Challenges and Strategies for Veno Venous (VV) Extracorporeal Membrane Oxygenation (ECMO) in COVID-19 Acute Respiratory Distress Syndrome (ARDS) During Second Wave of Pandemic: A Case Series
Indian Journal of Critical Care Medicine
; 26:S9, 2022.
Article
in English
| EMBASE | ID: covidwho-2006321
ABSTRACT
Case series Extracorporeal membrane oxygenation (ECMO) use for severe acute respiratory distress syndrome due to coronavirus disease 2019 (COVID-19) patients has increased during the second wave of the pandemic. However, there are many complications associated with the management of ECMO in critically ill COVID- 19 patients. We report a case series of challenges and strategies for managing critically ill COVID-19 patients on ECMO support for severe ARDS. Seven COVID-19 patients required VV ECMO of which three were women and four were men of median age of 43 years. Among seven, three cases (42%) recovered. We experienced multiple challenges and complications in the management of the patients, being a non-ECMO centre with limited resources, in heavy workload during the second wave of the pandemic. All the patients required multiple invasive procedures like placement of invasive lines, frequent bronchoscopies for bronchial toileting. Displacement of both ECMO cannulas required repositioning under ultrasound guidance, four patients underwent percutaneous tracheostomy on ECMO. Three patients had ECMO-oxygenator failure that required the exchange of a new ECMO circuit. ACT was monitored for the management of anticoagulation. A challenging task is to achieve a balance between bleeding and thrombotic events, for which anticoagulation had to be stopped for the acceptable ACT, required transfusion of multiple blood products for correcting coagulopathy. One patient developed HIT antibodies and managed with bivalirudin for the management of anticoagulation which was challenging in titrating the drug dose and ACT. Two patients had an intracranial haemorrhage on ECMO support, managed conservatively despite anticoagulation. Pseudoaneurysm of femoral vein diagnosed and managed with ultrasound-guided thrombin injection. Four patients got decannulated from ECMO. One patient had unexplained severe haemolysis immediately after initiation of ECMO, unfortunately, he could not recover. Management of VV ECMO in resource-limited, non-ECMO centre in a pandemic is challenging. Mortality depends on various factors, despite expertise, advanced critical care management in COVID- 19 ARDS and ECMO. Increased use of VV ECMO during the second wave of pandemic reported significant changes in strategies for management of challenges, though further studies are still required for the best outcome.
bivalirudin; endogenous compound; heparin platelet factor 4 antibody; thrombin; adult; adult respiratory distress syndrome; anticoagulation; blood clotting disorder; brain hemorrhage; bronchoscopy; case report; case study; clinical article; complication; conference abstract; coronavirus disease 2019; critically ill patient; drug dose titration; drug therapy; extracorporeal membrane oxygenation cannula; extracorporeal oxygenation; false aneurysm; female; femoral vein; hemolysis; human; intensive care; invasive procedure; male; mortality; oxygenator; pandemic; percutaneous dilational tracheostomy; thrombosis; toileting; treatment failure; ultrasound; veno-venous ECMO; workload
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Indian Journal of Critical Care Medicine
Year:
2022
Document Type:
Article
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