ECMO Papers

editado 29 de abril en Ciencia y datos
28.Apr.2020
Survival Rate of COVID-19 Patients on ECMO Machines are Three Times Higher Than On Ventilators

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  • editado 29 de abril
    17.Apr.2020

    Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in COVID-19
    Experience with 32 patients

    During the 24 days of this study, 32 consecutive patients with COVID-19 were placed on ECMO at 9 different hospitals. As of the time of analysis, 17 remain on ECMO, 10 died prior to or shortly after decannulation, and 5 are alive and extubated after removal from ECMO, with one of these 5 discharged from the hospital. Adjunctive medication in the surviving patients while on ECMO was as follows: 4 of 5 survivors received intravenous steroids, 3 of 5 survivors received antiviral medications (Remdesivir), 2 of 5 survivors were treated with anti-interleukin-6-receptor monoclonal antibodies (Tocilizumab or Sarilumab), and 1 of 5 survivors received hydroxychloroquine.

    https://journals.lww.com/asaiojournal/Abstract/9000/Extracorporeal_Membrane_Oxygenation_in_the.98533.aspx
  • editado 29 de abril
    Published Online:17 Apr 2020

    Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic

    Clinical reports of COVID-19 & the use of ECMO
    Reports have recently been published describing the clinical characteristics of this severe disease. A recent report from Wuhan, China, published in The Lancet reported that in this cohort six patients (11.5% of COVID-19 cases) in the ICU received ECMO of which only one patient survived [1]. In another report from Wuhan, China, published in JAMA, of 36 patients with COVID-19 admitted to the ICU, four patients (11.1%) were treated with ECMO [18]. In a letter in JAMA, describing the characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State, USA, an acute cardiomyopathy was reported in seven patients (33% of the cohort) [19]. It is still unknown if this is due to an acute viral myocarditis or due to overwhelming illness.
    The data so far report high rates of potentially fatal complication of COVID-19. However, the clinical courses and outcomes of these patients have not yet been reported and the benefit of ECMO cannot yet be determined.

    Current guidelines in COVID-19 pandemic
    The Society of Critical Care Medicine has released tentative guidelines for the management of COVID-19 patients. In these guidelines, they recommend VV ECMO in the management of ARDS in those in whom refractory hypoxemia persist despite optimized ventilation, the use of rescue therapies (such as the use of inhaled pulmonary vasodilators) and proning.
  • editado 29 de abril
    May, 2020
    Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai,China

    Abstract
    Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.
  • editado 29 de abril
    May 2020

    Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure

    The Extracorporeal Life Support Organization (ELSO) and all of the ELSO worldwide chapters have prepared this document to describe when and how to use extracorporeal membrane oxygenation (ECMO) in COVID-19 patients during this pandemic. It is a consensus guideline intended for experienced ECMO centers.
    COVID-19 is a disease caused by the novel SARS-CoV-2 virus which appeared in December 2019 and is now a worldwide pandemic. Because it is a new viral disease, this guidance document is based on limited experience and written with the intention to be updated frequently as new information becomes available. A link to the latest version of this document will be found at http://covid19.elso.org.
  • editado 29 de abril
    1.Apr.2020

    Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): Pooled analysis of early reports
    ...

    The results of this analysis using currently available literature would suggest that ECMO does not seemingly produce neither harm or benefit in COVID-19 patients progressing to ARDS. A few limitations shall be noted, however. Patients may have variable levels of ARDS severity, with those receiving ECMO being potentially more critically ill in some cases, which may have impacted the mortality rates. Nonetheless, the mortality rate in the conventional therapy group was relatively high (70.9%). Data on baseline characteristics and disease courses were not provided on ECMO patients. Lastly, the sample size of ECMO patients was considerably small (n = 17). However, when compared to the largest report of MERS patients receiving ECMO (n = 17), COVID-19 patients seem to have substantially higher mortality to-date (94.1% vs. 65.0%), raising questions about real utility of ECMO in this outbreak [1]. Further research is urgently needed. We encourage authors of future COVID-19 reports to provide more data specifically on the ECMO patients in order to aid in optimal patient selection in a limited resource setting.

    https://linkinghub.elsevier.com/retrieve/pii/S0883944120305426
  • editado 29 de abril
    28.Mar.2020
    Veno‐venous extracorporeal membrane oxygenation for severe pneumonia: COVID‐19 case in Japan

