Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Crisis Standards of Care.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
entrez:
25
2
2021
pubmed:
26
2
2021
medline:
5
3
2021
Statut:
ppublish
Résumé
The coronavirus disease 2019 (COVID-19) pandemic has placed extraordinary strain on global healthcare systems. Use of extracorporeal membrane oxygenation (ECMO) for patients with severe respiratory or cardiac failure attributed to COVID-19 has been debated due to uncertain survival benefit and the resources required to safely deliver ECMO support. We retrospectively investigated adult patients supported with ECMO for COVID-19 at our institution during the first 80 days following New York City's declaration of a state of emergency. The primary objective was to evaluate survival outcomes in patients supported with ECMO for COVID-19 and describe the programmatic adaptations made in response to pandemic-related crisis conditions. Twenty-two patients with COVID-19 were placed on ECMO during the study period. Median age was 52 years and 18 (81.8%) were male. Twenty-one patients (95.4%) had severe ARDS and seven (31.8%) had cardiac failure. Fifteen patients (68.1%) were managed with venovenous ECMO while 7 (31.8%) required arterial support. Twelve patients (54.5%) were transported on ECMO from external institutions. Twelve patients were discharged alive from the hospital (54.5%). Extracorporeal membrane oxygenation was used successfully in patients with respiratory and cardiac failure due to COVID-19. The continued use of ECMO, including ECMO transport, during crisis conditions was possible even at the height of the COVID-19 pandemic.
Identifiants
pubmed: 33627596
doi: 10.1097/MAT.0000000000001376
pii: 00002480-202103000-00005
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
245-249Informations de copyright
Copyright © ASAIO 2020.
Déclaration de conflit d'intérêts
Disclosure: D.B. is on the medical advisory boards for Breethe, Xenios and Hemovent, and is a past medical advisory board member for Baxter and Alung Technologies. The other authors have no conflicts of interest to report.
Références
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020; 8:475–481
MacLaren G, Fisher D, Brodie D. Preparing for the most critically ill patients with COVID-19: The potential role of extracorporeal membrane oxygenation. JAMA. 2020; 323:1245–1246
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020; 323:2052–2059
Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID-19 in New York City. New Engl J Med. 2020; 382:2372–2374
Combes A, Hajage D, Capellier G, et al.; EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018; 378:1965–1975
Abrams D, Ferguson ND, Brochard L, et al. ECMO for ARDS: From salvage to standard of care? Lancet Respir Med. 2019; 7:108–110
Guérin C, Reignier J, Richard JC, et al.; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013; 368:2159–2168
Tipograf Y, Liou P, Oommen R, et al. A decade of interfacility extracorporeal membrane oxygenation transport. J Thorac Cardiovasc Surg. 2019; 157:1696–1706
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: The Berlin Definition. JAMA. 2012; 307:2526–2533
Abrams D, Schmidt M, Pham T, et al. Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support. Research and practice. Am J Respir Crit Care Med. 2020; 201:514–525
Agerstrand CL, Burkart KM, Abrams DC, Bacchetta MD, Brodie D. Blood conservation in extracorporeal membrane oxygenation for acute respiratory distress syndrome. Ann Thorac Surg. 2015; 99:590–595
Helms J, Tacquard C, Severac F, et al.; CRICS TRIGGERSEP Group (Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis). High risk of thrombosis in patients with severe SARS-CoV-2 infection: a multicenter prospective cohort study. Intensive Care Med. 2020; 46:1089–1098
Llitjos JF, Leclerc M, Chochois C, et al. High incidence of venous thromboembolic events in anticoagulated severe COVID-19 patients. J Thromb Haemost. 2020; 18:1743–1746
Ramanathan K, Antognini D, Combes A, et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med. 2020; 8:518–526
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395:497–506
Chen J, Qi T, Liu L, et al. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect. 2020; 80:e1–e6
Lescure FX, Bouadma L, Nguyen D, et al. Clinical and virological data of the first cases of COVID-19 in Europe: A case series. Lancet Infect Dis. 2020; 20:697–706
Extracorporeal Life Support Organization. ECMO Registry of the Extraporporeal Life Support Organization (ELSO). 2020. Available at: https://www.elso.org/Portals/0/Files/Reports/2020_January/International%20Summary%20January%202020_page1.pdf . Accessed January 25, 2020.
Guihaire J, Owyang CG, Madhok J, et al. Specific considerations for pandemic. ASAIO J. 2020; 66:1069–1072