The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS

Abstract

Objective: The ProtekDuo with oxygenator mimics veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) in veno-pulmonary (V-P) configuration. We have recently developed a new configuration by utilizing a 25 Fr multistage femoral venous drainage cannula and by returning oxygenated blood through both lumina of the double lumen ProtekDuo cannula (V-VP configuration), thereby creating partial right ventricular bypass and oxygenated blood flow of up to seven LPM. We investigated our experience with V-P and V-VP ECMO in patients suffering from COVID-19 acute respiratory distress syndrome (ARDS). Methods: Single center, retrospective observational study. Results: Of nine patients, one was initiated on V-A, two on V-P, and six on V-V ECMO. All patients were reconfigured to V-P and five patients in addition had V-VP ECMO configuration. All patients had at least one and up to three circuit exchanges. Patients were on ECMO support between 20 and 122 (55 ± 29) days, were in ICU between 46 and 161 (78 ± 40) days with a total hospital length of stay between 35 and 171 (82 ± 42) days. Six of nine (67%) patients could successfully be weaned off ECMO, survived, and were discharged. Conclusion: The ProtekDuo cannula in V-P configuration provides ECMO blood flow while reducing RV flow, wall-stress and dilatation, as well as oxygen consumption. The V-VP configuration is useful to provide high blood flows of up to seven LPM of oxygenated blood, and partial RV support without over-circulating the pulmonary vascular bed. Our results show that V-P and V-VP ECMO configurations are feasible, have good outcome and are without complications.

The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review

“…In contrast to the above-mentioned studies where V-P ECMO was the initial configuration, the most recent study by the group of Maybauer showed that V-P or V-VP ECMO configuration was established weeks after the onset of ARDS and ECMO initiation. This selected group of patients still displayed good outcomes with a survival rate of 67% 12 and the ProtekDuo has been shown to be a game changer when used in patients with ARDS secondary to COVID-19. 13 However, the available data is scarce and may have institutional bias.…”

Oxygenated right ventricular assist device as part of veno-venopulmonary extracorporeal membrane oxygenation to support the right ventricle and pulmonary vasculature

“…We calibrated the flows based on end-organ dysfunction and resolution of liver failure and renal failure. There is are reports of V-VP ECMO configuration that were used for a partial duration of total ECMO support [18][19][20]. In these cases, described by Maybauer and colleagues, all patients were either on V-V ECMO or V-P ECMO before the configuration was changed to V-VP ECMO without any complications.…”

“…Given this understanding, we followed the strategy of deploying RV mechanical circulatory support while simultaneously protecting the pulmonary circulation from high continuous flow overcirculation and providing flow through the RV using a partial RA flow Veno-venopulmonary artery (V-VP) ECMO strategy. Previously, this strategy has been used in short temporary duration, however; we report one of the first novel case of a near entire ECMO duration using a protected RV protected, pulmonary circulation partial flow, oxygenated Veno-venopulmonary (V-VP) RVAD strategy [19,20].…”

Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome

“…ECMO is an intervention that allows for either cardiac-, respiratory-, or combined cardiorespiratory support for patients who cannot be managed with conventional treatment strategies. 2 …”