    Abstract
    Background
    Veno‐venous extracorporeal membrane oxygenation (VV‐ECMO) is one of the ultimate treatments for acute respiratory failure. However, the effectiveness of ECMO in patients with novel coronavirus disease (COVID‐19) is unknown.
    Case Presentation
    A 72‐year‐old woman who was a passenger of a cruise ship tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) while in quarantine on board using throat swab. Three days after admission, her condition deteriorated, and she was subsequently intubated. On day 6, VV‐ECMO was introduced. Lopinavir/ritonavir was given; continuous renal replacement therapy was also introduced. On day 10, her chest radiography and lung compliance improved. She was weaned off ECMO on day 12.

    Conclusion
    Treatment of severe pneumonia in COVID‐19 by ECMO should recognize lung plasticity considering time to ECMO introduction and interstitial biomarkers. In Japan, centralization of ECMO patients has not been sufficient. Thus, we suggest nationwide centralization and further research to respond to the crisis caused by COVID‐19.

    https://doi.org/10.1002/ams2.509
  • editado 29 de abril
    28.Feb.2020
    Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease
    indications, timing, and implementation

    The 2019 novel coronavirus disease (COVID-19) has spread rapidly across Hubei province and dispersed to all regions in China owing to its person-to-person transmission and strong invasiveness targeting the lower respiratory tract.[1] By the end of February 15, 2020, more than 68,000 cases of COVID-19 pneumonia had been confirmed in China, including over 1,600 fatalities.[2] Most infected patients who developed COVID-19 pneumonia suffered from only mild symptoms and then completely recovered. However, in some patients, the phenotype may rapidly progress to acute respiratory distress syndrome (ARDS) and multi-organ failure. The initial clinical data, collected in Jinyintan Hospital, Wuhan, showed that ARDS was reported in 12 (29%) among 41 confirmed patients.[3] Among the 41 patients, 13 patients received medical
    care in the intensive care unit (ICU), 4 patients were provided invasive mechanical ventilations, whereas for 2 others, extracorporeal membrane oxygenation (ECMO) treatment was applied. Finally, 6 of the 41 patients died. The clinical data of 99 confirmed patients from the same hospital demonstrated that 17 in 99 patients developed ARDS; among them, 3 received ECMO treatment, and 11 died.[4] Another study reported that 22 in 138 cases (16%) developed into ARDS and were admitted into the ICU, of which 4 received ECMO.[5]

  • editado 29 de abril
    20.Mar.2020
    Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

    Summary
    WHO interim guidelines recommend offering extracorporeal membrane oxygenation (ECMO) to eligible patients with acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). The number of patients with COVID-19 infection who might develop severe ARDS that is refractory to maximal medical management and require this level of support is currently unknown. Available evidence from similar patient populations suggests that carefully selected patients with severe ARDS who do not benefit from conventional treatment might be successfully supported with venovenous ECMO. The need for ECMO is relatively low and its use is mostly restricted to specialised centres globally. Providing complex therapies such as ECMO during outbreaks of emerging infectious diseases has unique challenges. Careful planning, judicious resource allocation, and training of personnel to provide complex therapeutic interventions while adhering to strict infection control measures are all crucial components of an ECMO action plan. ECMO can be initiated in specialist centres, or patients can receive ECMO during transportation from a centre that is not specialised for this procedure to an expert ECMO centre. Ensuring that systems enable safe and coordinated movement of critically ill patients, staff, and equipment is important to improve ECMO access. ECMO preparedness for the COVID-19 pandemic is important in view of the high transmission rate of the virus and respiratory-related mortality.

  • editado 29 de abril
    13.Mar.2020
    COVID-19, ECMO, and lymphopenia: a word of caution

    Lymphocyte count has been associated with increased disease severity in COVID19.1,2 Patients who died from COVID19 are reported to have had significantly lower lymphocyte counts than survivors.2 As such, we need to consider the potential compounding immunological insults involved with initiation of an extracorporeal circuit in these patients. During ECMO, substantial decreases in the number and function of some populations of lymphocytes is commonplace.3 As it might be hypothesised that repletion of lymphocytes could be key to recovery from COVID19, lymphocyte count should be closely monitored in these patients receiving ECMO.

