Veno-venous Extracorporeal Membrane Oxygenation Support in COVID-19 Respiratory Distress Syndrome: Initial Experience

Loforte, Antonio; Checco, Erika Dal; Gliozzi, Gregorio; Benedetto, Maria; Cavalli, Giulio Giovanni; Mariani, Carlo; Piccone, Giulia; Agulli, Marta; Pacini, Davide; Baiocchi, Massimo

doi:10.1097/mat.0000000000001198

Cited by 18 publications

(22 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A total of 102 articles were retrieved from the database search and snowballing. Following the exclusion of duplicates and screening, a total of 25 articles were selected for inclusion in this systematic review 6‐30 (Figure 1). The characteristics of these studies are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Loforte et al 15 also reported that three out of four patients were weaned off ECMO, and although a 75% weaning rate appears successful, one of the three weaned patients eventually died after VV‐ECMO removal. The final patient died due to severe gastrointestinal bleeding while on ECMO, highlighting the potentially fatal complications associated with ECMO (with bleeding being the most frequent) 32 .…”

Section: Discussionmentioning

confidence: 99%

“…Many of the studies specifying the use of VV‐ECMO resulted in positive outcomes 7‐9,11,15,17,19‐21,23,29 . For example, Jacobs et al 13 showed that out of 15 patients placed on ECMO, only 5 were successfully weaned off, all previously placed on the VV variation.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

View full text Add to dashboard Cite

Objective We aimed to examine the literature evidence behind using extracorporeal membrane oxygenation in COVID‐19 patients in a systematic review manner. Methods We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta‐analysis (PRISMA) guidelines. A comprehensive literature search was conducted on Global Health Medline, EMBASE, and Cochrane databases using keywords and MeSH terms to identify articles pertaining to extracorporeal membrane oxygenation (ECMO) and Coronavirus disease 2019 (COVID‐19). A narrative synthesis was then undertaken to identify the key themes. Results A total of 25 articles met the inclusion criteria of this systematic review. Three main themes were identified following the data extraction: (a) evidence against/inconclusive regarding ECMO for COVID‐19, (b) evidence supporting ECMO for COVID‐19, and finally (c) VV‐ECMO and VA‐ECMO. After combining the data, there were 3428 patients diagnosed with COVID‐19 and 95 ECMO‐associated deaths (19.83%). Conclusion Our study highlights the paucity of evidence and the need for further data to consolidate the efficacy of ECMO in improving patient outcomes. Although ECMO has been shown to be beneficial in a selected group of patients, the recuperative effects of ECMO remain inconclusive. We must ensure that risk‐benefit analysis for each candidate is conducted thoroughly so that patients that have increased probability of survival can benefit from this scarce resource.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In a separate research study by Loforte et al., 75% weaning rate was reported; however,one- third of weaned patients died after subsequent VV-ECMO removal. 17 Also, the remaining patient of the four had severe gastrointestinal bleeding while on ECMO, a severe complication linked to ECMO. 18 Thus, with a final mortality rate of 50%, with 2 out of 4 patients eventually dying, these results were also inconclusive in terms of the benefit of ECMO in COVID-19.…”

mentioning

confidence: 99%

“… 15 China Case series 16 (8) N/A 7 on VV-ECMO 1 on VA-ECMO N/A Loforte et al. 17 Italy Observational 59 (4) 59 VV-ECMO used in all patients 1 (25) Marullo et al. 16 Europe Retrospective 333 (333) N/A VV-ECMO used in 93.7% of cases 57 (17.1) Nakamura et al.…”

mentioning

confidence: 99%

Use of ECMO in Patients With Coronavirus Disease 2019: Does the Evidence Suffice?

