Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

Ramanathan, Kollengode; Antognini, David; Combes, Alain; Paden, Matthew L.; Zakhary, Bishoy; Ogino, Mieko; MacLaren, Graeme; Brodie, Daniel; Shekar, Kiran

doi:10.1016/s2213-2600(20)30121-1

Cited by 480 publications

(515 citation statements)

References 50 publications

(48 reference statements)

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“…As respiratory failure worsens, there is a need for extracorporeal membrane oxygenation due to hypoxemia and distributive and cardiogenic shock. 49 The large majority of mortality in these patients is attributed to respiratory failure and shock. 6 These observations-the frequent development of ARDS and the possibility of cardiac dysfunction in addition to active expanding lung infiltrates-make it crucial for physicians to be vigilant with fluid management strategies.…”

Section: Covid-19 In the Spotlightmentioning

confidence: 99%

SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill

Kazory

Ronco

McCullough

2020

Baylor University Medical Center Proceedings

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread across the globe, and millions of people may be affected. While knowledge regarding epidemiologic features and diagnostic tools of coronavirus disease 2019 (COVID-19) is rapidly evolving, uncertainties surrounding various aspects of its optimal management strategies persist. A subset of these patients develop a more severe form of the disease characterized by expanding pulmonary lesions, sepsis, acute respiratory distress syndrome, and respiratory failure. Due to lack of data on treatment strategies specific to this subset of patients, currently available evidence on management of the critically ill needs to be extrapolated and customized to their clinical needs. The article calls attention to fluid stewardship in the critically ill with COVID-19 by judiciously applying the evidence-based resuscitation principles to their specific clinical features such as high rates of cardiac injury. As we await more data from treating these patients, this strategy is likely to help reduce potential complications.

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Section: Covid-19 In the Spotlightmentioning

confidence: 99%

SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill

Kazory

Ronco

McCullough

2020

Baylor University Medical Center Proceedings

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“…The effectiveness of ECMO as a therapy for COVID-19 has not yet been established, but there are reports of it saving lives in severe cases (5)(6)(7), and emergency guidelines have been promulgated (8,9). Treatment of respiratory failure via ECMO requires specialized knowledge and training for not only doctors but also nurses, clinical engineers, and several other staff members (10,11). ECMO is known to improve the prognosis for patients in facilities that have used it in more cases (4); this therapy requires considerable experience and skill on the part of the medical team administering it.…”

Section: Ecmomentioning

confidence: 99%

Nursing care for patients with COVID-19 on extracorporeal membrane oxygenation (ECMO) support

Umeda

Sugiki

2020

GHM

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In Japan, four medical facilities including our own -the National Center for Global health and Medicine (NCGM) -have been designated for the treatment of specified infectious diseases by the Minister of Health, Labour, and Welfare. Here, we report our nursing care for patients with severe COVID-19 on extracorporeal membrane oxygenation (ECMO) support. In addition to infection control measures in the form of an N95 mask, a water-repellent isolation gown, a cap, a shielded mask on top of the N95, and double-layered gloves, nurses were required to wear onepiece suits (DuPont™ Tyvek ® ) and use powered air-purifying respirators (PAPRs). While closed system catheters are normally changed once a day to limit aerosol exposure, they are now changed once every 4 days. Nursing care included equipment checks, monitoring of hemodynamics and respiratory status, management of anticoagulants, observation of the patient's general condition, management of sedatives and analgesics, prevention of medical device-related pressure ulcers and bedsores, and maintenance of hygiene. Fundamentally sound nursing remains the best practice for patient treatment and management. During nursing care for patients with COVID-19 on ECMO, infection control measures should be faithfully and properly followed.

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“…[3][4][5] Despite the recommended initial recommended approaches for adult respiratory distress syndrome associated with COVID-19, overall oxygenation may deteriorate clinically as tracked by a falling blood oxygen tension/inspired oxygen ratio. [14][15] When this important ratio drops below 150 mmHg, it should trigger consideration of the following acute care interventions to improve gas exchange: lung recruitment maneuvers, positive end-expiratory pressure titration, neuromuscular blockade, and prone positioning. [3][4][5] Inhaled selective pulmonary vasodilators such as nitric oxide and epoprostenol may be considered in specialized centers to further optimize matching of ventilation and perfusion matching throughout ventilated lung areas.…”

Section: Consider the Challenges In Critical Care For Acute Respiratomentioning

confidence: 99%

“…[3][4][5] The contraindications for ECMO in patients with COVID-19 should be hospital-specific, with consideration of local factors such as team experience and resource availability. [14][15] Clinical risk factors such as advanced age, frailty, prior lung disease, diabetes, heart failure, and immunosuppression may also qualify as contraindications to 4 ECMO. [14][15][16] The indications and contraindications to ECMO during the coronavirus crisis should be adjusted in real-time to local factors.…”

Section: Consider the Challenges In Critical Care For Acute Respiratomentioning

confidence: 99%

“…[14][15] Clinical risk factors such as advanced age, frailty, prior lung disease, diabetes, heart failure, and immunosuppression may also qualify as contraindications to 4 ECMO. [14][15][16] The indications and contraindications to ECMO during the coronavirus crisis should be adjusted in real-time to local factors.…”

Section: Consider the Challenges In Critical Care For Acute Respiratomentioning

confidence: 99%

See 1 more Smart Citation

Critical Care During the Coronavirus Crisis: Challenges and Considerations for the Cardiothoracic and Vascular Anesthesia Community

Augoustides

2020

Journal of Cardiothoracic and Vascular Anesthesia

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Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases

Cited by 480 publications

References 50 publications

SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill

SARS-CoV-2 (COVID-19) and intravascular volume management strategies in the critically ill

Nursing care for patients with COVID-19 on extracorporeal membrane oxygenation (ECMO) support

Critical Care During the Coronavirus Crisis: Challenges and Considerations for the Cardiothoracic and Vascular Anesthesia Community

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