Veno-venous extracorporeal membrane oxygenation in coronavirus disease 2019: a case series.
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 2â 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 46â years (interquartile range 35.5-52.5) and 76.7% were male. Median time from symptom onset to VV-ECMO was 14â 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 13â 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 9.5â mg·L-1, fibrinogen equivalent units; p=0.035) and creatinine (169 versus 73â 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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