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Coronavirus (COVID-19)

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

JAMA Surgery

Published Online: August 11, 2020

Research Letter

Article Information and Disclosures

Asif K. Mustafa, MD, PhD^1,2;

Philip J. Alexander, MD^1,2;

Devang J. Joshi, MD^1,2;

Deborah R. Tabachnick, MD^1,2;

Chadrick A. Cross, MD^1,2;

Pat S. Pappas, MD^1,2;

Antone J. Tatooles, MD^1,2

Author Affiliations

¹Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois
²Cardiothoracic and Vascular Surgical Associates SC, Advocate Christ Medical Center, Oak Lawn, Illinois

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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

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.2020.6775 PubMed Google Scholar Crossref

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/NEJMoa1800385 PubMed Google Scholar Crossref

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.201610-792OC PubMed Google Scholar Crossref

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.0112316 PubMed Google Scholar

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/NEJMc2010459 PubMed Google Scholar

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.2020.03.011 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.