1. Extracorporeal membrane oxygenation (ECMO) for COVID-19-related acute respiratory distress syndrome (ARDS) associated with 60-day survival rates similar to other studies comparing ECMO in severe ARDS.
2. ECMO in COVID-19-related SED related to an increased threat of pulmonary embolism despite thromboprophylaxis.
Evidence level: 2 (good)
Study Summary: There are more than 17 million cases of international COVID-19 shown. Severe and critical COVID-19 may be related to acute respiratory distress syndrome (ARDS) and severe hypoxemia. Previous case series in China have shown that ARDS linked to COVID-19 responds poorly to extracorporeal membrane oxygenation (ECMO), despite recommendations for its international use during the pandemic. This multicenter retrospective cohort study attempted to further characterize the use of ECMO in patients with severe COVID-19 ARDS. Patients who received ECMO for COVID-19-related ARDS withdrew, and clinical standing (and time spent in other clinical states) up to day 90 after ECMO was the number one outcome. Overall, ECMO patients showed a 60-day survival similar to previous studies in patients with severe ARDS unrelated to COVID-19. The prone position before ECMO was associated with significant benefit. Despite thromboprophylaxis, there was an increased threat of pulmonary embolism in this population, which is consistent with previous reports of SARS-CoV-2 with related pulmonary endothelial injury. This study supports ECMO care in early management of patients with deep respiratory failure refractory to optimized traditional care, adding the prone position. Limitations come with only recruiting patients from sites with a lot of experience in using ECMO, restricting generalizability to sites with less experience and with limited resources.
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Relevant reading: Poor survival with extracorporeal membrane oxygenation in Acute Respiratory Difficulty Syndrome (DRA) by coronavirus 2019 (COVID-19)
In intensity [retrospective cohort]: this multicenter retrospective cohort study took up positions in five hospitals in Paris, France, and recruited 83 patients (median age four9, interquartile diversity [IQR] four1 to 56 years); 61 (73%) were men. Patients with laboratory-confirmed SARS-CoV-2 infection who obtained venous or venous ECMO for severe acute respiratory distress syndrome (ARDS) were included. ECMO was contraindicated if patients were older than 70 years or had other severe comorbidities, recent cardiac arrest, or invasive ventilation for more than 10 days. The number one endpoint was clinical status in one of the following four states: (i) on ECMO; (ii) in the intensive care unit (ICU) and weaned from ECMO; (iii) alive and out of extensive care; and (iv) death. Clinical outcomes were assessed several times after the start of ECMO, up to day 90 after the start of ECMO. Secondary outcomes refer to the characterization of headaches similar to those in ICU or ECMO. Of the 83 patients in whom ECMO was initiated, 67 (81%) were supine, 80 (96%) gained neuromuscular blockers, 17 (20%) gained high-dose corticosteroids, and five (6%) gained nitric oxide . ECMO support was provided for a median of 20 days (IQR 10 to 40) and the mean length of stay in the ICU was 36 days (IQR 23 to 60). Complete follow-up was required at 60 days for all 83 patients. The estimated probability of being in each of the four states 60 days after the start of ECMO was calculated as follows: (i) 6% (95% confidence period [CI] 3 to 1 four%); (ii) 18% (95% CI: 11 to 28%); (iii) four 5% (95% CI: 35 to 56%); and (iv) 31% (95% CI 22 to 42%). Among the supine patients, 9. 4% showed a benefit. Despite good enough thromboprophylaxis, 16 (19%) patients developed pulmonary embolism, which was higher than that seen in ARDS patients without COVID-19 on ECMO. 35 (four2%) patients experienced primary bleeding, of which four (5%) suffered a hemorrhagic stroke. 30 deaths were observed during follow-up. Overall, given survival rates similar to non-COVID-19 ARDS patients on ECMO from previous studies, the use of ECMO in ARDS COVID-19 deserves to be considered as a remedial modality. for patients refractory to traditional optimization, adding the supine position.
Picture: PD
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