tetano
Editor, Senior Moderator
ERJ Open Res
. 2020 Oct 26;6(4):00463-2020.
doi: 10.1183/23120541.00463-2020. eCollection 2020 Oct.
Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series
Joe Zhang[SUP] 1 [/SUP], Blair Merrick[SUP] 2 [/SUP], Genex L Correa[SUP] 1 [/SUP], Luigi Camporota[SUP] 1 [/SUP], Andrew Retter[SUP] 1 [/SUP], Andrew Doyle[SUP] 3 [/SUP], Guy W Glover[SUP] 1 [/SUP], Peter B Sherren[SUP] 1 [/SUP], Stephen J Tricklebank[SUP] 1 [/SUP], Sangita Agarwal[SUP] 4 [/SUP], Boris E Lams[SUP] 5 [/SUP], Nicholas A Barrett[SUP] 1 [/SUP], Nicholas Ioannou[SUP] 1 [/SUP], Jonathan Edgeworth[SUP] 2 [/SUP], Christopher I S Meadows[SUP] 1 [/SUP]
Affiliations
Abstract
Background: The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume centre in the UK.
Methods: Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3 March and 2 May 2020. Clinical management is described. Data are reported for survivors and nonsurvivors.
Results: We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years (interquartile range 35.5-52.5) and 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days (interquartile range 11-17.5). All patients underwent computed tomography imaging, revealing extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. Overall, 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days (interquartile range 8-20). 14 patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Nonsurvivors had significantly higher d-dimer (38.2 versus 9.5 mg?L[SUP]-1[/SUP], fibrinogen equivalent units; p=0.035) and creatinine (169 versus 73 μmol?L[SUP]-1[/SUP]; p=0.022) at commencement of VV-ECMO.
Conclusions: Our data support the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation and intravascular thrombosis.
. 2020 Oct 26;6(4):00463-2020.
doi: 10.1183/23120541.00463-2020. eCollection 2020 Oct.
Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series
Joe Zhang[SUP] 1 [/SUP], Blair Merrick[SUP] 2 [/SUP], Genex L Correa[SUP] 1 [/SUP], Luigi Camporota[SUP] 1 [/SUP], Andrew Retter[SUP] 1 [/SUP], Andrew Doyle[SUP] 3 [/SUP], Guy W Glover[SUP] 1 [/SUP], Peter B Sherren[SUP] 1 [/SUP], Stephen J Tricklebank[SUP] 1 [/SUP], Sangita Agarwal[SUP] 4 [/SUP], Boris E Lams[SUP] 5 [/SUP], Nicholas A Barrett[SUP] 1 [/SUP], Nicholas Ioannou[SUP] 1 [/SUP], Jonathan Edgeworth[SUP] 2 [/SUP], Christopher I S Meadows[SUP] 1 [/SUP]
Affiliations
- PMID: 33257913
- PMCID: PMC7520944
- DOI: 10.1183/23120541.00463-2020
Abstract
Background: The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume centre in the UK.
Methods: Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3 March and 2 May 2020. Clinical management is described. Data are reported for survivors and nonsurvivors.
Results: We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years (interquartile range 35.5-52.5) and 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days (interquartile range 11-17.5). All patients underwent computed tomography imaging, revealing extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. Overall, 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days (interquartile range 8-20). 14 patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Nonsurvivors had significantly higher d-dimer (38.2 versus 9.5 mg?L[SUP]-1[/SUP], fibrinogen equivalent units; p=0.035) and creatinine (169 versus 73 μmol?L[SUP]-1[/SUP]; p=0.022) at commencement of VV-ECMO.
Conclusions: Our data support the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation and intravascular thrombosis.