ECMO in COVID–ARDS

ABSTRACT

Acute respiratory distress syndrome (ARDS) is a complex pathologic manifesto of acute lung injury that causes noncardiogenic pulmonary edema in different clinical presentations and increases the mortality rate up to 40%. The main physiologic changes are alveolar collapse/de-recruitment, decreased lung compliance, higher pulmonary vascular resistance, and gas-exchange disturbance, which may be combined with the patient's own respiratory response or assisted ventilatory support due to regional heterogeneity of the underlying lung injury. Since the main clinical features of COVID-19 (coronavirus disease 2019) pneumonia are hypoxemia and dyspnea, noninvasive oxygen therapy or mechanical ventilation remains the cornerstone of managing more severe cases. The aim of this chapter is to summarize the current state of knowledge on the worst pulmonary manifestation of the long COVID-19 syndrome, namely, COVID–ARDS, including parenchymal and functional abnormalities, follow-up strategies for early identification, and timely therapeutic interventions including veno-venous extracorporeal membrane oxygenation (vv-ECMO) management. Although only a limited proportion of COVID-19 patients develop severe respiratory failure refractory to advanced conventional treatments, it is of utmost importance to clearly define criteria for the use of vv-ECMO in this steadily growing patient population. The use of vv-ECMO in COVID–ARDS is a rescue treatment, if mechanical ventilation cannot guarantee appropriate gas exchange anymore, resulting in life-threatening or organ-damaging hypoxia and/or hypercapnia, whereas the vv-ECMO treatment modality still has a high all mortality rate in COVID–ARDS (> 50%). © 2023 Elsevier Inc. All rights reserved.