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Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients: Early Experience From a Major Academic Medical Center in North America.
Ann Surg. 2020 Aug; 272(2):e75-e78.AnnS

Abstract

AND BACKGROUND DATA

VV ECMO can be utilized as an advanced therapy in select patients with COVID-19 respiratory failure refractory to traditional critical care management and optimal mechanical ventilation. Anticipating a need for such therapies during the pandemic, our center created a targeted protocol for ECMO therapy in COVID-19 patients that allows us to provide this life-saving therapy to our sickest patients without overburdening already stretched resources or excessively exposing healthcare staff to infection risk.

METHODS

As a major regional referral program, we used the framework of our well-established ECMO service-line to outline specific team structures, modified patient eligibility criteria, cannulation strategies, and management protocols for the COVID-19 ECMO program.

RESULTS

During the first month of the COVID-19 outbreak in Massachusetts, 6 patients were placed on VV ECMO for refractory hypoxemic respiratory failure. The median (interquartile range) age was 47 years (43-53) with most patients being male (83%) and obese (67%). All cannulations were performed at the bedside in the intensive care unit in patients who had undergone a trial of rescue therapies for acute respiratory distress syndrome including lung protective ventilation, paralysis, prone positioning, and inhaled nitric oxide. At the time of this report, 83% (5/6) of the patients are still alive with 1 death on ECMO, attributed to hemorrhagic stroke. 67% of patients (4/6) have been successfully decannulated, including 2 that have been successfully extubated and one who was discharged from the hospital. The median duration of VV ECMO therapy for patients who have been decannulated is 12 days (4-18 days).

CONCLUSIONS

This is 1 the first case series describing VV ECMO outcomes in COVID-19 patients. Our initial data suggest that VV ECMO can be successfully utilized in appropriately selected COVID-19 patients with advanced respiratory failure.

Authors+Show Affiliations

Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Anesthesia, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Anesthesia, Massachusetts General Hospital, Boston, Massachusetts.Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts.Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32675503

Citation

Osho, Asishana A., et al. "Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients: Early Experience From a Major Academic Medical Center in North America." Annals of Surgery, vol. 272, no. 2, 2020, pp. e75-e78.
Osho AA, Moonsamy P, Hibbert KA, et al. Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients: Early Experience From a Major Academic Medical Center in North America. Ann Surg. 2020;272(2):e75-e78.
Osho, A. A., Moonsamy, P., Hibbert, K. A., Shelton, K. T., Trahanas, J. M., Attia, R. Q., Bloom, J. P., Onwugbufor, M. T., D'Alessandro, D. A., Villavicencio, M. A., Sundt, T. M., Crowley, J. C., Raz, Y., & Funamoto, M. (2020). Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients: Early Experience From a Major Academic Medical Center in North America. Annals of Surgery, 272(2), e75-e78. https://doi.org/10.1097/SLA.0000000000004084
Osho AA, et al. Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients: Early Experience From a Major Academic Medical Center in North America. Ann Surg. 2020;272(2):e75-e78. PubMed PMID: 32675503.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Veno-venous Extracorporeal Membrane Oxygenation for Respiratory Failure in COVID-19 Patients: Early Experience From a Major Academic Medical Center in North America. AU - Osho,Asishana A, AU - Moonsamy,Philicia, AU - Hibbert,Kathryn A, AU - Shelton,Kenneth T, AU - Trahanas,John M, AU - Attia,Rizwan Q, AU - Bloom,Jordan P, AU - Onwugbufor,Michael T, AU - D'Alessandro,David A, AU - Villavicencio,Mauricio A, AU - Sundt,Thoralf M, AU - Crowley,Jerome C, AU - Raz,Yuval, AU - Funamoto,Masaki, PY - 2020/7/18/entrez PY - 2020/7/18/pubmed PY - 2020/8/4/medline SP - e75 EP - e78 JF - Annals of surgery JO - Ann Surg VL - 272 IS - 2 N2 - AND BACKGROUND DATA: VV ECMO can be utilized as an advanced therapy in select patients with COVID-19 respiratory failure refractory to traditional critical care management and optimal mechanical ventilation. Anticipating a need for such therapies during the pandemic, our center created a targeted protocol for ECMO therapy in COVID-19 patients that allows us to provide this life-saving therapy to our sickest patients without overburdening already stretched resources or excessively exposing healthcare staff to infection risk. METHODS: As a major regional referral program, we used the framework of our well-established ECMO service-line to outline specific team structures, modified patient eligibility criteria, cannulation strategies, and management protocols for the COVID-19 ECMO program. RESULTS: During the first month of the COVID-19 outbreak in Massachusetts, 6 patients were placed on VV ECMO for refractory hypoxemic respiratory failure. The median (interquartile range) age was 47 years (43-53) with most patients being male (83%) and obese (67%). All cannulations were performed at the bedside in the intensive care unit in patients who had undergone a trial of rescue therapies for acute respiratory distress syndrome including lung protective ventilation, paralysis, prone positioning, and inhaled nitric oxide. At the time of this report, 83% (5/6) of the patients are still alive with 1 death on ECMO, attributed to hemorrhagic stroke. 67% of patients (4/6) have been successfully decannulated, including 2 that have been successfully extubated and one who was discharged from the hospital. The median duration of VV ECMO therapy for patients who have been decannulated is 12 days (4-18 days). CONCLUSIONS: This is 1 the first case series describing VV ECMO outcomes in COVID-19 patients. Our initial data suggest that VV ECMO can be successfully utilized in appropriately selected COVID-19 patients with advanced respiratory failure. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/32675503/Veno_venous_Extracorporeal_Membrane_Oxygenation_for_Respiratory_Failure_in_COVID_19_Patients:_Early_Experience_From_a_Major_Academic_Medical_Center_in_North_America_ DB - PRIME DP - Unbound Medicine ER -