SARS-CoV-2 and ECMO: early results and experience

Area of Science:

• Critical Care Medicine
• Pulmonology
• Infectious Diseases

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to critical illness requiring advanced respiratory support.
• Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with severe respiratory failure.
• Understanding the outcomes and management of SARS-CoV-2 patients on ECMO is crucial for optimizing care.

Purpose of the Study:

• To describe the experience and early outcomes of critically unwell SARS-CoV-2 patients managed with ECMO.
• To present standard practices for ECMO decision-making, retrieval, cannulation, ventilation, anticoagulation, tracheostomy, imaging, and steroid use.
• To evaluate the effectiveness of ECMO in severe SARS-CoV-2 respiratory failure.

Main Methods:

• A retrospective cohort study was conducted.
• Data were collected from hospital records of SARS-CoV-2 patients requiring extracorporeal support.
• The study period was from March 1, 2020, to July 31, 2020, at St Bartholomew's Hospital, including 18 patients.

Main Results:

• Out of 18 patients, 14 (78%) survived. Mean ECMO duration was 17.7 days.
• Veno-venous (VV) ECMO was the initial mode for 15 patients (83%).
• Complications included renal replacement therapy in 56%, thromboembolic events in 56%, and intracranial hemorrhage in 11%. Tracheostomy was performed in 50%.

Conclusions:

• Patients with severe SARS-CoV-2 respiratory failure requiring prolonged invasive ventilation and ECMO can achieve good outcomes.
• A significant burden of thromboembolic disease and renal injury was observed.
• Tracheostomy and steroid use were frequently required to facilitate weaning in this cohort.