Extracorporeal Membrane Oxygenation for COVID-19 Respiratory Distress Syndrome: An Italian Society for Cardiac Surgery Report

Abstract

An increased need of extracorporeal membrane oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of the Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1 and September 15, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n = 26). Main causes of death were multiple organ failure (n = 14, 31.1%) and sepsis (n = 11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p = 0.048), elevated pre-ECMO C-reactive protein level (p = 0.048), higher positive end-expiratory pressure on ventilator (p = 0.036) and lower lung compliance (p = 0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.

Overview of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Support for the Management of Cardiogenic Shock

“…Recent reports suggest that only 5% of ECMO-supported patients for COVID-19 infection required VA configuration, while the need for VAV cannulation was reported in 6% ( 132 , 133 ). As the severity of CS improves more rapidly than the respiratory failure, most patients on VAV-ECMO were ultimately converted to VV support for ongoing ARDS.…”

ECMO Support and Operator Safety in the Context of COVID-19 Outbreak: A Regional Center Experience

“…ECMO is a highly skilled operation [ 2 , 3 , 4 , 5 ]. Considering the initial uncertainties about the 2019-nCov transmission, the invasiveness of the procedure, the possible long duration of exposure to patients and the possible recurrence of exposure by healthcare personnel specialized in ECMO positioning, we decided to provide healthcare workers in charge of ECMO missions with infection control precautions, consisting of a disposable waterproof suit, waterproof shoe covers and a hood.…”

“…Pending a definitive confirmation about the effectiveness of ECMO in the context of COVID-19 infection [ 1 , 2 , 3 , 4 ], possible concern emerged about the possibility that ECMO positioning could be risky for healthcare workers if performed on COVID-19 patients.…”

Transition from Simple V-V to V-A and Hybrid ECMO Configurations in COVID-19 ARDS

“…In this population, circulatory support is required in up to 64% of patients, while the remaining cases might benefit from additional venous cannulations to improve the blood return or perfusion in respiratory support. Contrarily, the available literature reports a much lower percentage of ECMO configuration conversions ranging from 2% to 7% [31][32][33][34][35][36]. This difference might be explained with the different policies applied in ECMO centres all over the world.…”