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Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review.
Ann Acad Med Singap. 2020 04; 49(4):199-214.AA

Abstract

INTRODUCTION

Epidemics and pandemics from zoonotic respiratory viruses, such as the 2019 novel coronavirus, can lead to significant global intensive care burden as patients progress to acute respiratory distress syndrome (ARDS). A subset of these patients developed refractory hypoxaemia despite maximal conventional mechanical ventilation and required extracorporeal membrane oxygenation (ECMO). This review focuses on considerations for ventilatory strategies, infection control and patient selection related to ECMO for ARDS in a pandemic. We also summarise the experiences with ECMO in previous respiratory pandemics.

METHODS

A review of pertinent studies was conducted via a search using MEDLINE, EMBASE and Google Scholar. References of articles were also examined to identify other relevant publications.

RESULTS

Since the H1N1 Influenza pandemic in 2009, the use of ECMO for ARDS continues to grow despite limitations in evidence for survival benefit. There is emerging evidence to suggest that lung protective ventilation for ARDS can be further optimised while receiving ECMO so as to minimise ventilator-induced lung injury and subsequent contributions to multi-organ failure. Efforts to improve outcomes should also encompass appropriate infection control measures to reduce co-infections and prevent nosocomial transmission of novel respiratory viruses. Patient selection for ECMO in a pandemic can be challenging. We discuss important ethical considerations and predictive scoring systems that may assist clinical decision-making to optimise resource allocation.

CONCLUSION

The role of ECMO in managing ARDS during respiratory pandemics continues to grow. This is supported by efforts to redefine optimal ventilatory strategies, reinforce infection control measures and enhance patient selection.

Authors+Show Affiliations

Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32296808

Citation

Lim, Joel Kian Boon, et al. "Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: a Narrative Review." Annals of the Academy of Medicine, Singapore, vol. 49, no. 4, 2020, pp. 199-214.
Lim JKB, Qadri SK, Toh TSW, et al. Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review. Ann Acad Med Singap. 2020;49(4):199-214.
Lim, J. K. B., Qadri, S. K., Toh, T. S. W., Lin, C. B., Mok, Y. H., & Lee, J. H. (2020). Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review. Annals of the Academy of Medicine, Singapore, 49(4), 199-214.
Lim JKB, et al. Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: a Narrative Review. Ann Acad Med Singap. 2020;49(4):199-214. PubMed PMID: 32296808.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review. AU - Lim,Joel Kian Boon, AU - Qadri,Syeda Kashfi, AU - Toh,Theresa Shu Wen, AU - Lin,Cheryl Bin, AU - Mok,Yee Hui, AU - Lee,Jan Hau, PY - 2020/4/17/entrez PY - 2020/4/17/pubmed PY - 2020/9/17/medline SP - 199 EP - 214 JF - Annals of the Academy of Medicine, Singapore JO - Ann Acad Med Singap VL - 49 IS - 4 N2 - INTRODUCTION: Epidemics and pandemics from zoonotic respiratory viruses, such as the 2019 novel coronavirus, can lead to significant global intensive care burden as patients progress to acute respiratory distress syndrome (ARDS). A subset of these patients developed refractory hypoxaemia despite maximal conventional mechanical ventilation and required extracorporeal membrane oxygenation (ECMO). This review focuses on considerations for ventilatory strategies, infection control and patient selection related to ECMO for ARDS in a pandemic. We also summarise the experiences with ECMO in previous respiratory pandemics. METHODS: A review of pertinent studies was conducted via a search using MEDLINE, EMBASE and Google Scholar. References of articles were also examined to identify other relevant publications. RESULTS: Since the H1N1 Influenza pandemic in 2009, the use of ECMO for ARDS continues to grow despite limitations in evidence for survival benefit. There is emerging evidence to suggest that lung protective ventilation for ARDS can be further optimised while receiving ECMO so as to minimise ventilator-induced lung injury and subsequent contributions to multi-organ failure. Efforts to improve outcomes should also encompass appropriate infection control measures to reduce co-infections and prevent nosocomial transmission of novel respiratory viruses. Patient selection for ECMO in a pandemic can be challenging. We discuss important ethical considerations and predictive scoring systems that may assist clinical decision-making to optimise resource allocation. CONCLUSION: The role of ECMO in managing ARDS during respiratory pandemics continues to grow. This is supported by efforts to redefine optimal ventilatory strategies, reinforce infection control measures and enhance patient selection. SN - 0304-4602 UR - https://www.unboundmedicine.com/medline/citation/32296808/Extracorporeal_Membrane_Oxygenation_for_Severe_Respiratory_Failure_During_Respiratory_Epidemics_and_Pandemics:_A_Narrative_Review_ L2 - http://www.annals.edu.sg/pdf/49VolNo4Apr2020/V49N4p199.pdf DB - PRIME DP - Unbound Medicine ER -