scholarly journals Dismal Survival in COVID-19 Patients Requiring ECMO as Rescue Therapy after Corticosteroid Failure

2021 ◽  
Vol 11 (11) ◽  
pp. 1238
Author(s):  
Sebastian Voicu ◽  
Antoine Goury ◽  
Thomas Lacoste-Palasset ◽  
Isabelle Malissin ◽  
Lucie Fanet ◽  
...  
Keyword(s):  
Cohort Study ◽  
Survival Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Rescue Therapy ◽  
Therapeutic Strategies ◽  
Improve Outcome ◽  
Refractory Hypoxemia ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Group 3

(1) Background: COVID-19 may lead to refractory hypoxemia requiring venovenous extracorporeal membrane oxygenation (ECMO). Survival rate if ECMO is implemented as rescue therapy after corticosteroid failure is unknown. We aimed to investigate if ECMO implemented after failure of the full-recommended 10-day corticosteroid course can improve outcome. (2) Methods: We conducted a three-center cohort study including consecutive dexamethasone-treated COVID-19 patients requiring ECMO between 03/2020 and 05/2021. We compared survival at hospital discharge between patients implemented after (ECMO-after group) and before the end of the 10-day dexamethasone course (ECMO-before group). (3) Results: Forty patients (28M/12F; age, 57 years (51–62) (median (25th–75th percentiles)) were included, 28 (70%) in the ECMO-before and 12 (30%) in the ECMO-after group. In the ECMO-before group, 9/28 patients (32%) received the 6 mg/day dexamethasone regimen versus 12/12 (100%) in the ECMO-after group (p < 0.0001). The rest of the patients received an alternative dexamethasone regimen consisting of 20 mg/day during 5 days followed by 10 mg/day during 5 days. Patients in the ECMO-before group tended to be younger (57 years (51–59) versus 62 years (57–67), p = 0.053). In the ECMO-after group, no patient (0%) survived while 12 patients (43%) survived in the ECMO-before group (p = 0.007). (4) Conclusions: Survival is poor in COVID-19 patients requiring ECMO implemented after the full-recommended 10-day dexamethasone course. Since these patients may have developed a particularly severe presentation, new therapeutic strategies are urgently required.

scholarly journals Extracorporeal Membrane Oxygenation for Acute Respiratory and Cardiac Failure

2021 ◽  
Vol 33 ◽  
pp. 55-64
Author(s):  
Hideshi ITOH ◽  
Nguyen The Binh ◽  
Le Ngoc Thanh ◽  
Hitomi Ando ◽  
Naohiro Inagawa ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Rescue Therapy ◽  
World Health ◽  
Lung Protective Ventilation ◽  
Critical Situation ◽  
Membrane Oxygenation ◽  
The World ◽  
Refractory Hypoxemia ◽  
Health Organization

Extracorporeal Membrane Oxygenation (ECMO) is widely used for acute respiratory and cardiac failure in critical situations as mechanical circulatory and respiratory support systems. Historically, ECMO had been two arguments both for and against using in critical situation. Despite the widespread adoption of ECMO in critical situation, the use of ECMO remains associated with significant morbidity and mortality. In 2019, an outbreak of pneumonia caused by severe acute respiratory distress syndrome (ARDS) by corona virus 2 (SARS-CoV-2) has occurred in China. SARS-CoV-2 has rapidly spread out the community of whole over the world, and cause severe respiratory failure disease (COVID-19) associated mortality and lack of immunization and treatment. According to the interim guidance formulated by the World Health Organization (WHO), ECMO should be considered as a rescue therapy or COVID-19 with refractory hypoxemia despite lung protective ventilation. The focus of this review will be on the physiological aspects of respiratory and cardiac ECMO.

scholarly journals Successful management of severe acute respiratory distress syndrome due to COVID-19 with extracorporeal membrane oxygenation during mid-trimester of pregnancy

2021 ◽  
Vol 14 (2) ◽  
pp. e240823
Author(s):  
Zenab Yusuf Tambawala ◽  
Zeinabsadat Tabatabaei Hakim ◽  
Lama Khalid Hamza ◽  
Maryam Al Rayes
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Rescue Therapy ◽  
Good Condition ◽  
Nasopharyngeal Swab ◽  
Membrane Oxygenation ◽  
Surgical Icu ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

A 29-year-old pregnant woman presented at 26 weeks of gestation with fever and cough for 4 days. On admission, her nasopharyngeal swab confirmed COVID-19. As her respiratory distress worsened, she was shifted to the intensive care unit (ICU). Since the patient was unable to maintain saturation even on high settings of mechanical ventilation, she underwent venovenous extracorporeal membrane oxygenation (VV-ECMO) and was monitored in surgical ICU by a multidisciplinary team. The obstetrical team was on standby to perform urgent delivery if needed. Her condition improved, and she was weaned off after 5 days on extracorporeal membrane oxygenation. She was observed in the antenatal ward for another week and discharged home with the mother and fetus in good condition. VV-ECMO can be considered as rescue therapy for pregnant women with refractory hypoxaemia of severe respiratory failure due to COVID-19. It can save two lives, the mother and fetus.

scholarly journals Venovenous extracorporeal membrane oxygenation versus conventional mechanical ventilation to treat refractory hypoxemia in patients with acute respiratory distress syndrome: a retrospective cohort study

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093570
Author(s):  
Surat Tongyoo ◽  
Chairat Permpikul ◽  
Siwalai Sucher ◽  
Preecha Thomrongpairoj ◽  
Akekarin Poompichet ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Retrospective Cohort ◽  
Distress Syndrome ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Objective To compare the treatment outcome of venovenous extracorporeal membrane oxygenation (VV-ECMO) versus mechanical ventilation in hypoxemic patients with acute respiratory distress syndrome (ARDS) at a referral center that started offering VV-EMCO support in 2010. Methods This retrospective cohort study enrolled adults with severe ARDS (PaO2/FiO2 ratio of <100 with FiO2 of ≥90 or Murray score of ≥3) who were admitted to the intensive care unit of Siriraj Hospital (Bangkok, Thailand) from January 2010 to December 2018. All patients were treated using a low tidal volume (TV) and optimal positive end-expiratory pressure. The primary outcome was hospital mortality. Results Sixty-four patients (ECMO, n = 30; mechanical ventilation, n = 34) were recruited. There was no significant difference in the baseline PaO2/FiO2 ratio (67.2 ± 25.7 vs. 76.6 ± 16.0), FiO2 (97 ± 9 vs. 94 ± 8), or Murray score (3.4 ± 0.5 vs. 3.3 ± 0.5) between the ECMO and mechanical ventilation groups. The hospital mortality rate was also not significantly different between the two groups (ECMO, 20/30 [66.7%] vs. mechanical ventilation, 24/34 [70.6%]). Patients who underwent ECMO were ventilated with a significantly lower TV than patients who underwent mechanical ventilation (3.8 ± 1.8 vs. 6.6 ± 1.4 mL, respectively). Conclusion Although VV-ECMO promoted lower-TV ventilation, it did not improve the in-hospital mortality rate. Trial registration: www.clinicaltrials.gov (NCT 04031794).

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