Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

Yang, Xiaobo; Hu, Ming; Yu, Yuan; Zhang, Xijing; Fang, Minghao; Lian, Yingtao; Peng, Yong; Wu, Lingling; Wu, Yongran; Jun, Yi; Zhang, Lu; Wang, Bing; Xu, Zhengqin; Liu, Boyi; Yang, Yadong; Xiang, Xiaowei; Qu, Xingguang; Xu, Wenhao; Li, Hunian; Shen, Zubo; Yang, Changming; Cao, Fengsheng; Liu, Jie; Zhang, Zhaohui; Li, Lianghai; Liu, Xiaoyun; Li, Ruiting; Zou, Xiaojing; Shu, Huaqing; Ouyang, Yaqi; Xu, Dan; Xu, Jiqian; Zhang, Jiancheng; Liu, Hong; Qi, Hong; Fan, Xiaolin; Huang, Chaolin; Zhang, Yu; Yuan, Shiying; Zhang, Dingyu; Shang, You

doi:10.3389/fmed.2020.611460

Cited by 20 publications

(42 citation statements)

References 30 publications

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“…We also recognize significant heterogeneity in survival outcomes reported, which may be due in part to the inclusion of studies with COVID-19 patients who often have differing clinical presentation than other causes of ARDS. It is also notable that some of the studies had reported much lower survival (14%, 21%) than the pooled average (57%) [ 18 , 26 ], possibly from inclusion of an older and sicker cohort of patients. We also note that included studies have varying PP strategies and protocols (eg.…”

Section: Discussionmentioning

confidence: 99%

Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis

et al. 2021

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Background Prone positioning (PP) improves oxygenation and respiratory mechanics and is associated with lower mortality in patients with moderate to severe acute respiratory distress syndrome (ARDS). Despite this, some patients develop refractory hypoxemia and hypercapnia requiring venovenous extracorporeal membrane oxygenation (VV ECMO) support and are usually cared for in supine position. The physiologic and outcome benefits of routine PP of patients during VV ECMO remains unclear. Hence, we conducted the systematic review and meta-analysis to evaluate the outcome benefits of PP for patients with ARDS being treated with VV ECMO. Methods After registration with PROSPERO (CRD42020199723), MEDLINE, EMBASE, Scopus and Cochrane databases were searched for relevant studies that reported PP in more than 10 adult patients supported with VV ECMO from origin to 1 March 2021. Studies were reviewed for quality using appropriate Joanna Briggs Institute (JBI) checklists, and certainty of evidence was assessed using the GRADE approach. The random-effects model (DerSimonian and Laird) was used. The primary outcome of interest was cumulative survival. Secondary outcomes were intensive care unit length of stay (ICU LOS) and ECMO duration. Changes in arterial blood gas (ABG) values, ventilator mechanics and complication rates were also studied. Results Of 812 potentially relevant publications, 12 studies (640 patients) met our inclusion criteria. Due to overlapping study populations, 11 studies were included in the final meta-analysis. Cumulative survival in patients that underwent PP was 57% (95% CI 41.9–71.4, high certainty). Patients that underwent PP had longer ICU LOS (+ 14.5 days, 95% CI 3.4–25.7, p = 0.01) and ECMO duration (+ 9.6 days, 95% CI 5.5–13.7, p < 0.0001). After PP, patients had significantly higher PaO2/FiO2 ratio, lower PaCO2 and reduced ventilator driving pressure, and no major complications were reported. Conclusions PP during VV ECMO appears safe with a cumulative survival of 57% and may result in longer ECMO runs and ICU LOS. However, evidence from appropriately designed randomized trials is needed prior to widespread adoption of PP on VV ECMO.

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Section: Discussionmentioning

confidence: 99%

Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis

et al. 2021

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“…ELSO recommends that ECMO should be used as a rescue therapy after the failure of standard treatment approaches, including optimal ventilation strategies, neuromuscular blockade, appropriate positive end-expiratory pressure (PEEP) and prone positioning [22]. Previous studies reported that the early initiation of ECMO in COVID-19 patients with ARDS is beneficial, especially among younger patients [10,16]. However, due to a shortage of personnel and equipment, the early application of ECMO may be impractical during the COVID-19 epidemic.…”

Section: Indications For Ecmo In Patients With Covid-19mentioning

confidence: 99%

“…It is worth noting that ECMO can also affect normal physiology and exacerbate coagulation and immune abnormalities in patients with COVID-19 despite having good therapeutic effects (Table 1) [4,9]. The outcomes in COVID-19 patients after receiving ECMO treatment have varied substantially in different studies, probably due to differences in clinical, organizational and resource management factors [10][11][12][13][14][15][16]. Recommendations from the World Health Organization (WHO) published in August 2020 stated that the use of ECMO for the treatment of severe ARDS due to COVID-19 should be offered only in expert centres with sufficient experience [17].…”

Section: Introductionmentioning

confidence: 99%

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The role of extracorporeal membrane oxygenation in critically ill patients with COVID-19: a narrative review

et al. 2021

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Extracorporeal life support treatments such as extracorporeal membrane oxygenation (ECMO) have been recommended for the treatment of severe acute respiratory distress syndrome (ARDS) patients with coronavirus disease 2019 (COVID-19). To date, many countries, including China, have adopted ECMO as a treatment for severe COVID-19. However, marked differences in patient survival rates have been reported, and the underlying reasons are unclear. This study aimed to summarize the experience of using ECMO to treat severe COVID-19 and provide suggestions for improving ECMO management. The effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the pathophysiology of COVID-19 and the effects of ECMO on the clinical outcomes in patients with severe cases of COVID-19 were reviewed. Recent data from frontline workers involved in the use of ECMO in Wuhan, China, and those experienced in the implementation of artificial heart and lung support strategies were analysed. There is evidence that ECMO may complicate the pathophysiological state in COVID-19 patients. However, many studies have shown that the appropriate application of ECMO improves the prognosis of such patients. To expand our understanding of the benefits of ECMO for critically ill patients with COVID-19, further prospective, multicentre clinical trials are needed.

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“…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.…”

Section: Discussionmentioning

confidence: 98%

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

et al. 2021

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In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine (p = 0.007) and a shorter ICU duration (p = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank p = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.

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Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

Cited by 20 publications

References 30 publications

Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis

Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis

The role of extracorporeal membrane oxygenation in critically ill patients with COVID-19: a narrative review

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

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