  • editado 29 de abril
    20.Apr.2020
    Therapeutic strategies for critically ill patients with COVID-19

    Abstract
    Since the 2019 novel coronavirus disease (COVID-19) outbreak originated from Wuhan, Hubei Province, China, at the end of 2019, it has become a clinical threat to the general population worldwide. Among people infected with the novel coronavirus (2019-nCoV), the intensive management of the critically ill patients in intensive care unit (ICU) needs substantial medical resource. In the present article, we have summarized the promising drugs, adjunctive agents, respiratory supportive strategies, as well as circulation management, multiple organ function monitoring and appropriate nutritional strategies for the treatment of COVID-19 in the ICU based on the previous experience of treating other viral infections and influenza. These treatments are referable before the vaccine and specific drugs are available for COVID-19.

    https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00661-z
  • editado 29 de abril
    15.Apr.2020

    Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series

    Worldwide data on prognosis when using ECMO to treat critically ill patients with COVID-19 infection are not available, and whether ECMO plays a role in reducing patient mortality rates is currently unknown. This research letter provides the first evidence of prognosis in treating critically ill COVID-19 patients with ECMO in China. These preliminary data were collected from two medical centers of Wuhan, China (Table 1). These data could be of considerable value in judging whether ECMO should be recommended as a salvage therapy for critically ill COVID-19 patients.

  • editado 29 de abril
    07.Apr.2020
    Japan ECMOnet for COVID-19: telephone consultations for cases with severe respiratory failure caused by COVID-19

    Abstract
    Recently, the novel coronavirus disease 2019 (COVID-19) started spreading in Japan. Therefore, the number of patients with severe COVID-19 requiring extracorporeal membranous oxygenation (ECMO) is expected to increase. A working group has been formed to provide telephone consultation services for cases with severe respiratory failure caused by COVID-19 in Japan. During the first 13 days of the service, there were 12 consultations. For each consultation, we advised the patient on the initiation of ECMO and arranged transportation for patients with ECMO. Based on experience from the H1N1 influenza pandemic, transporting patients to experienced facilities is essential to obtain better outcomes.

  • editado 29 de abril
    Extracorporeal membrane oxygenation (ECMO): does it have a role in the treatment of severe COVID-19?

  • editado 29 de abril
    26.Mar.2020

    ECMO for ARDS due to COVID-19

    Dear Editor,
    As of 09 March 2020, a cumulative total of 109,577 confirmed cases of coronavirus disease 2019 (COVID-19) were reported in 105 countries and territories worldwide.1 In China, approximately 5% (2087/44,672) of critically ill patients with COVID-19 infection have presented rapidly progressive respiratory failure, development of acute respiratory distress syndrome (ARDS), and intensive care unit (ICU) admission.2 Of the 2087 critically ill patients with COVID-19, 1023 (49%; 95%CI, 46.1% to 52.1%) have died in the ICU.2 The prevalence of ARDS caused by COVID-19 is approximately 8.2% (187/2278) (95% CI, 7.07% to 9.47%)3.,  4.,  5.,  6.,  7.,  8. (Table 1). Recently, Xu et al.9 described the pathological characteristics of a patient who died from severe infection with severe acute respiratory syndrome coronavirus 2. The postmortem biopsies revealed that, apart from bilateral diffuse alveolar damage with cellular fibromyxoid exudates, the lungs of the patient showed pulmonary oedema with desquamation of pneumocytes and hyaline membrane formation, indicating ARDS.

  • editado 29 de abril
    February 19, 2020

    Preparing for the Most Critically Ill Patients With COVID-19The Potential Role of Extracorporeal Membrane Oxygenation

    The role of ECMO in the management of COVID-19 is unclear at this point. It has been used in some patients with COVID-19 in China but detailed information is unavailable.3ECMO may have a role in the management of some patients with COVID-19 who have refractory hypoxemic respiratory failure.6 However, much about the virus is unknown, including the natural history, incidence of late complications, viral persistence, or the prognoses in different subsets of patients. This uncertainty might be compared to the emergence of influenza A(H1N1) in 2009, when it was initially unclear what the role of ECMO should be.8 However, the degree of uncertainty surrounding COVID-19 is much greater. To address this, prompt mobilization of existing registries and clinical research groups should help facilitate the systematic collection of data. For example, the Extracorporeal Life Support Organization (ELSO) Registry is being adapted to acquire new information about COVID-19 and prospective observational studies are under way.


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