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Extracorporeal Membrane Oxygenation for Patients With COVID-19 in Severe Respiratory Failure

Educational Objective
To understand the results of using extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure
1 Credit CME

Coronavirus disease 2019 (COVID-19) can lead to acute respiratory distress syndrome (ARDS), necessitating prolonged mechanical ventilation.1 In some cases, even ventilatory support fails. Venovenous extracorporeal membrane oxygenation (ECMO) has been used in severe cases of respiratory failure.2 However, the need for prolonged ventilation, sedation, and immobility may limit its long-term benefits.3 The application of ECMO in patients with COVID-19 whose condition has rendered mechanical ventilatory support insufficient is not fully established. We present our experience in using single-access, dual-stage venovenous ECMO, with an emphasis on early extubation of patients while they received ECMO support.

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Article Information

Accepted for Publication: July 23, 2020.

Corresponding Author: Antone J. Tatooles, MD, Cardiothoracic and Vascular Surgical Associates SC, Advocate Christ Medical Center, 4400 W 95th St, Ste 308, Oak Lawn, IL 60453 (antone_tatooles@rush.edu).

Published Online: August 11, 2020. doi:10.1001/jamasurg.2020.3950

Author Contributions: Drs Mustafa and Tatooles had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mustafa, Alexander, Joshi, Tabachnick, Cross, Tatooles.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mustafa, Joshi, Cross, Tatooles.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Mustafa, Joshi.

Administrative, technical, or material support: All authors.

Supervision: Mustafa, Alexander, Tabachnick, Cross, Pappas, Tatooles.

Other—performed substantial part of the procedures: Alexander.

Conflict of Interest Disclosures: Dr Tatooles reported serving as a consultant with Abbott Laboratories outside the submitted work. No other disclosures were reported.

Additional Contributions: We would like to thank Gillian Alex, MD, Rush University Medical Center, for help with institutional board review approvals. She was not compensated for this contribution. We would also like to thank all our brave medical staff, including the intensivists, nurses, physician assistants, nurse practitioners, respiratory therapists, perfusionists, physical therapists, and speech and occupational therapists, among others who selflessly took care of the patients.

Additional Information: All authors performed extracorporeal membrane oxygenation–associated care as attending cardiac surgeons.

References
1.
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al; and the Northwell COVID-19 Research Consortium.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. 2020;323(20):2052-2059. doi:10.1001/jama.2020.6775PubMedGoogle ScholarCrossref
2.
Combes  A , Hajage  D , Capellier  G ,  et al; EOLIA Trial Group, REVA, and ECMONet.  Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome.   N Engl J Med. 2018;378(21):1965-1975. doi:10.1056/NEJMoa1800385PubMedGoogle ScholarCrossref
3.
Hill  AD , Fowler  RA , Burns  KE , Rose  L , Pinto  RL , Scales  DC .  Long-term outcomes and health care utilization after prolonged mechanical ventilation.   Ann Am Thorac Soc. 2017;14(3):355-362. doi:10.1513/AnnalsATS.201610-792OCPubMedGoogle ScholarCrossref
4.
Lubnow  M , Philipp  A , Foltan  M ,  et al.  Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange—retrospective analysis of 265 cases.   PLoS One. 2014;9(12):e112316. doi:10.1371/journal.pone.0112316PubMedGoogle Scholar
5.
Creel-Bulos  C , Hockstein  M , Amin  N , Melhem  S , Truong  A , Sharifpour  M .  Acute cor pulmonale in critically ill patients with COVID-19.   N Engl J Med. 2020;382(21):e70. doi:10.1056/NEJMc2010459PubMedGoogle Scholar
6.
Henry  BM , Lippi  G .  Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): pooled analysis of early reports.   J Crit Care. 2020;58:27-28. doi:10.1016/j.jcrc.2020.03.011PubMedGoogle ScholarCrossref
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