Extracorporeal Membrane Oxygenation for COVID-19: A Systematic Review

Aljishi, Rawah Shafiq; Alkuaibi, Ali Hussin; Zayer, Fadel Abbas Al; Matouq, Ali Hassan Al

doi:10.7759/cureus.27522

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…This could potentially lead to an increased duration of mechanical ventilation prior to ECMO cannulation [ 10 ]. However, this finding is in contrast to other studies, which report no significant difference in in-hospital or long-term mortality in COVID-19-infected patients compared to patients without COVID-19 [ 11 , 12 ].…”

Section: Discussioncontrasting

confidence: 99%

Clinical Outcome Comparison of Patients Requiring Extracorporeal Membrane Oxygenation With or Without COVID-19 Infection

Park¹,

Shah²,

Rao³

et al. 2023

Cureus

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In severe COVID-19-related respiratory failure, extracorporeal membrane oxygenation (ECMO) is a useful modality that is used to provide effective oxygenation and ventilation to the patient. This descriptive study aimed to investigate and compare the outcomes between COVID-19-infected patients and patients who were not infected and required ECMO support. A retrospective study was undertaken on a cohort of 82 adult patients ( \begin{document}\geq\end{document} 18-year-old) who required venoarterial (VA-ECMO) and venovenous (VV-ECMO) ECMO between January 2019 and December 2022 in a single academic center. Patients who were cannulated for COVID-19-related respiratory failure (C-group) were compared to patients who were cannulated for non-COVID etiologies (non-group). Patients were excluded if data were missing regarding cannulation, decannulation, presenting diagnosis, and survival status. Categorical data were reported as counts and percentages, and continuous data were reported as means with 95% confidence intervals. Out of the 82 included ECMO patients, 33 (40.2%) were cannulated for COVID-related reasons, and 49 (59.8%) were cannulated for reasons other than COVID-19 infection. Compared to the non-group, the C-group had a higher in-hospital (75.8% vs. 55.1%) and overall mortality rate (78.8% vs. 61.2%). The C-group also had an average hospital length of stay (LOS) of 46.6 ± 13.2 days and an average intensive care unit (ICU) LOS of 44.1 ± 13.3 days. The non-group had an average hospital LOS of 24.8 ± 6.6 days and an average ICU LOS of 20.8 ± 5.9 days. Subgroup analysis of patients only treated with VV-ECMO yielded a greater in-hospital mortality rate for the C-group compared to the non-group (75.0% vs. 42.1%). COVID-19-infected patients may experience different morbidity and mortality rates as well as clinical presentations compared to non-COVID-infected patients when requiring ECMO support.

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Section: Discussioncontrasting

confidence: 99%

Clinical Outcome Comparison of Patients Requiring Extracorporeal Membrane Oxygenation With or Without COVID-19 Infection

Park¹,

Shah²,

Rao³

et al. 2023

Cureus

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“…Of the 21 agenT-797 treated patients (including the EUA patient), 5 were given agenT-797 during VV-ECMO, traditionally regarded as ‘the most aggressive salvage therapy’ for critically ill individuals with COVID-19 (with one systematic review showing a 41% mortality in VV-ECMO treated patients 23 ). Survival of the VV-ECMO cohort was 80% (4/5) at 30 and 90 days and 60% (3/5) at 120 days.…”

Section: Resultsmentioning

confidence: 99%

A phase 1/2 clinical trial of invariant natural killer T cell therapy in moderate-severe acute respiratory distress syndrome

Hammond,

Purbhoo,

Kadel

et al. 2024

Nat Commun

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Invariant natural killer T (iNKT) cells, a unique T cell population, lend themselves for use as adoptive therapy due to diverse roles in orchestrating immune responses. Originally developed for use in cancer, agenT-797 is a donor-unrestricted allogeneic ex vivo expanded iNKT cell therapy. We conducted an open-label study in virally induced acute respiratory distress syndrome (ARDS) caused by the severe acute respiratory syndrome-2 virus (trial registration NCT04582201). Here we show that agenT-797 rescues exhausted T cells and rapidly activates both innate and adaptive immunity. In 21 ventilated patients including 5 individuals receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO), there are no dose-limiting toxicities. We observe an anti-inflammatory systemic cytokine response and infused iNKT cells are persistent during follow-up, inducing only transient donor-specific antibodies. Clinical signals of associated survival and prevention of secondary infections are evident. Cellular therapy using off-the-shelf iNKT cells is safe, can be rapidly scaled and is associated with an anti-inflammatory response. The safety and therapeutic potential of iNKT cells across diseases including infections and cancer, warrants randomized-controlled trials.

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“…The use of extracorporeal membrane oxygenation (ECMO) has increased exponentially in recent times [ 1 ], particularly following the H1N1 and COVID-19 pandemics [ 2 ]. It represents a modified cardiopulmonary bypass system that facilitates extracorporeal decarboxylation and oxygenation.…”

Section: Introductionmentioning

confidence: 99%

Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review

Šoltés,

Skribuckij,

Říha

et al. 2023

JCM

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The use of extracorporeal membrane oxygenation (ECMO) has recently increased exponentially. ECMO has become the preferred mode of organ support in refractory respiratory or circulatory failure. The fragile balance of haemostasis physiology is massively altered by the patient’s critical condition and specifically the aetiology of the underlying disease. Furthermore, an application of ECMO conveys another disturbance of haemostasis due to blood-circuit interaction and the presence of an oxygenator. The purpose of this review is to summarise current knowledge on the anticoagulation management in patients undergoing ECMO therapy. The unfractionated heparin modality with monitoring of activated partial thromboplastin tests is considered to be a gold standard for anticoagulation in this specific subgroup of intensive care patients. However, alternative modalities with other agents are comprehensively discussed. Furthermore, other ways of monitoring can represent the actual state of coagulation in a more complex fashion, such as thromboelastometric/graphic methods, and might become more frequent. In conclusion, the coagulation system of patients with ECMO is altered by multiple variables, and there is a significant lack of evidence in this area. Therefore, a highly individualised approach is the best solution today.

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Extracorporeal Membrane Oxygenation for COVID-19: A Systematic Review

Cited by 5 publications

References 38 publications

Clinical Outcome Comparison of Patients Requiring Extracorporeal Membrane Oxygenation With or Without COVID-19 Infection

Clinical Outcome Comparison of Patients Requiring Extracorporeal Membrane Oxygenation With or Without COVID-19 Infection

A phase 1/2 clinical trial of invariant natural killer T cell therapy in moderate-severe acute respiratory distress syndrome

Update on Anticoagulation Strategies in Patients with ECMO—A Narrative Review

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