Venovenous extracorporeal membrane oxygenation in patients with COVID-19 respiratory failure

Abstract

Adjustments to candidacy and traditional approaches to extracorporeal support may mitigate mortality during a pandemic.

Cannulate, extubate, ambulate approach for extracorporeal membrane oxygenation for COVID-19

“…Beyond this age, mortality rates increase dramatically. 27 Second, we modified the EOLIA criteria by limiting the period of maximal conventional therapy to 4 days or less during which the patient should have undergone a trial of proning, pulmonary vasodilator therapy (either nitric oxide or isoproterenol), and have received the gamut of conventional therapy, most important of which was intravenous steroids. If, however, there had been no improvement by day 4 despite maximal conventional therapy and the patient continued to exhibit a partial pressure of arterial oxygen/ fraction of inspired oxygen ratio of <80 for >6 hours or fraction of inspired oxygen ratio <50 for >3 hours, then we pivoted to urgent cannulation, to proffer protection from the further vagaries of barotrauma that almost universally accompany high ventilatory settings and maximal driving power.…”

2021: Perioperative and critical care year in review for the cardiothoracic surgery team

“…A team of experts published a consensus that provided timely guidance to the surgical community and steered practices by distilling key knowledge obtained during the care of these patients. 1 Defining candidacy in extracorporeal life support has been an area of controversy. The amalgam of discouraging single-center mortalities >80% and virulent strains, resource scarcity, and fluctuations in capacity and staffing served to complicate the efforts to manage these patients.…”

“…Once again, the Journal of Thoracic and Cardiothoracic Surgery offers a distilled expert opinion on the use of extracorporeal support in managing the sickest patients afflicted by the virus. 1 In the editorial, the authors challenge the status quo and offer an abbreviated algorithm of care which practical application has been associated with higher survival rates. 1 , 2 We also report the results of an analysis of the effect of the pandemic on cardiac surgery volume.…”

“… 1 In the editorial, the authors challenge the status quo and offer an abbreviated algorithm of care which practical application has been associated with higher survival rates. 1 , 2 We also report the results of an analysis of the effect of the pandemic on cardiac surgery volume. 3 , 4 Beyond COVID-19 and its effect nevertheless, we also present 6 other articles of import that each resonated with the readership and which are summarized herein.…”

Commentary: Respiratory failure in patients with Coronavirus Disease 2019 infection: Can extracorporeal membrane oxygenation help?

“…In the current issue of the Journal, Hayanga and colleagues 1 describe evolving approaches to the use of extracorporeal membrane oxygenation (ECMO) for treatment of advanced Coronavirus Disease 2019 (COVID-19) infections in patients with respiratory failure. ECMO can be used to treat patients with severe, refractory adult respiratory disease syndrome (ARDS) from viral pneumonia and a variety of infectious agents.…”