Utility of extracorporeal membrane oxygenation in COVID-19

Khan, Rizwan; Anandamurthy, Balaram; McCurry, Kenneth R.; Krishnan, Sudhir

doi:10.3949/ccjm.87a.ccc014

Cited by 7 publications

(8 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The first is that the laboratory investigations in this tool are in addition to the routine laboratory evaluations such as CBC, ESR, CRP, and blood glucose. Secondly, it should be borne in mind that for consideration of mechanical circulatory support, the conventional indications and contraindications in patients with COVID-19, in addition to the precautions for prevention and treatment of infections, should be strictly followed [109][110][111].…”

Section: Triage Risk Stratification Tool For Patients With Covid-19 Amentioning

confidence: 99%

Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

et al. 2020

View full text Add to dashboard Cite

Background: Coronavirus disease 2019 (COVID-19) pandemic has drastically affected global health. Despite several studies, there is yet a dearth of data regarding the mechanisms of cardiac injury, clinical presentation, risk factors, and treatment of COVID-19-associated cardiovascular disease. This systematic review and meta-analysis is aimed at defining the clinical, electrocardiographic, and pathologic spectrum of cardiovascular disease (CVD), frequency of elevated cardiac and inflammatory biomarkers, and their frequency and relationship with severity of the disease and mortality in COVID-19 patients and to develop a triage risk stratification tool (TRST) that can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy. We conducted an online search in databases of PubMed and Embase to identify relevant studies. Data selection was in concordance with PRISMA guidelines. Results were presented as pooled frequencies, odds ratio, standardized mean difference (SMD), and forest and funnel plots. Results: We gathered a total of 54 studies and included 35 of them in our meta-analysis. Acute cardiac injury occurred in more than 25% of cases, mortality was 20 times higher, and admission to intensive care unit increased by 13.5 times. Hypertension was the most common pre-existing comorbidity with a frequency of 29.2%, followed by diabetes mellitus (13.5%). The deceased group of patients had higher cardiac and inflammatory biomarkers, with statistically significant SMD, compared with survivors. Pediatric patients were predominantly mildly affected. However, less frequently, the presentation was very similar to Kawasaki disease or Kawasaki shock syndrome. This latter presentation hass been called as multisystem inflammatory syndrome in children (MIS-C). Conclusions: There is a wide spectrum of cardiac involvement in COVID-19 patients, and hence a Triage Risk Stratification Tool can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy.

show abstract

Section: Triage Risk Stratification Tool For Patients With Covid-19 Amentioning

confidence: 99%

Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

et al. 2020

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…Patients with advanced age, terminal diseases such as advanced malignancy, severe multiorgan failure, severe neurologic damage such as anoxic brain injury, inability to receive blood transfusions, or anticoagulation would be some of the absolute contraindications to ECMO therapy in COVID-19 patients. 7,11 To ensure the ethical distribution of resources, the relative and absolute contraindications may vary with time as the health care resources get overburdened due to the progressing COVID-19 pandemic. Although not prospectively validated in COVID-19 patients, the pulmonary and extrapulmonary predictive survival models such as RESP and PRESET might serve as decision support in COVID-19 patients with ARDS to be placed on ECMO therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Improvement in mortality with ECMO was reported in the non-randomized studies during the influenza A H1N1 epidemic in 2009 and the Middle East respiratory syndrome coronavirus epidemic in 2014, supporting the use of ECMO for refractory hypoxemia. [11][12][13] As the world is currently facing the COVID-19 pandemic, the role of ECMO in ARDS secondary to COVID-19 is being explored. Early reports from China on the use of ECMO for COVID-19 suggested a high mortality rate of around 80% to 90% in adult patients with ARDS.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence

Rajdev

Farr

Saeed

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

View full text Add to dashboard Cite

Coronavirus disease 2019 (COVID-19) caused by a novel human coronavirus has led to a tsunami of viral illness across the globe, originating from Wuhan, China. Although the value and effectiveness of extracorporeal membrane oxygenation (ECMO) in severe respiratory illness from COVID-19 remains unclear at this time, there is emerging evidence suggesting that it could be utilized as an ultimate treatment in appropriately selected patients not responding to conventional care. We present a case of a 32-year-old COVID-19 positive male with a history of diabetes mellitus who was intubated for severe acute respiratory distress syndrome (ARDS). The patient’s hypoxemia failed to improve despite positive pressure ventilation, prone positioning, and use of neuromuscular blockade for ventilator asynchrony. He was evaluated by a multidisciplinary team for considering ECMO for refractory ARDS. He was initiated on venovenous ECMO via dual-site cannulation performed at the bedside. Although his ECMO course was complicated by bleeding, he showed a remarkable improvement in his lung function. ECMO was successfully decannulated after 17 days of initiation. The patient was discharged home after 47 days of hospitalization without any supplemental oxygen and was able to undergo active physical rehabilitation. A multidisciplinary approach is imperative in the initiation and management of ECMO in COVID-19 patients with severe ARDS. While ECMO is labor-intensive, using it in the right phenotype and in specialized centers may lead to positive results. Patients who are young, with fewer comorbidities and single organ dysfunction portray a better prognosis for patients in which ECMO is utilized.

show abstract

“…Dual-site cannulation is preferred for COVID-19 patients for pulmonary support, as it can be performed safely at the bedside without the need for fluoroscopy or transesophageal echocardiography, so that fewer personnel need to come into the room. V-A-ECMO provides cardiac and circulatory support in addition to oxygenation 60 . Nonrandomized studies, case series, and reports of using ECMO as a bridge to recovery in ARDS during the 2009 influenza A (H1N1) epidemic suggest that the mortality rate is lower with ECMO 61 .…”

Section: Mechanical Assist Devices and Extracorporeal Devices In Multmentioning

confidence: 99%

Multiorgan failure during COVID-19 pandemic in cardiovascular patients. Role of advanced cardiac and pulmonary support

Barbagelata¹,

Giorgi²,

Koerner³

et al. 2020

RACI

View full text Add to dashboard Cite

COVID-19 has now claimed several thousands of lives and overwhelmed the healthcare systems of several countries. Patients with cardiovascular disease are at particular risk not just of the infection itself but of its cardiac complications. Compared to other hospitalized patients with COVID-19, those needing intensive care, are more likely to have preexisting cardiovascular diseases or risk factors. Cytokine storm with hyperinflammation correlates with the severity of the disease. It is associated with mortality and is a key factor in determining the clinical course of extrapulmonary multiple-organ failure, suggesting that the inflammatory storm is associated with damage in extrapulmonary tissues and organs. Advanced Cardiac and Pulmonary Support has been reported in selected a COVID population.

show abstract

Utility of extracorporeal membrane oxygenation in COVID-19

Cited by 7 publications

References 11 publications

Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

A Case of Extracorporeal Membrane Oxygenation as a Salvage Therapy for COVID-19-Associated Severe Acute Respiratory Distress Syndrome: Mounting Evidence

Multiorgan failure during COVID-19 pandemic in cardiovascular patients. Role of advanced cardiac and pulmonary support

Contact Info

Product

Resources

About