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. 2020 Apr 17;10.1097/MAT.0000000000001185.
doi: 10.1097/MAT.0000000000001185. Online ahead of print.

Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in COVID-19: Experience With 32 Patients

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Free PMC article

Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in COVID-19: Experience With 32 Patients

Jeffrey P Jacobs et al. ASAIO J. .
Free PMC article

Abstract

As COVID-19 cases surge worldwide, an urgent need exists to enhance our understanding of the role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with COVID-19 who develop acute respiratory and cardiac compromise refractory to conventional therapy. The purpose of this manuscript is to review our initial clinical experience in 32 patients with confirmed COVID-19 treated with ECMO.A multi-institutional registry and database was created and utilized to assess all patients who were supported with ECMO provided by SpecialtyCare. Data captured included patient characteristics, pre-COVID-19 risk factors and comorbidities, confirmation of COVID-19 diagnosis, features of ECMO support, specific medications utilized to treat COVID-19, and short-term outcomes through hospital discharge. This analysis includes all of our patients with COVID-19 supported with ECMO, with an analytic window starting March 17, 2020 when our first COVID-19 patient was placed on ECMO, and ending April 9, 2020.During the 24 days of this study, 32 consecutive patients with COVID-19 were placed on ECMO at 9 different hospitals. As of the time of analysis, 17 remain on ECMO, 10 died prior to or shortly after decannulation, and 5 are alive and extubated after removal from ECMO, with one of these 5 discharged from the hospital. Adjunctive medication in the surviving patients while on ECMO was as follows: 4 of 5 survivors received intravenous steroids, 3 of 5 survivors received antiviral medications (Remdesivir), 2 of 5 survivors were treated with anti-interleukin-6-receptor monoclonal antibodies (Tocilizumab or Sarilumab), and 1 of 5 survivors received hydroxychloroquine.An analysis of 32 COVID-19 patients with severe pulmonary compromise supported with ECMO suggests that ECMO may play a useful role in salvaging select critically ill patients with COVID-19. Additional patient experience and associated clinical and laboratory data must be obtained to further define the optimal role of ECMO in patients with COVID-19 and ARDS. These initial data may provide useful information to help define the best strategies to care for these challenging patients, and may also provide a framework for much-needed future research about the use of ECMO to treat patients with COVID-19.

Conflict of interest statement

Disclosure: Dr. Slepian has received funds from Maquet Cardiovascular and Medtronic. Dr. Jacobs receives funds from SpecialtyCare. Dr. Firstenberg has received funds from Maquet Cardiovascular and Medtronic. Dr. Tesdahl is a paid employee of SpecialtyCare, Inc. The remaining authors have no conflicts of interest to report.

Figures

Figure 1.
Figure 1.
The current status of all 32 COVID-19 ECMO patients. COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation.
Figure 2.
Figure 2.
The number of patients cannulated each week. COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation.
Figure 3.
Figure 3.
The distribution of hours on ECMO, comparing the survivors with the nonsurvivors. ECMO, extracorporeal membrane oxygenation.
Figure 4.
Figure 4.
The distribution of age of the patients, comparing the survivors with the nonsurvivors.

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