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

Huang, Shiqian; Zhao, Shuai; Luo, Huilin; Wu, Zhouyang; Wu, Jing; Xia, Haifa; Chen, Xiangdong

doi:10.1186/s12890-021-01479-6

Cited by 20 publications

(14 citation statements)

References 71 publications

(111 reference statements)

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“…Although a detailed discussion on VV-ECMO in COVID-19 ARDS is beyond the scope of this review and can be found elsewhere [167], some results of the most recent large cohorts of patients will be briefly presented. In a retrospective analysis of 83 patients treated with VV-ECMO for severe COVID-19 ARDS (median PO 2 /FiO 2 of 60 mm Hg before ECMO initiation), Schmidt et al reported an estimated 31% probability of day-60 mortality, comparable to that of the EOLIA trial for non-COVID ARDS (35%) [168].…”

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

The Right Ventricle in COVID-19

Bonnemain

Ltaief

Liaudet

2021

JCM

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Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop various cardiac complications, among which dysfunction of the right ventricle (RV) appears particularly common, especially in severe forms of the disease, and which is associated with a dismal prognosis. Echocardiographic studies indeed reveal right ventricular dysfunction in up to 40% of patients, a proportion even greater when the RV is explored with strain imaging echocardiography. The pathophysiological mechanisms of RV dysfunction in COVID-19 include processes increasing the pulmonary vascular hydraulic load and others reducing RV contractility, which precipitate the acute uncoupling of the RV with the pulmonary circulation. Understanding these mechanisms provides the fundamental basis for the adequate therapeutic management of RV dysfunction, which incorporates protective mechanical ventilation, the prevention and treatment of pulmonary vasoconstriction and thrombotic complications, as well as the appropriate management of RV preload and contractility. This comprehensive review provides a detailed update of the evidence of RV dysfunction in COVID-19, its pathophysiological mechanisms, and its therapy.

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Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

The Right Ventricle in COVID-19

Bonnemain

Ltaief

Liaudet

2021

JCM

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“…Concurrently, the median time on MV prior ECMO was 9 days in patients of the second wave. MV for <7 days is recommended for ECLS in patients with COVID-19 (14); of note, 55% of patients from the second wave exceeded this limit (Table 1). This was due to late requests for ECMO in our hospital, which have been associated with worse outcomes (19).…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies added further knowledge regarding the appropriate utilization of ECMO and found interesting prognostic factors in patients with COVID-19. Old age (>65 years), immunosuppression, need for VA-ECMO, and presence of common comorbidities (hypertension, diabetes, and obesity) are associated with poor ECMO outcomes (14). The present study included only four patients aged >65 years, one patient receiving immunosuppressive medication, and one patient who received VA-ECMO.…”

Section: Discussionmentioning

confidence: 99%

“…Critically ill patients with COVID-19 were considered for ECMO treatment based on the following criteria: (14); and (II) Failure of all other treatments options (i.e., lung protective invasive MV, prone positioning, neuro-muscular blockade, and inhaled nitric oxide [iNO] rescue therapy). The decision on initiation of ECMO treatment was determined by consensus of our (mobile) ECMO-team consisting of internal medicine intensivists, cardiothoracic surgeons, and pneumologists.…”

Section: Ecmo Settingsmentioning

confidence: 99%

“…Regarding treatments before and/or during initiation of ECMO, patients of the second wave received less CytoSorb (cytokine absorption) therapy (47% vs. 20%, respectively, P=0.096) and more corticosteroids (47% vs. 75%, respectively, P=0.105). Patients of the second wave showed a higher (pre-ECMO) MV time[4][5][6][7][8][9][10][11][12][13][14][15] vs. 9 (IQR: 3-15) days, respectively, P=0.708]. The median RESP scores were similar in both groups [0 (IQR: −3-2) vs. 0 (IQR: −1-2), respectively, P=0.214].…”

mentioning

confidence: 99%

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Extracorporeal membrane oxygenation in patients with COVID-19: 1-year experience

Durak¹,

Zayat²,

Grottke³

et al. 2021

J Thorac Dis

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Background: Extracorporeal membrane oxygenation (ECMO) in patients with coronavirus disease 2019 (COVID-19) showed reasonable outcomes. However, recent studies indicated a negative trend and analysis is needed. Methods: Baseline characteristics, laboratory parameters, and outcomes of ECMO-supported patients with COVID-19 were analyzed in a retrospective single-center study. We included hospital admissions until February 28, 2021; patients were followed until discharge/death. Eventually, we compared data between patients hospitalized before and after September 1, 2020. Results: Median age of patients treated with ECMO (n=39) was 56 years; most patients were males (n=28, 72%). Median mechanical ventilation time (prior to ECMO) was 6 days, while the median ECMO duration was 19 days. Overall survival rate was 41%. In the sub-analysis, survival until discharge in the first and second epidemic waves was 53% (n=19) and 30% (n=20), respectively (P=0.2). At baseline, compared with patients of the first wave, those of the second wave had higher median body mass index (28.2 vs. 31.1 kg/m 2 , respectively, P=0.02), bicarbonate (27 vs. 31.8 mmol/L, respectively, P=0.033), plasma free hemoglobin (36 vs. 58 mg/L, respectively, P=0.013), alanine aminotransferase (33 vs. 52 U/L, respectively, P=0.018), and pH (7.29 vs. 7.42, respectively, P=0.005), lower rate of pulmonary hypertension (32% vs. 0%, respectively, P=0.008), lower positive end-expiratory pressure (14 vs. 12 cmH 2 O, respectively, P=0.04), longer median ECMO duration (16 vs. 24.5 days, respectively, P=0.074), and more frequent major bleeding events (42% vs. 80%, respectively, P=0.022). Conclusions: ECMO-supported patients with COVID-19 had an overall survival rate of 41%. Similar to international registries, we observed less favorable outcomes during the second wave. Further research is needed to confirm this signal and find predictors for mortality.

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