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

Abstract

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.

Role of extracorporeal membrane oxygenation in COVID‐19: A systematic review

“…In our study, six case reports and two case series reported positive endpoints (weaned off ECMO/discharged from hospital) for patients on ECMO 7‐9,11,17,19,23,29 . These outcomes supporting ECMO for COVID‐19 are likely to have occurred for the following reasons.…”

“…Third, in cases where the association between COVID‐19, cytokine storm and mortality has been established, 34 the role of ECMO in reducing inflammatory substances has also been attributed to patient survival 23 . ECMO as a therapeutic adjunct has shown promising results in reducing inflammation when utilized in conjunction with primary treatment 9,11,20 …”

Pharmacokinetics and tissue distribution of remdesivir and its metabolites nucleotide monophosphate, nucleotide triphosphate, and nucleoside in mice

“…Recently, RDV was shown to have strong inhibitory activities against SARS-CoV-2 in in vitro and animal studies, such as studies of monkeys and mice [6]. Several clinical trials and case reports on patients also support that RDV is a promising candidate for the treatment of COVID-19 [9,10]. However, there are only a few preliminary studies on the in vivo processes of RDV.…”

Critical Care Demand and Intensive Care Supply for Patients in Japan with COVID-19 at the Time of the State of Emergency Declaration in April 2020: A Descriptive Analysis

“…Although approximately 70–80% of patients with COVID-19 have mild to moderate symptoms and recover, 5–20% of patients develop severe respiratory failure and may require admission to an intensive care unit (ICU) [ 3 , 4 , 5 ]. Symptomatic treatment for severe respiratory failure has involved the use of mechanical ventilation and extracorporeal membrane oxygenation (ECMO) [ 5 , 6 , 7 , 8 , 9 ], although there are candidate drugs available to treat severe patients with COVID-19 as of September 2020 [ 10 , 11 ]; remdesivir [ 12 , 13 ] and dexamethasone [ 14 ]. One study that analyzed clinical cases of COVID-19 reported a better prognosis in patients with a mild infection, whereas the prognosis for patients with severe and critical infections is poor.…”