Extracorporeal Membrane Oxygenation instead of Invasive Mechanical Ventilation in a Patient with Severe COVID-19–associated Acute Respiratory Distress Syndrome

Schmidt, Matthieu; Chambrun, Marc Pineton de; Lebreton, Guillaume; Hékimian, Guillaume; Chommeloux, Juliette; Bréchot, Nicolas; Barhoum, Pétra; Lefèvre, Lucie; Juvin, Charles; Molle, Julie; Luyt, Charles Edouard

doi:10.1164/rccm.202102-0259le

Cited by 50 publications

(84 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In this context, early detection of Macklin effect could help to identify patients at high risk for overt/clinically relevant barotrauma. It is possible that this complication may be avoided by applying different ventilation strategies as compared with standard practice, for example by further reducing tidal volumes/airways pressures [ 22 ], and considering early application of extracorporeal techniques if maintaining safer ventilatory parameters does not allow adequate gas exchange [ 23 ]. Use of extracorporeal membrane oxygenation (ECMO) without intubation has already been described in case reports, and may be a potentially interesting approach [ [23] , [24] , [25] ].…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that this complication may be avoided by applying different ventilation strategies as compared with standard practice, for example by further reducing tidal volumes/airways pressures [ 22 ], and considering early application of extracorporeal techniques if maintaining safer ventilatory parameters does not allow adequate gas exchange [ 23 ]. Use of extracorporeal membrane oxygenation (ECMO) without intubation has already been described in case reports, and may be a potentially interesting approach [ [23] , [24] , [25] ]. However, further studies are required to confirm the effectiveness of ultraprotective ventilation or ECMO in preventing overt barotrauma development in Macklin-positive patients, and that prevention of barotrauma actually translates in improved outcome.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients

Palumbo

Zangrillo

Belletti

et al. 2021

Journal of Critical Care

View full text Add to dashboard Cite

Purpose To determine whether Macklin effect (a linear collection of air contiguous to the bronchovascular sheath) on baseline CT imaging is an accurate predictor for subsequent pneumomediastinum (PMD)/pneumothorax (PNX) development in invasively ventilated patients with COVID-19-related acute respiratory distress syndrome (ARDS). Materials and methods This is an observational, case-control study. From a prospectively acquired database, all consecutive invasively ventilated COVID-19 ARDS patients who underwent at least one baseline chest CT scan during the study time period (February 25th, 2020–December 31st, 2020) were identified; those who had tracheal lesion or already had PMD/PNX at the time of the first available chest imaging were excluded. Results 37/173 (21.4%) patients enrolled had PMD/PNX; specifically, 20 (11.5%) had PMD, 10 (5.8%) PNX, 7 (4%) both. 33/37 patients with subsequent PMD/PNX had Macklin effect on baseline CT (89.2%, true positive s) 8.5 days [range, 1–18] before the first actual radiological evidence of PMD/PNX. Conversely, 6/136 patients without PMD/PNX (4.4%, false positive s) demonstrated Macklin effect ( p < 0.001). Macklin effect yielded a sensitivity of 89.2% (95% confidence interval [CI]: 74.6–96.9), a specificity of 95.6% (95% CI: 90.6–98.4), a positive predictive value (PV) of 84.5% (95% CI: 71.3–92.3), a negative PV of 97.1% (95% CI: 74.6–96.9) and an accuracy of 94.2% (95% CI: 89.6–97.2) in predicting PMD/PNX (AUC:0.924). Conclusions Macklin effect accurately predicts, 8.5 days in advance, PMD/PNX development in COVID-19 ARDS patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients

Palumbo

Zangrillo

Belletti

et al. 2021

Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…Another case series of six patients with ARDS from pneumonia resulted in an intubation rate of 50% ( 7 ). To date, there is only one case report of SARS-CoV-2 ARDS that was managed with the upfront awake approach ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Awake Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Acute Respiratory Failure

Assanangkornchai¹,

Slobod

Qutob

et al. 2021

Critical Care Explorations

View full text Add to dashboard Cite

show abstract

“…Considering the high mortality rate associated with development of barotrauma in COVID-19 patients, and the ongoing debate on optimal timing of intubation in these patients [19][20][21], we believe that it might be justified to avoid intubation in patients with Macklin-like radiological sign on chest CT, and prefer early support with alternative techniques including awake prone positioning and extracorporeal membrane oxygenation [22][23][24][25].…”

mentioning

confidence: 99%

Pneumothorax and barotrauma in invasively ventilated patients with COVID-19

Belletti

Landoni

Zangrillo

2021

Respiratory Medicine

View full text Add to dashboard Cite

We read with great interest the article by Chopra et al. recently published on Respiratory Medicine [1].In their multicenter study, the Authors present incidence, clinical characteristics and outcome of pneumothorax in critically ill patients with coronavirus disease 2019 . They found that pneumothorax rate among invasively ventilated COVID-19 patients is 80/594 (13 %), and mortality rate for patients who developed pneumothorax is 50/80 (62 %). On the contrary, among 160 randomly selected invasively ventilated COVID-19 patients without pneumothorax, mortality was 78/ 160 (49 %).We recently published a systematic review on rate of barotrauma among invasively ventilated COVID-19 patients [2]. Our pooled analysis included data from 13 studies and 1814 patients [3][4][5][6][7][8][9][10][11][12][13][14][15] and we found that pooled estimate of pneumothorax rate was 10.7 % (95 % confidence interval [CI] = 6.7 %-14.7 %), while overall rate of barotrauma event was 16.1 % (95 % CI = 11.8 %-20.4 %). In addition, we found an overall mortality rate for COVID-19 patients who developed barotrauma of 61.6 % (95 % CI = 50.2 %-73.0 %), as compared with a mortality of 49.5 % (95 % CI = 41.1 %-58.0 %) for COVID-19 patients who did not develop barotrauma.We are pleased to read that our findings are further reinforced by another study, that confirms that pneumothorax rate among mechanically ventilated COVID-19 patients is between 10 and 15 %. Indeed, after including the study by Chopra et al. in an updated meta-analysis, the pooled pneumothorax rate is 11.1 % (95 % CI = 7.4 %-14.8 %) (Fig. 1), while the overall barotrauma rate is 15.4 % (95 % CI = 11.7 %-19 %) (Fig. 2). Furthermore, the study by Chopra et al. also confirms a mortality rate above 60 % for COVID-19 patients with barotrauma

show abstract

Extracorporeal Membrane Oxygenation instead of Invasive Mechanical Ventilation in a Patient with Severe COVID-19–associated Acute Respiratory Distress Syndrome

Cited by 50 publications

References 15 publications

A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients

A radiological predictor for pneumomediastinum/pneumothorax in COVID-19 ARDS patients

Awake Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Acute Respiratory Failure

Pneumothorax and barotrauma in invasively ventilated patients with COVID-19

Contact Info

Product

Resources

About