Extracorporeal membrane oxygenation in the management of critically ill patients with coronavirus disease 2019: A narrative review

Abstract

What started with 41 hospitalized patients identified as having laboratory-confirmed coronavirus disease 2019 in Wuhan, China, by January 2, 2020, turned into an unprecedented pandemic with more than 113 million confirmed cases and a mortality exceeding 2.5 million deaths worldwide by the beginning of March 2021. Although the course of the disease is uneventful in most cases, there is a percentage of patients who become critically ill and need admission in the intensive care unit for severe respiratory failure. Numerous of these patients undergo invasive mechanical ventilation and have an extremely high mortality rate. For these patients, extracorporeal membrane oxygenation (ECMO) has emerged as a last standing resource. In the present study, the literature was reviewed to evaluate the worldwide data regarding the use of ECMO in the management of critically ill COVID-19 patients. ISI Thomson Web of Science was searched for articles with English language abstracts from inception to March 1, 2021, with 'ECMO in COVID-19' as key words. A total of 214 abstracts were screened (case reports, guidelines, reviews) and the most relevant articles were included in the present review. The use of ECMO in the management of critically ill patients with COVID-19-induced acute respiratory distress syndrome refractory to conventional mechanical invasive ventilation is increasing. By increasing the survival rate from less than 20% to more than 50%, ECMO proved to be a valuable resource in the management of the most challenging critically ill COVID-19 patients. Contents 1. Introduction 2. Worldwide data regarding the critically ill COVID-19 patients 3. Rational for extracorporeal membrane oxygenation (ECMO) use in the management of critically ill COVID-19 patients 4. ECMO use in the management of critically ill COVID-19 patients: Current guidelines 5. Worldwide data regarding ECMO-supported COVID-19 patients 6. Discussion 7. Conclusions

Coagulation abnormalities in patients with COVID‐19 on venovenous ECLS increased risk for technical complications and support times but had no impact on survival

“… 1 , 2 , 3 ECLS could offer life‐saving rescue organ support when maximal conventional treatment fails to maintain adequate oxygenation and ventilation in COVID‐19 patients. 4 , 5 , 6 , 7 …”

“…[1][2][3] ECLS could offer life-saving rescue organ support when maximal conventional treatment fails to maintain adequate oxygenation and ventilation in COVID-19 patients. [4][5][6][7] However, there are only limited data describing ECLS support for COVID-19 patients with a special focus on the coagulation characteristics of these patients 8,9 and the risk of thrombotic complications during ECLS organ support. 10,11 These studies reported about experiences within the early period of the COVID-19 pandemics (March 2020 to July 2020), and included only low patient numbers (6 to 43 patients) with a complication rate of 0% to 88%.…”

“…Among these critically ill patients, up to 20% will require mechanical ventilation and 1%–4% will receive venovenous ECLS (V‐V ECLS) 1–3 . ECLS could offer life‐saving rescue organ support when maximal conventional treatment fails to maintain adequate oxygenation and ventilation in COVID‐19 patients 4–7 …”

Early Tracheostomy May Be Performed Safely in Obese COVID-19 Patients Supported on VV-ECMO

“…The ongoing coronavirus disease 2019 (COVID-19) pandemic has led to increased utilization of extracorporeal membrane oxygenation (ECMO) and notably longer durations of venovenous ECMO (VV-ECMO) support in comparison with those initiated for other indications. 1,2 VV-ECMO has been shown to be equally beneficial in obese and nonobese patients and has thus been used in the treatment of obese patients with COVID-19-associated acute respiratory distress syndrome (ARDS). [3][4][5] However, optimal timing of tracheostomy for patients with COVID-19 remains uncertain.…”

Factor XI Inhibition With Heparin Reduces Clot Formation in Simulated Pediatric Extracorporeal Membrane Oxygenation

“…Use of extracorporeal membrane oxygenation (ECMO) is increasing worldwide, driven by increased need during the 2009 H1N1 Influenza and the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. 1,2 ECMO is a modified form of cardiopulmonary bypass that provides support for severe cardiac or respiratory failure. Retrospective studies document that ECMO can improve the rate of survival to discharge in patients with severe respiratory failure up to 90% with proper patient selection and management.…”