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Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series.
Zhang, Joe; Merrick, Blair; Correa, Genex L; Camporota, Luigi; Retter, Andrew; Doyle, Andrew; Glover, Guy W; Sherren, Peter B; Tricklebank, Stephen J; Agarwal, Sangita; Lams, Boris E; Barrett, Nicholas A; Ioannou, Nicholas; Edgeworth, Jonathan; Meadows, Christopher I S.
  • Zhang J; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Merrick B; Dept of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Correa GL; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Camporota L; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Retter A; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Doyle A; Dept of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Glover GW; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Sherren PB; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Tricklebank SJ; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Agarwal S; Dept of Rheumatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Lams BE; Dept of Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Barrett NA; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Ioannou N; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Edgeworth J; Dept of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK.
  • Meadows CIS; Dept of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
ERJ Open Res ; 6(4)2020 Oct.
Article in English | MEDLINE | ID: covidwho-917915
ABSTRACT

BACKGROUND:

The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume centre in the UK.

METHODS:

Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3 March and 2 May 2020. Clinical management is described. Data are reported for survivors and nonsurvivors.

RESULTS:

We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years (interquartile range 35.5-52.5) and 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days (interquartile range 11-17.5). All patients underwent computed tomography imaging, revealing extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. Overall, 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days (interquartile range 8-20). 14 patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Nonsurvivors had significantly higher d-dimer (38.2 versus 9.5 mg·L-1, fibrinogen equivalent units; p=0.035) and creatinine (169 versus 73 µmol·L-1; p=0.022) at commencement of VV-ECMO.

CONCLUSIONS:

Our data support the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation and intravascular thrombosis.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Language: English Year: 2020 Document Type: Article Affiliation country: 23120541.00463-2020

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Language: English Year: 2020 Document Type: Article Affiliation country: 23120541.00463-2020