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Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19
Acute respiratory distress syndrome (ARDS) related to Coronavirus disease (COVID-19) is associated with high mortality. It has been suggested that venovenous extracorporeal membrane oxygenation (ECMO) was suitable in this indication, albeit the effects of ECMO on the mechanical respiratory parameter...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758460/ https://www.ncbi.nlm.nih.gov/pubmed/33363190 http://dx.doi.org/10.3389/fmed.2020.614569 |
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author | Jozwiak, Mathieu Chiche, Jean-Daniel Charpentier, Julien Ait Hamou, Zakaria Jaubert, Paul Benghanem, Sarah Dupland, Pierre Gavaud, Ariane Péne, Frédéric Cariou, Alain Mira, Jean-Paul Nguyen, Lee S. |
author_facet | Jozwiak, Mathieu Chiche, Jean-Daniel Charpentier, Julien Ait Hamou, Zakaria Jaubert, Paul Benghanem, Sarah Dupland, Pierre Gavaud, Ariane Péne, Frédéric Cariou, Alain Mira, Jean-Paul Nguyen, Lee S. |
author_sort | Jozwiak, Mathieu |
collection | PubMed |
description | Acute respiratory distress syndrome (ARDS) related to Coronavirus disease (COVID-19) is associated with high mortality. It has been suggested that venovenous extracorporeal membrane oxygenation (ECMO) was suitable in this indication, albeit the effects of ECMO on the mechanical respiratory parameters have been scarcely described. In this case-series, we prospectively described the use of venovenous ECMO and its effects on mechanical respiratory parameters in eleven COVID-19 patients with severe ARDS. Implantation of ECMO occurred 6 [3–11] days after the onset of mechanical ventilation. At the time of ECMO implantation, all patients received neuromuscular blocking agents, three (27%) received inhaled nitric oxide and prone positioning was performed in all patients with 4 [3−5] sessions of PP per patient. Under ECMO, the tidal volume was significantly decreased from 6.1 [4.0–6.3] to 3.4 [2.5–3.6] mL/kg of predicted body weight and the positive end-expiratory pressure level was increased by 25 ± 27% whereas the driving pressure and the mechanical power decreased by 33 ± 25% and 71 ± 27%, respectively. The PaO(2)/FiO(2) ratio significantly increased from 68 [58–89] to 168 [137–218] and the oxygenation index significantly decreased from 28 [26–35] to 13 [10–15]. The duration of ECMO was 12 [8–25] days. Nine (82%) patients experienced ECMO-related complications and the main complication was major bleeding requiring blood transfusions. Intensive care unit mortality rate was 55% but no patient died from ECMO-related complications. In COVID-19 patients with severe ARDS, venovenous ECMO allowed ultra-protective ventilation, improved oxygenation and should be considered in highly selected patients with the most severe ARDS. |
format | Online Article Text |
id | pubmed-7758460 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-77584602020-12-25 Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19 Jozwiak, Mathieu Chiche, Jean-Daniel Charpentier, Julien Ait Hamou, Zakaria Jaubert, Paul Benghanem, Sarah Dupland, Pierre Gavaud, Ariane Péne, Frédéric Cariou, Alain Mira, Jean-Paul Nguyen, Lee S. Front Med (Lausanne) Medicine Acute respiratory distress syndrome (ARDS) related to Coronavirus disease (COVID-19) is associated with high mortality. It has been suggested that venovenous extracorporeal membrane oxygenation (ECMO) was suitable in this indication, albeit the effects of ECMO on the mechanical respiratory parameters have been scarcely described. In this case-series, we prospectively described the use of venovenous ECMO and its effects on mechanical respiratory parameters in eleven COVID-19 patients with severe ARDS. Implantation of ECMO occurred 6 [3–11] days after the onset of mechanical ventilation. At the time of ECMO implantation, all patients received neuromuscular blocking agents, three (27%) received inhaled nitric oxide and prone positioning was performed in all patients with 4 [3−5] sessions of PP per patient. Under ECMO, the tidal volume was significantly decreased from 6.1 [4.0–6.3] to 3.4 [2.5–3.6] mL/kg of predicted body weight and the positive end-expiratory pressure level was increased by 25 ± 27% whereas the driving pressure and the mechanical power decreased by 33 ± 25% and 71 ± 27%, respectively. The PaO(2)/FiO(2) ratio significantly increased from 68 [58–89] to 168 [137–218] and the oxygenation index significantly decreased from 28 [26–35] to 13 [10–15]. The duration of ECMO was 12 [8–25] days. Nine (82%) patients experienced ECMO-related complications and the main complication was major bleeding requiring blood transfusions. Intensive care unit mortality rate was 55% but no patient died from ECMO-related complications. In COVID-19 patients with severe ARDS, venovenous ECMO allowed ultra-protective ventilation, improved oxygenation and should be considered in highly selected patients with the most severe ARDS. Frontiers Media S.A. 2020-12-10 /pmc/articles/PMC7758460/ /pubmed/33363190 http://dx.doi.org/10.3389/fmed.2020.614569 Text en Copyright © 2020 Jozwiak, Chiche, Charpentier, Ait Hamou, Jaubert, Benghanem, Dupland, Gavaud, Péne, Cariou, Mira and Nguyen. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Jozwiak, Mathieu Chiche, Jean-Daniel Charpentier, Julien Ait Hamou, Zakaria Jaubert, Paul Benghanem, Sarah Dupland, Pierre Gavaud, Ariane Péne, Frédéric Cariou, Alain Mira, Jean-Paul Nguyen, Lee S. Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19 |
title | Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19 |
title_full | Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19 |
title_fullStr | Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19 |
title_full_unstemmed | Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19 |
title_short | Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19 |
title_sort | use of venovenous extracorporeal membrane oxygenation in critically-ill patients with covid-19 |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758460/ https://www.ncbi.nlm.nih.gov/pubmed/33363190 http://dx.doi.org/10.3389/fmed.2020.614569 |
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