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DOI: 10.1055/s-0040-1719156
COVID-19 Pulmonary Failure and Extracorporeal Membrane Oxygenation: First Experience from Three European Extracorporeal Membrane Oxygenation Centers

Abstract
On April 17, 2020, a coronavirus disease 2019 (COVID-19) webinar was held by selected international experts in the field of intensive care and specialized respiratory ECMO centers from Germany, Italy, Spain, and the United Kingdom, which was hosted by the German Heart Centre Berlin/Charité. The experts shared their experience about the treatment of 42 patients with severe acute respiratory failure requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). Patients were predominantly male (male-to-female ratio: 3:1), with a mean age of 51 years (range: 25–73 years). VV-ECMO support was indicated in 30% of the ventilated COVID-19 patients. The mean time requiring mechanical ventilation was 16.5 days, with a mean duration of ECMO support of 10.6 days. At the time of the webinar, a total of 17 patients had already been decannulated from ECMO, whereas six died with multiorgan failure. 18 patients remained on ECMO, with their final outcomes unknown at the time of the webinar. Hospital mortality was 25.6% (as of April 17, 2020). In this respect, VV-ECMO, provided by expert centers, is a recognized and validated mode of advanced life-support during the recent COVID-19 pandemic with good outcomes.
Keywords
acute respiratory failure - C-ARDS - advanced life support - VV ECMO, VA ECM - pulmonary thrombosis (microthrombosis, systemic microthrombosis, thrombolysis)Publication History
Received: 17 June 2020
Accepted: 17 September 2020
Article published online:
13 November 2020
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
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References
- 1 Wu Z, McGoogan JM. Characteristics of important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323 (13) 1239-1242
- 2 Ramanathan K, Antognini D, Combes A. et al. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med 2020; 8 (05) 518-526
- 3 Zeng Y, Cai Z, Xianyu Y, Yang BX, Song T, Yan Q. Prognosis when using extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients in China: a retrospective case series. Crit Care 2020; 24 (01) 148
- 4 MacLaren G, Fisher D, Brodie D. Preparing for the most critically ill patients with COVID-19: the potential role of extracorporeal membrane oxygenation. JAMA 2020; 323 (13) 1245-1246
- 5 Johns Hopkins Coronavirus Resource Centre.COVID-19 Map. https://coronavirus.jhu.edu/map.html . Accessed June 15, 2020
- 6 World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance. https://apps.who.int/iris/bitstream/handle/10665/330854/WHO-nCoV-Clinical-2020.2-eng.pdf?sequence=1&isAllowed=yWHO/nCoV/Clinical/2020.2 . Accessed May 19, 2020
- 7 Extracorporeal Life Support Organization. ELSO Guidance document: ECMO for COVID-19 Patients with severe cardiopulmonary failure. https://www.elso.org/Portals/0/Files/pdf/ECMO%20for%20COVID%2019%20Guidance%20Document.Final%2003.24.2020.pdf . Accessed May 19, 2020
- 8 Luo P, Liu Y, Qiu L, Liu X, Liu D, Li J. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol 2020; 92 (07) 814-818
- 9 Tanaka T, Narazaki M, Kishimoto T. Immunotherapeutic implications of IL-6 blockade for cytokine storm. Immunotherapy 2016; 8 (08) 959-970
- 10 Beck DL. Cardiac injury common in COVID-19, predicts mortality. https://www.medscape.com/viewarticle/927505 . Accessed May 19, 2020
- 11 Zakhary B, Shekar K, Diaz R. et al. Extracorporeal Life Support Organization (ELSO) ECMOed Taskforce. Position paper on global extracorporeal membrane oxygenation education and educational agenda for the future: a statement from the Extracorporeal Life Support Organization ECMOed Taskforce. Crit Care Med 2020; 48 (03) 406-414
- 12 Abrams D, Pham T, Burns KEA. et al. International ECMO Network (ECMONet). Practice patterns and ethical considerations in the management of venovenous extracorporeal membrane oxygenation patients: an international survey. Crit Care Med 2019; 47 (10) 1346-1355
- 13 Combes A, Hajage D, Capellier G. et al. EOLIA Trial Group, REVA, and ECMONet. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med 2018; 378 (21) 1965-1975
- 14 Munshi L, Walkey A, Goligher E, Pham T, Uleryk EM, Fan E. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis. Lancet Respir Med 2019; 7 (02) 163-172
- 15 EL PAIS. Why is the coronavirus killing nearly twice as many men as women in Spain?. https://english.elpais.com/society/2020-03-25/why-is-the-coronavirus-killing-nearly-twice-as-many-men-as-women-in-spain.html . Accessed May 19, 2020
- 16 Intensive Care National Audit & Research Centre (ICNARC) report on COVID-19 in critical care. Report on 8250 patients critically ill with COVID-19. https://www.icnarc.org/Reporting . Accessed May 19, 2020
- 17 Guervilly C, Prud'homme E, Pauly V. et al. Prone positioning and extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: time for a randomized trial?. Intensive Care Med 2019; 45 (07) 1040-1042
- 18 Khan IH, Savarimuthu S, Leung MST, Harky A. The need to manage the risk of thromboembolism in COVID-19 patients. J Vasc Surg 2020; 72 (03) 799-804
- 19 Wu C, Chen X, Cai Y. et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020; 180 (07) 934-943
- 20 Gibson PG, Qin L, Puah S. COVID-19 ARDS: clinical features and differences to “usual” pre-COVID ARDS. https://www.mja.com.au/journal/2020/covid-19-ards-clinical-features-and-differences-usual-pre-covid-ards . Accessed May 19 2020
- 21 Morris C, Gray L, Giovannelli M. Early report: the use of Cytosorb™ haemabsorption column as an adjunct in managing severe sepsis: initial experiences, review and recommendations. J Intensive Care Soc 2015; 16 (03) 257-264
- 22 Zou S, Liu K. Dying coronavirus patients saved by lung transplants. https://www.chinadaily.com.cn/a/202005/13/WS5ebb394fa310a8b24115538c.html . Accessed June 12, 2020