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

ABSTRACT

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.