injury during ECMO therapy, the survival rate was more than half of the cases. Our data may support the application of VV-ECMO in COVID-19 patients.
“…Extracorporeal membrane oxygenation (ECMO) is an effective means of treating critically ill cardiopulmonary dysfunction. ECMO has attracted much attention [ 1 , 2 , 3 , 4 , 5 ], as the coronavirus disease 2019 (COVID-19) continues to ravage the world since the use of ECMO is clinically beneficial for patients with severe heart failure or lung failure [ 6 , 7 , 8 , 9 ]. One of the key parts of ECMO comprises hollow fiber oxygenation membranes, which are made from polyolefin, e.g., polydimethylsiloxane, poly-1-methyl-4-pentene, polypropylene, and other polyolefin polymers [ 10 ], and polypropylene (PP) is one of the promising membrane material due to its stable, inexpensive, and easy-to-process characteristics.…”
Plasma leakage limits the development of polypropylene membranes as oxygenated membranes. Here, a new method named the dissolution-induced pore method was adapted to prepare polypropylene hollow fiber membranes: after polypropylene and polyvinyl chloride were melt-blended and extruded, the polyvinyl chloride was removed by N, N-dimethylacetamide to obtain a porous polypropylene membrane material. The variation of membranes has been explored in detail with respect to the influence of different parameters on the flux and mechanical properties of membranes and the feasibility of the polyvinyl chloride recovery. The resulting polypropylene hollow fiber membrane shows that plasma penetration was zero within 6 h of test, gas flux can reach 189,000 L/(m2·h·0.1 MPa), and its strength at break reaches 65 MPa and the elongation at break is 890%; polyvinyl chloride recovery achieves more than 99%. This research has developed a promising and low-cost extracorporeal membrane oxygenation material, which provides benefits for patients with less capacity for medical expenditure.
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