Ann Thorac Surg. 2020 Jul 17:S0003-4975(20)31152-8. doi: 10.1016/j.athoracsur.2020.07.002. Online ahead of print.
BACKGROUND: Coronavirus disease 2019 (Covid-19) remains a worldwide pandemic with a high mortality rate among patients requiring mechanical ventilation. The limited data that exists regarding the utility of extracorporeal membrane oxygenation (ECMO) in these critically ill patients shows poor overall outcomes. This paper describes our institutional practice regarding the application and management of ECMO support for patients with Covid-19 and reports promising early outcomes.
METHODS: All critically ill patients with confirmed Covid-19 evaluated for ECMO support from March 10th, 2020-April 24th, 2020 were retrospectively reviewed. Patients were selected for ECMO support based on a PaO2/FiO2 (P/F) ratio<150 mmHg OR pH<7.25 with a pCO2>60 mmHg with no life-limiting comorbidities. Patients were cannulated at bedside and were managed with protective lung ventilation, early tracheostomy, bronchoscopies and proning as clinically indicated.
RESULTS: Of 321 patients intubated for Covid-19, 77 (24%) patients were evaluated for ECMO support with 27 (8.4%) patients placed on ECMO. All patients were placed on veno-venous ECMO. Current survival is 96.3%, with only one mortality to date in over 350 days of total ECMO support. Thirteen patients (48.1%) remain on ECMO support, while 13 patients (48.1%) have been successfully decannulated. Seven patients (25.9%) have been discharged from the hospital. Six patients (22.2%) remain in the hospital of which four are on room-air. No healthcare workers that participated in ECMO cannulation developed symptoms of or tested positive for Covid-19.
CONCLUSIONS: The early outcomes presented here suggest that the judicious use of ECMO support in severe Covid-19 may be clinically beneficial.