The use of VV-ECMO in patients with COVID 19 (is the first experience)

Introduction: Purpose of the study: to analyze the effectiveness of the use of intravenous ECMO as part of the complex therapy of patients with confirmed SARS-Cov-2 infection. Methods: VV-ECMO was used in 19 patients (11 men, 8 women) over 18 years old (50 ± 12.5) with body mass index 32 ± 3.4 and severity of organ dysfunctions SOFA 3 points. Previously, all patients underwent therapy with interleukin-6 receptor inhibitors and glucocorticoids, non-invasive ventilation. The duration of mechanical ventilation before the start of ECMO was 1 ± 0.75 days, PaO2/FiO2 index-68 ± 12 mmHg, pHa were 7.25 ± 0.06, lactate 2.5 ± 0.6 mmol/l. ECMO was connected according to the femoral vena-jugular vein scheme, volumetric flow rate 3-4 l/min, oxygen 3 l/min. Results: Disconnected from ECMO 37% (7), discharged 26% (5), 60- day survival-26%. Patients with an unfavorable outcome, compared with those who were discharged, had pronounced leukocytosis 14(10- 17) versus 8 (4-8) × 109/ l, p = 0.009) and lymphocytopenia 7 ± 4% versus 12 ± 2%, p = 0.007). After initiation of the procedure, by day 3 in the lethal group: SOFA scores increased from 3 to 9 (in the group of survivors from 3 to 4 (p = 0.027));the level of procalcitonin from 0.2 to 1.45 ng/ml;the number of platelets decreased by 48% (in the group of survivors it increased by 42% (p = 0.011);PaO2/FiO2 index did not change significantly (an increase of 200% in the group of survivors up to 206 mmHg (p = 0.011). The following complications developed in the group of patients with an adverse outcome: bleeding from cannulation sites (26.3%, n = 5), nosebleeds (26.3%, n = 5), circuit thrombosis (10.5%, n = 2) and pneumothorax (5.2%, n = 1). Conclusions: VV-ECMO is an effective method of supporting lung function in patients with confirmed SARS-Cov-2 infection. The presence and progression of a bacterial infection is a predictor of an adverse outcome.

The successful use of combined extracorporeal life support in treatment of the new Coronavirus infection complicated by the development of multiple organ dysfunction in a pregnant woman

Pregnant and postpartum women are at a higher risk of infection with SARS-CoV-2 as well as a higher risk of adverse outcomes for the mother and fetus. Standard approaches to the management of COVID-19-associated multiple organ dysfunction may not always be implemented in this category ofpatients. In the clinical case ofa patient, who developed multiple organ dysfunction syndrome (severe ARDS, coagulopathy) associated with COVID-19 in the postpartum period, we demonstrate the successful use of combined extracorporeal life support that included veno-venous extracorporeal membrane oxygenation, therapeutic plasma exchange and renal replacement therapy with the universal oXiris set. © 2021 Journal of Otolaryngology of Japan. All rights reserved.