Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series.
Journal
ERJ open research
ISSN: 2312-0541
Titre abrégé: ERJ Open Res
Pays: England
ID NLM: 101671641
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
03
07
2020
accepted:
09
09
2020
entrez:
1
12
2020
pubmed:
2
12
2020
medline:
2
12
2020
Statut:
epublish
Résumé
The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume centre in the UK. Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3 March and 2 May 2020. Clinical management is described. Data are reported for survivors and nonsurvivors. We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years (interquartile range 35.5-52.5) and 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days (interquartile range 11-17.5). All patients underwent computed tomography imaging, revealing extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. Overall, 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days (interquartile range 8-20). 14 patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Nonsurvivors had significantly higher d-dimer (38.2 Our data support the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation and intravascular thrombosis.
Sections du résumé
BACKGROUND
BACKGROUND
The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume centre in the UK.
METHODS
METHODS
Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3 March and 2 May 2020. Clinical management is described. Data are reported for survivors and nonsurvivors.
RESULTS
RESULTS
We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years (interquartile range 35.5-52.5) and 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days (interquartile range 11-17.5). All patients underwent computed tomography imaging, revealing extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. Overall, 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days (interquartile range 8-20). 14 patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Nonsurvivors had significantly higher d-dimer (38.2
CONCLUSIONS
CONCLUSIONS
Our data support the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation and intravascular thrombosis.
Identifiants
pubmed: 33257913
doi: 10.1183/23120541.00463-2020
pii: 00463-2020
pmc: PMC7520944
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright ©ERS 2020.
Déclaration de conflit d'intérêts
Conflict of interest: J. Zhang has nothing to disclose. Conflict of interest: B. Merrick has nothing to disclose. Conflict of interest: G.L. Correa has nothing to disclose. Conflict of interest: L. Camporota has nothing to disclose. Conflict of interest: A. Retter has nothing to disclose. Conflict of interest: A. Doyle has nothing to disclose. Conflict of interest: G.W. Glover has nothing to disclose. Conflict of interest: P.B. Sherren has nothing to disclose. Conflict of interest: S.J. Tricklebank has nothing to disclose. Conflict of interest: S. Agarwal has nothing to disclose. Conflict of interest: B.E. Lams has nothing to disclose. Conflict of interest: N.A. Barrett has nothing to disclose. Conflict of interest: N. Ioannou has nothing to disclose. Conflict of interest: J. Edgeworth has nothing to disclose. Conflict of interest: C.I.S. Meadows has nothing to disclose.
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