Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019-Induced Acute Respiratory Distress Syndrome: A Multicenter Descriptive Study*

Abstract

Objectives: Severe acute respiratory distress syndrome is complicated with coronavirus disease 2019 and extracorporeal membrane oxygenation support may be necessary in severe cases. This study is to summarize the clinical features, extracorporeal membrane oxygenation characteristics, and outcomes of patients with severe acute respiratory syndrome coronavirus 2 pneumonia received extracorporeal membrane oxygenation. Design: Descriptive study from two hospitals. Setting: The ICUs from university hospitals. Patients: Patients with severe acute respiratory syndrome coronavirus 2 pneumonia received mechanical ventilation, including those underwent extracorporeal membrane oxygenation from Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital from January 8, 2020, to March 31, 2020. Interventions: None. Measurements and Main Results: Clinical records, laboratory results, ventilator parameters, and extracorporeal membrane oxygenation-related data were abstracted from the medical records. One-hundred twenty-nine critically ill patients with severe acute respiratory syndrome coronavirus 2 pneumonia were admitted to ICU of the two referral hospitals. Fifty-nine patients received mechanical ventilation and 21 of them received extracorporeal membrane oxygenation support (fourteen from Zhongnan hospital and seven from Wuhan pulmonary hospital). Compared to mechanical ventilation patients without extracorporeal membrane oxygenation support, there was a tendency of decline in mortality but with no significant difference (no-extracorporeal membrane oxygenation group 24/38 [63.2%] vs extracorporeal membrane oxygenation group 12/21 [57.1%]; p = 0.782). For those patients with extracorporeal membrane oxygenation, 12 patients died and nine survived by April 7, 2020. Among extracorporeal membrane oxygenation patients, the Paco 2 prior to extracorporeal membrane oxygenation was lower (54.40 mm Hg [29.20–57.50 mm Hg] vs 63.20 mm Hg [55.40–72.12 mm Hg]; p = 0.006), and pH prior to extracorporeal membrane oxygenation was higher (7.38 [7.28–7.48] vs 7.23 [7.16–7.33]; p = 0.023) in survivors than nonsurvivors. Conclusions: Extracorporeal membrane oxygenation might be an effective salvage treatment for patients with severe acute respiratory syndrome coronavirus 2 pneumonia associated with severe acute respiratory distress syndrome. Severe Co 2 retention and acidosis prior to extracorporeal membrane oxygenation indicated a poor prognosis.

Mechanical ventilation and mortality among 223 critically ill patients with coronavirus disease 2019: A multicentric study in Germany

“…However, the outcome of patients treated with ECMO due to ARDS caused by COVID-19 is unclear. A recent report from China with 21 of 129 (16%) critically ill patients receiving ECMO reported a mortality of 57% ( 33 ). In our study 9% of our patients received ECMO.…”

Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome: Possible Late Indication for Coronavirus Disease 2019?

“…Recent studies have reported that mortality in patients requiring ECMO for COVID-19 severe ARDS ranged from 40% to 60% ( 3 – 5 , 10 , 11 ). This mortality is somewhat higher than that in non-COVID-19 ARDS patients including bacterial pneumonia and severe influenza A (H1N1) ARDS ( 1 , 12 , 13 ).…”

“…In reported cases of COVID-19, the time between the onset of symptoms and cannulation was of approximately 10–17 days ( 3 , 10 , 14 ). In addition, all reported cases of COVID-19 had a duration from invasive mechanical ventilation to ECMO of less than 7 days ( 3 , 10 , 14 ). Furthermore, Yang et al ( 3 ) suggested that in the setting of COVID-19, earlier initiation of ECMO (evaluated by the length of mechanical ventilation before ECMO initiation) might be associated with improved outcomes.…”

“…In addition, all reported cases of COVID-19 had a duration from invasive mechanical ventilation to ECMO of less than 7 days ( 3 , 10 , 14 ). Furthermore, Yang et al ( 3 ) suggested that in the setting of COVID-19, earlier initiation of ECMO (evaluated by the length of mechanical ventilation before ECMO initiation) might be associated with improved outcomes. In that view, our case is of interest, as it highlights that late initiation of ECMO may be considered in severe COVID-19.…”

“…Venovenous extracorporeal membrane oxygenation (VV-ECMO) can support gas exchange and there is now substantial evidence to support its efficacy and safety for patients with severe acute respiratory distress syndrome (ARDS) ( 1 , 2 ). Recent reports have suggested that ECMO might be an effective salvage treatment for patients with coronavirus disease 2019 (COVID-19) severe acute respiratory distress syndrome (ARDS), but data are conflicting ( 3 – 5 ). In addition, the timing of ECMO initiation is still debated but early initiation is associated with improved outcomes in non-COVID-19 severe ARDS ( 6 ).…”