Prevention of pneumothorax using venovenous ECMO in acute respiratory distress syndrome with emphysematous/cystic changes in the lung

Otani, Toshikatsu; Ohshimo, Shinichiro; Ota, Kohei; Kida, Yoshiko; Inagawa, Tetsuji; Itai, Junji; Yamaga, Satoshi; Une, Kazunobu; Iwasaki, Yoshinobu; Hirohashi, Nobuyuki; Kohno, Nobuoki; Tanigawa, Koichi

doi:10.1186/cc13524

Cited by 1 publication

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“…This data further suggests reducing time on the ventilator prior to cannulation, as ECMO has been shown to decrease the rate of pneumothorax particular in high risk patients with ARDS. 29 In our study, non-COVID-19 patients had a higher incidence of acute kidney injury and use of RRT both before and after cannulation for VV ECMO, which is similar to current literature. 12,14 As our institution limited VV ECMO support in COVID-19 patients with severe renal impairment or those already on renal replacement therapy, this may account for the difference in groups prior to cannulation.…”

Section: Discussionsupporting

confidence: 90%

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COVID-19 outcomes of venovenous extracorporeal membrane oxygenation for acute respiratory failure vs historical cohort of non-COVID-19 viral infections

et al. 2022

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Introduction Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a support modality for patients with acute respiratory failure refractory to standard therapies. VV ECMO has been increasingly used during the current COVID-19 pandemic for patients with refractory respiratory failure. The object of this study was to evaluate the outcomes of VV ECMO in patients with COVID-19 compared to patients with non-COVID-19 viral infections. Methods We retrospectively reviewed all patients supported with VV ECMO between 8/2014 and 8/2020 whose etiology of illness was a viral pulmonary infection. The primary outcome of this study was to evaluate in-hospital mortality. The secondary outcomes included length of ECMO course, ventilator duration, hospital length of stay, incidence of adverse events through ECMO course. Results Eighty-nine patients were included (35 COVID-19 vs 54 non-COVID-19). Forty (74%) of the non-COVID-19 patients had influenza virus. Prior to cannulation, COVID-19 patients had longer ventilator duration (3 vs 1 day, p = .003), higher PaCO2 (64 vs 53 mmHg, p = .012), and white blood cell count (14 vs 9 ×103/μL, p = .004). Overall in-hospital mortality was 33.7% ( n = 30). COVID-19 patients had a higher mortality (49% vs. 24%, p = .017) when compared to non-COVID-19 patients. COVID-19 survivors had longer median time on ECMO than non-COVID-19 survivors (24.4 vs 16.5 days p = .03) but had a similar hospital length of stay (HLOS) (41 vs 48 Extracorporeal Membrane Oxygenationdays p = .33). Conclusion COVID-19 patients supported with VV ECMO have a higher mortality than non-COVID-19 patients. While COVID-19 survivors had significantly longer VV ECMO runs than non-COVID-19 survivors, HLOS was similar. This data add to a growing body of literature supporting the use of ECMO for potentially reversible causes of respiratory failure.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%