Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients
ECMO for COVID-19
Keywords:ECMO, COVID-19, Acute respiratory distress syndrome, ARDS, VV-ECMO, Extracoporeal membrane oxygenator
During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720.
Peek GJ, Mugford M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, Hibbert CL, Truesdale A, Clemens F, Cooper N, Firmin RK, Elbourne D; CESAR trial collaboration. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial. Lancet. 2009;374(9698):1351-63.
Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome. N Engl J Med. 2018;378(21):1965-1975.
Combes A, Hajage D, Capellier G, Demoule A, Lavoué S, Guervilly C, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965–75.
Ruangnapa K, Samransamruajkit R, Namchaisiri J, Pongsanont K, Boonthim K, Deelodejanawong J, et al. The long duration of extracorporeal membrane oxygenation in a child with acute severe hypoxic respiratory failure treated in a resource-limited center. Perfusion. 2012;27(6):547-9.
Assanangkornchai N, Vichitkunakorn P, Bhurayanontachai R. Characteristics and Outcomes of Severe ARDS Patients Receiving ECMO in Southern Thailand. Clin Med Insights Circ Respir Pulm Med. 2019;13:1179548419885137.
Chaikajornwat J, Rattanajiajaroen P, Srisawat N, Kawkitinarong K. Leptospirosis manifested with severe pulmonary haemorrhagic syndrome successfully treated with venovenous extracorporeal membrane oxygenation. BMJ Case Rep. 2020;13(1):e230075.
Tongyoo S, Permpikul C, Sucher S, Thomrongpairoj P, Poompichet A, Ratanarat R, et al. Venovenous extracorporeal membrane oxygenation versus conventional mechanical ventilation to treat refractory hypoxemia in patients with acute respiratory distress syndrome: a retrospective cohort study. J Int Med Res. 2020;48(6):300060520935704.
Pirompanich P, Patiyakul N, Daorattanachai K, Homvises B, Tantiyavarong P. Clinical characteristics and outcomes of adults with peripheral extracorporeal membrane oxygenation in a developing country: A single center 8-year retrospective study. Perfusion. 2020:267659120980376.
Tantibundit P, Mekjarasnapha M, Pulnitiporn A, Jirasavetakul A. Extracorporeal cardiopulmonary resuscitation in a woman with twin pregnancy. Perfusion. 2021:2676591211003281.
Jenelle B, M. Velia A, Christine M S, Lara S, Lakshmi R, Matthew L P, et al. ELSO COVID-19 Working Group Members Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization, ASAIO J. 2021;67(5):485-495
Writing Group for the Alveolar Recruitment for Acute Respiratory Distress Syndrome Trial (ART) Investigators, Cavalcanti AB, Suzumura ÉA, Laranjeira LN, Paisani DM, Damiani LP, et al. Effect of Lung Recruitment and Titrated Positive End-Expiratory Pressure (PEEP) vs Low PEEP on Mortality in Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2017;318(14):1335-1345.
Li X, Guo Z, Li B, Zhang X, Tian R, Wu W, et al. Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai, China. ASAIO J. 2020;66(5):475-481.
Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, et al. Extracorporeal Life Support Organization. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet. 2020;396(10257):1071-1078.
Lorusso R, Combes A, Coco VL, De Piero ME, Belohlavek J. EuroECMO COVID-19 WorkingGroup; Euro-ELSO Steering Committee. ECMO for COVID-19 patients in Europe and Israel. Intensive Care Med. 2021;47(3):344-348.
Rabie AA, Azzam MH, Al-Fares A.A. et al. Implementation of new ECMO centers during the COVID-19 pandemic: experience and results from the Middle East and India. Intensive Care Med. 2021;47:887–895.
Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, et al. Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université; Paris-Sorbonne ECMO-COVID investigators. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: a retrospective cohort study. Lancet Respir Med. 2020;8(11):1121-1131.
Hu BS, -Z Hu M, Jiang LX, Yu J, Chang Y, Cao Y, et al. Extracorporeal membrane oxygenation (ECMO) in patients with COVID-19: a rapid systematic review of case studies. Eur Rev Med Pharmacol Sci. 2020;24(22):11945-11952.
Shaefi S, Brenner SK, Gupta S, O’Gara BP, Krajewski ML, Charytan DM, et al. Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19. Intensive Care Med. 2021;47:208–221.
Autschbach T, Hatam N, Durak K, Grottke O, Dreher M, Nubbemeyer K, et al. Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis. J Clin Med. 2021;10(12):2547.