SARS-CoV-2 Leakage From the Gas Outlet Port During Extracorporeal Membrane Oxygenation for COVID-19

Abstract

Patients with the coronavirus disease 2019 (COVID-19) sometimes develop refractory respiratory failure and may require venovenous extracorporeal membrane oxygenation (VV-ECMO). It is known that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is sometimes present in the blood of COVID-19 patients. VV-ECMO is often used for several weeks, and plasma leaks can occur, albeit rarely. Hence, in terms of infection control, a concern is that SARS-CoV-2 may leak from the gas outlet port of the oxygenator during ECMO support of critically ill COVID-19 patients. The aim of this study was to clarify whether SARS-CoV-2 leaks from the oxygenator during ECMO support. Five patients with critical COVID-19 pneumonia were placed on VV-ECMO. Silicone-coated polypropylene membrane oxygenators were used in the ECMO circuits for these patients. SARS-CoV-2 ribonucleic acid (RNA) was measured by quantitative reverse transcription polymerase chain reaction in serum and at the gas outlet port of the ECMO circuit at the time of circuit replacement or liberation from ECMO. SARS-CoV-2 RNA was detected in the gas outlet port of the ECMO circuit for three of the five patients. None of the medical staff involved in the care of these five patients has been infected with COVID-19. In conclusion, SARS-CoV-2 could leak to the gas outlet port of the ECMO circuit through silicone-coated polypropylene membranes during ECMO support of critically ill COVID-19 patients.

Electron Microscopic Confirmation of Anisotropic Pore Characteristics for ECMO Membranes Theoretically Validating the Risk of SARS-CoV-2 Permeation

“…Although the output of our study may not provide direct evidence, it provides novel insights to ECMO support of COVID-19 critically ill patients. From our research and other studies [ 2 , 29 ], SARS-CoV-2 is highly likely to permeate the membrane transporting from the patient’s blood to the gas side, and may diffuse from the gas side outlet port of ECMO.…”

“…During the current COVID-19 pandemic, it has been reported that the plasma components from the gas outlet port of the membrane oxygenator became yellow foam and positive PCR test results were obtained from the gas outlet port of the membrane oxygenator [ 2 , 29 ]. This is due to the fact that SARS-CoV-2 in plasma may permeate the hollow fiber membrane and aerosol diffusion occurs from the gas outlet port [ 29 ]. Therefore, in ECMO support for COVID-19 patients, it must be recognized that there is the risk of ECMO infection due to extra-circulatory spread of the SARS-CoV-2.…”

“…However, there was no direct evidence of how such a SARS-CoV-2 infection phenomenon occurred. In particular, there is the need to verify the risk of SARS-CoV-2 leakage through PMP membrane and silicone-coated membrane, and to examine the damaged membranes [ 29 ].…”

Insights into Gradient and Anisotropic Pore Structures of Capiox® Gas Exchange Membranes for ECMO: Theoretically Verifying SARS-CoV-2 Permeability

“…The oxygen diffusivity in water is 2.76 × 10 −9 m 2 /s, and glucose diffusivity in water is 9.30 × 10 −10 m 2 /s (the values in the literature). The values calculated based on the model [19,21] Permeability (P m ) of SARS-CoV-2 (4) [m/s] NA 3.1 × 10 −9 3.3 × 10 −10…”

“…(3) Oxygen diffusivity in water: 2.76 × 10 −9 m 2 /s, glucose diffusivity in water 9.30 × 10 −10 m 2 /s (the value in the literature) [21]. (4) Calculated oxygen diffusivity in water using this model 3.26 × 10 −9 m 2 /s (molecular diameter 0.2 nm), glucose diffusivity in water 4.68 × 10 −10 m 2 /s (molecular diameter 0.7 nm). NA; not available.…”