Higher Education | Medicine and Health Sciences
Introduction: Veno-venous extracorporeal membrane oxygenation (VV ECMO) is an indicated treatment for severe acute respiratory distress syndrome (ARDS) refractory to conventional medical treatment. Severe ARDS is a common complication of CoVID-19 infection. Subsequently, the efficacy of VV ECMO in CoVID-19 severe ARDS patients must be investigated. ECMO is a resource-intensive treatment modality, meaning that its use must be reserved for patients with robust indications and paucity of contraindications.
Methods: We performed retrospective chart review of three patients at the University of Nebraska Medical Center that were placed on VV ECMO secondary to severe ARDS from CoVID-19 infection.
Results: All patients were male with a median age of 39 years. Two patients were of Hispanic descent, and the third was of Asian descent. No patients had underlying lung disease, and all patients had type II diabetes mellitus. Median time on mechanical ventilation prior to ECMO cannulation was six days. Median duration of ECMO treatment was 21 days with a range of 17 to 27 days. All patients were decannulated from ECMO during their hospital stay, and all patients survived to 60 days post-hospital discharge. Complications while on ECMO included GI bleeding in two patients, hematuria in one patient, necessitation of vasodilator and vasopressor support in all patients, AKI in two patients, secondary bacterial pneumonia in two patients, and blood cultures positive for gram-positive organisms in all patients. No patients suffered DVT or CVA. All patients required pRBC transfusion during ECMO treatment. Two patients were treated with remdesivir and one patient received baricitinib, a JAK-inhibitor.
Conclusion: VV ECMO is a viable treatment for patients with severe ARDS secondary to CoVID-19 infection that have failed conventional therapy. Stringent adherence to inclusion and exclusion criteria is imperative. VV ECMO combined with lung protective ventilation strategies with a focus on minimizing driving pressure can provide life-saving treatment to patients with severe ARDS secondary to CoVID-19 infection
ECMO, VV ECMO, CoVID-19, Coronavirus, Driving Pressure, Treatment, Outcomes
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Ewald, C. J., Zehr, L., , Thompson, S. L. VV ECMO for Treatment of Severe ARDS in CoVID-19 Patients at UNMC. Graduate Medical Education Research Journal. 2021 Oct 04; 3(1).
Table 1: Definition of ARDS.9
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Table 2: ELSO criteria for ECMO cannulation.
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Figure 1: VV ECMO accesses deoxygenated blood through a major vein (commonly a femoral vein), removes the deoxygenated blood, oxygenates and removes CO2 from the blood, then returns the oxygenated blood to the right ventricle via the same or a different vein.
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Table 3: Inclusion Criteria for VV ECMO in CoVID-19 Severe ARDS Patients at UNMC (Shaun L. Thompson, MD).
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Figure 2: Chest radiograph displaying proper placement of ECMO cannulas.
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Figure 3: Complications on ECMO. *One patient that suffered an AKI required 17 days of continuous hemodialysis. **ROSC occurred after two minutes of CPR. ***Median units of RBC required on ECMO was 17. One patient also required transfusion of 3 units of platelets, 2 units of fresh frozen plasma (FFP), and 10 units of cryoprecipitate during ECMO treatment. ****One patient required small bowel resection as a result of their GI bleed.
Works Cited COVID.docx (13 kB)