Early initiation of awake venovenous extracorporeal membrane oxygenation (ECMO) in critical COVID-19 pneumonia: A case reports

Ghizlane, El Aidouni; Merbouh, Manal; Berrajaa, Sara; Bahouh, Choukri; Berrichi, Samia; Abderrahim, El Kaouini; Ziani, Hamid; Bouabdallaoui, Amine; Bkiyar, Houssam; Housni, Brahim

doi:10.1016/j.amsu.2021.102641

Cited by 4 publications

(5 citation statements)

References 12 publications

(8 reference statements)

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“…A total of 57 articles including data from 467 awake ECMO patients (923 total ECMO patients) were included in the analysis ( Fig. 1 ) (21–73). Of these, 28 articles (49%) were case reports including a single patient each and 29 articles (51%) were case series with a median sample size of 10 patients (range, 3–65 patients) ( Supplementary Table 1 , http://links.lww.com/CCM/H411).…”

Section: Resultsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Belletti,

Sofia,

Cicero

et al. 2023

Critical Care Medicine

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OBJECTIVES: Extracorporeal membrane oxygenation (ECMO) is an advanced treatment for acute severe respiratory failure. Patients on ECMO are frequently maintained sedated and immobilized until weaning from ECMO, first, and then from mechanical ventilation. Avoidance of sedation and invasive ventilation during ECMO may have potential advantages. We performed a systematic literature review to assess efficacy and safety of awake ECMO without invasive ventilation in patients with respiratory failure. DATA SOURCES: PubMed, Web of Science, and Scopus were searched for studies reporting outcome of awake ECMO for adult patients with respiratory failure. STUDY SELECTION: We included all studies reporting outcome of awake ECMO in patients with respiratory failure. Studies on ECMO for cardiovascular failure, cardiac arrest, or perioperative support and studies on pediatric patients were excluded. Two investigators independently screened and selected studies for inclusion. DATA EXTRACTION: Two investigators abstracted data on study characteristics, rate of awake ECMO failure, and mortality. Primary outcome was rate of awake ECMO failure (need for intubation). Pooled estimates with corresponding 95% CIs were calculated. Subgroup analyses by setting were performed. DATA SYNTHESIS: A total of 57 studies (28 case reports) included data from 467 awake ECMO patients. The subgroup of patients with acute respiratory distress syndrome showed a pooled estimate for awake ECMO failure of 39.3% (95% CI, 24.0–54.7%), while in patients bridged to lung transplantation, pooled estimate was 23.4% (95% CI, 13.3–33.5%). Longest follow-up mortality was 121 of 439 (pooled estimate, 28%; 95% CI, 22.3–33.6%). Mortality in patients who failed awake ECMO strategy was 43 of 74 (pooled estimate, 57.2%; 95% CI, 40.2–74.3%). Two cases of cannula self-removal were reported. CONCLUSIONS: Awake ECMO is feasible in selected patients, although the effect on outcome remains to be demonstrated. Mortality is almost 60% in patients who failed awake ECMO strategy.

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Section: Resultsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Belletti,

Sofia,

Cicero

et al. 2023

Critical Care Medicine

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“…A retrospective case series describing eight cases where awake vv-ECMO was applied in COVID-19 patients with severe ARDS found a mortality rate of only 14.3% (1 patient) [12]. Other single case reports also showed promising results [13][14][15]. However, a prospective observational trial on four German ICUs found that out of 18 patients that were treated with awake vv-ECMO implantation, 14 were intubated during the further stay on ICU [16].…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of a Patient with COVID-19-Induced Severe ARDS, Pneumothorax, and Pneumomediastinum with Awake vv-ECMO Implantation

Umlauf

Eilenberger

Spring

2022

Case Reports in Critical Care

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Management of acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still a challenge for the staff on intensive-care units (ICU’s) around the world. Many of these patients are treated with invasive ventilation. Sometimes, the occurrence of pneumothorax and/or pneumomediastinum can complicate the course of the disease because initiation of invasive ventilation might be fatal in those patients. Venovenous extracorporal membrane oxygenation (vv-ECMO) is increasingly used to prevent patients with severe ARDS from hypoxia. However, clear recommendations for or against the initiation of vv-ECMO in awake patients are currently lacking. We present the case of a 42-year-old patient with COVID-19-associated severe ARDS, pneumothorax, and pneumomediastinum. To preserve sufficient oxygenation and to avoid invasive ventilation, we implanted a vv-ECMO while the patient was awake. The patient recovered and was discharged home 41 days after transfer to our hospital. We therefore suggest that awake implantation of vv-ECMO might be useful in a subgroup of patients with severe ARDS caused by SARS-CoV-2. However, further evidence is needed to verify our hypothesis.

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“…ECMO is a type of membrane oxygenator application used as life support in patients suffering from acute heart, lung, or cardiopulmonary failure [ 11 , 12 ]. This device is used when mechanical breathing fails and there is not enough time to treat the underlying pathology [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Novel polymer composite coated with ethylcellulose nanoparticle from waste paper as an alternative material to extracorporeal oxygenation membrane

Pratama,

Lestari,

Rofida

et al. 2023

J Polym Res

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Extracorporeal membrane oxygenator (ECMO) is a valuable technology to support people with acute respiratory distress syndrome (ARDS) and is recommended for COVID-19 patients. This study aims to fabricate polymer-based composite membranes coated with ethylcellulose nanoparticles from waste paper and identify the performance of the composite as ECMO candidates. Composite membranes were made from four types of polymers, namely, nylon, PTFE (polytetrafluoroethylene), Pebax ® MH-1657, and SBS (poly-(styrene-b-butadiene-b-styrene)). PDMS (polydimethylsiloxane) 1 wt.% and ethylcellulose nanoparticles (3% and 10 wt.%) were used as membrane coatings to increase their hydrophobic properties. The success of cellulose isolation and ethylcellulose synthesis from waste paper was confirmed by the FTIR and XRD analysis. The size of the synthesized ethylcellulose nanoparticles was 32.68 nm. The coating effect on composite membranes was studied by measuring the contact angle, membrane porosity, protein quantification tests, and single gas permeation of O 2 and CO 2 . Based on the protein quantification test, the protein could not pass through the Pebax/PDMS and SBS/PDMS composites coated with 10 wt.% ethylcellulose; this indicated less risk of plasma leakage. The gas permeation test on nylon/PDMS, PTFE/PDMS, and SBS/PDMS composites coated with 10% ethylcellulose resulted high CO 2 /O 2 selectivity, respectively, 2.17, 3.48, and 3.22 as good indication for extracorporeal oxygenation membrane. Supplementary Information The online version contains supplementary material available at 10.1007/s10965-023-03576-y.

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Early initiation of awake venovenous extracorporeal membrane oxygenation (ECMO) in critical COVID-19 pneumonia: A case reports

Cited by 4 publications

References 12 publications

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Extracorporeal Membrane Oxygenation Without Invasive Ventilation for Respiratory Failure in Adults: A Systematic Review*

Successful Treatment of a Patient with COVID-19-Induced Severe ARDS, Pneumothorax, and Pneumomediastinum with Awake vv-ECMO Implantation

Novel polymer composite coated with ethylcellulose nanoparticle from waste paper as an alternative material to extracorporeal oxygenation membrane

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