ECMO Papers
28.Apr.2020
Survival Rate of COVID-19 Patients on ECMO Machines are Three Times Higher Than On Ventilators
Survival Rate of COVID-19 Patients on ECMO Machines are Three Times Higher Than On Ventilators
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Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in COVID-19
Experience with 32 patients
https://journals.lww.com/asaiojournal/Abstract/9000/Extracorporeal_Membrane_Oxygenation_in_the.98533.aspx
Extracorporeal membrane oxygenation therapy in the COVID-19 pandemic
Clinical reports of COVID-19 & the use of ECMO
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
https://doi.org/10.2217/fca-2020-0040
Abstract
https://journals.lww.com/asaiojournal/FullText/2020/05000/Extracorporeal_Membrane_Oxygenation_for.4.aspx
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.
https://doi.org/10.1097/mat.0000000000001173
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
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.
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
Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease
indications, timing, and implementation
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]
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.
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
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.
Japan ECMOnet for COVID-19: telephone consultations for cases with severe respiratory failure caused by COVID-19
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.
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.
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.