Extracorporeal Life Support Organization Coronavirus Disease 2019 Interim Guidelines: A Consensus Document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers

Abstract

Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance recent multivariable analysis confirmed older age, higher Sequential Organ Failure Assessment (SOFA) score and d-dimer > 1 µg/L on admission were associated with higher mortality. This study also observed a median duration of viral RNA detection of 20.0 days (IQR 17.0-24.0) in survivors, but COVID-19 virus was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days (3,4).Building on evidence-informed guidelines developed by a multidisciplinary panel of health care providers with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS and MERS, as well as sepsis and ARDS, this guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials (5,6).There are few data on the clinical presentation of COVID-19 in specific populations, such as children and pregnant women. In children with COVID-19 the symptoms are usually less severe than adults and present mainly with cough and fever, and coinfection has been observed (7, 8). Relatively few cases have been reported of infants confirmed with COVID-19; those experienced mild illness (9). There is currently no known difference between the clinical manifestations of COVID-19 pregnant and non-pregnant women or adults of reproductive age. Pregnant and recently pregnant women with suspected or confirmed COVID-19 should be treated with supportive and management therapies, as described below, taking into account the immunologic and physiologic adaptations during and after pregnancy. * See Global Surveillance for human infection with coronavirus disease (COVID-19) for latest case definitions.

Full recovery from severe SARS-CoV-2 infection after requiring extracorporeal membrane oxygenation and continuous hemodiafiltration

“…Once ECMO is deemed indicated, timely introduction is preferable to allow injured lungs to rest and recover as much as possible, because of its ability to confer lung protection from mechanical ventilator-associated injury. 3 Among the contraindications for ECMO administration, obesity (BMI of 35.6 in Case 1) and underlying lung disease (emphysema in Case 2) require extra care over the course of treatment. Bilateral diaphragmatic elevation by the obese abdomen makes it di cult to maintain e cient ventilatory volume.…”

Managing Patients on Extracorporeal Membrane Oxygenation Support During The COVID-19 Pandemic – A Proposal for A Nursing Standard Operating Procedure

“…There are ELSO guidelines available, but are limited to the use of PPE during ECMO in patinets with COVID-19 [5,10,13]. No publications dedicated to nursing management of patients with COVID-19 ECMO were found.…”

“…The correct use of PPE by healthcare professionals for COVID -19 is key for limiting the spread of infection. Detailed guidelines for the use of PPE during ECMO have been included in the latest ELSO COVID guidelines [5]. A full-face mask with an absorber, a level 3 protection (Scott-Vision 4000 with Pro2000 lter, 3M, USA), is safe and comfortable (Fig.…”

“…Although there are numerous publications [1][2][3] related to nursing management of extracorporeal membrane oxygenation (ECMO), no guidelines exist about its application during a disaster, such as the global coronavirus disease 2019 (COVID-19) pandemic [4]. Moreover, the guidelines are unspeci ed for clinical nursing management of ECMO, and the use of personal protective equipment (PPE) during COVID-19 in ECMO [5]. Consequently, ECMO centres are strained to develop own institutional procedures.…”

“…However, its implementation in epidemic conditions -such as the COVID-19 disease -is only possible with appropriate both human and hardware resources [14,15]. Due to its invasiveness, ECMO is a high-risk application with possible sudden and severe complications such as air entrapment in the ECMO circuit, and dislodgement, dislodgment of cannulae [5,16]. Accordingly, the constant presence of at least two ECMO-trained clinicians is necessary for emergent life-saving interventions.…”