Alom

Haiduc

Melamed

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

CORONAVIRUS DISEASE 2019 (COVID-19) is a contagious infection precipitated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2. It is a novel virus of which transmissability, incidence and mortality rates have made it a global emergency. While the clinical manifestations of the virus may vary in severity, it is widely known that the cardiorespiratory system is the principle infection point of the virus, with acute respiratory distress syndrome (ARDS) and shock being possibilities. 1 Although severe and critically ill patients account for 15-26% of patients, there are currently no targeted COVID-19 therapeutics. 2 At present, supportive care forms the core of disease management, with emphasis on oxygen delivery in the early stage of the disease. 3 In March 2020, the World Health Organization (WHO) published interim guidelines recommending the use of extracorporeal membrane oxygenation (ECMO) in ARDS patients unresponsive to mainstream therapies, in order to maintain cardiorespiratory function. 4 In this letter, we present a systematic review of the literature to summarize the evidence behind using ECMO in COVID-19 patients, in accordance to the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis: (PRISMA) Guidelines. We have performed a comprehensive electronic literature search using key words "COVID-19," "SARS-CoV2," "Coronavirus," "ECMO," "Extracorporeal membrane oxygenation," "VA-ECMO," "VV-ECMO," "Outcomes," "Respiratory support," and "circulatory support," either as MeSH terms or in the combined key word formats. Our results showed a total of 102 articles that were collected from the database search and through snowballing. A total of 25 articles were selected to be included, after exclusion of duplication and subsequent screening (Fig 1). A summary of each of the chosen studies was conducted as shown in Table 1. After combining the data from the studies, 3,428 patients were diagnosed with COVID-19 overall, 612 patients were diagnosed with ARDS, and 479 were placed on ECMO, with VV-ECMO being the most commonly used type. Commonly used as a form of rescue therapy, ECMO was delivered to COVID-19 patients with induced ARDS and other

show abstract

Mortality Risk Assessment in COVID-19 Venovenous Extracorporeal Membrane Oxygenation

Tabatabai

Ghneim

Kaczorowski

et al. 2021

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

BACKGROUND A life-threatening complication of coronavirus disease 2019 (COVID-19) is acute respiratory distress syndrome (ARDS) refractory to conventional management. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) (VV-ECMO) is used to support patients with ARDS in whom conventional management fails. Scoring systems to predict mortality in VV-ECMO remain unvalidated in COVID-19 ARDS. This report describes a large single-center experience with VV-ECMO in COVID-19 and assesses the utility of standard risk calculators.METHODS A retrospective review of a prospective database of all patients with COVID-19 who underwent VV-ECMO cannulation between March 15 and June 27, 2020 at a single academic center was performed. Demographic, clinical, and ECMO characteristics were collected. The primary outcome was in-hospital mortality; survivor and nonsurvivor cohorts were compared by using univariate and bivariate analyses.RESULTS Forty patients who had COVID-19 and underwent ECMO were identified. Of the 33 patients (82.5%) in whom ECMO had been discontinued at the time of analysis, 18 patients (54.5%) survived to hospital discharge, and 15 (45.5%) died during ECMO. Nonsurvivors presented with a statistically significant higher Prediction of Survival on ECMO Therapy (PRESET)-Score (mean ± SD, 8.33 ± 0.8 vs 6.17 ± 1.8; P [ .001). The PRESET score demonstrated accurate mortality prediction. All patients with a PRESET-Score of 6 or lowers survived, and a score of 7 or higher was associated with a dramatic increase in mortality.CONCLUSIONS These results suggest that favorable outcomes are possible in patients with COVID-19 who undergo ECMO at high-volume centers. This study demonstrated an association between the PRESET-Score and survival in patients with COVID-19 who underwent VV-ECMO. Standard risk calculators may aid in appropriate selection of patients with COVID-19 ARDS for ECMO.

show abstract

Veno-venous Extracorporeal Membrane Oxygenation Support in COVID-19 Respiratory Distress Syndrome: Initial Experience

Cited by 18 publications

References 5 publications

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

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

Use of ECMO in Patients With Coronavirus Disease 2019: Does the Evidence Suffice?

Mortality Risk Assessment in COVID-19 Venovenous Extracorporeal Membrane Oxygenation

Contact Info

Product

Resources

About