Extracorporeal Membrane Oxygenation in Patients With COVID-19: An International Multicenter Cohort Study
In case of cardiac and/or respiratory failure in COVID-19 patients, extracorporeal membrane oxygenation (ECMO) is recommended as a final supportive therapy. The fewer data available isn’t sufficient to put forward robust conclusions that supports the administration of ECMO in patients with severe respiratory failure due to COVID-19. Senta Jorinde Raasveld and colleagues conducted research published in the Journal of Intensive Care Medicine under the title “Extracorporeal Membrane Oxygenation in Patients With COVID-19: An International Multicenter Cohort Study”. The summary of this study is given below:
Objective:
To provide additional information on the role of ECMO in refractory ARDS due to COVID-19
Method:
This is an international retrospective study of COVID-19 patients which was performed on ECMO from March 1 to April 30, 2020. A total of 13 intensive care units were included in the study. ECMO characteristics, Demographic data, and clinical outcomes were collected. The main outcome was to investigate the complication rate and 28-day mortality; the other outcome was to compare patient and ECMO characteristics between non-COVID-19 related ARDS patients on ECMO and COVID-19 patients on ECMO.
Findings:
The study suggests that ECMO can be considered as supportive therapy in case of severe, refractory ARDS due to COVID-19 if conventional therapies prove insufficient. It is advised to apply the best possible conventional intensive care before to initiation of ECMO. The study reports that the characteristics prior to initiation of ECMO in COVID-19 patients as well as the ECMO characteristics themselves were in line with previous ECMO non-COVID-19 ARDS groups. There were no differences found in comorbidities between survivors and non-survivors in the COVID-19 group on ECMO. On the other hand, the arterial blood gas of non-survivors was found to have a significantly lower pH and higher PCO2.
While SSCM and WHO states that this is not a time to implement ECMO in centers, investigators suggest considering ECMO if there is the availability of sufficient resources, including personnel and equipment.
Limitation:
Some biases cannot be excluded due to the observational nature of the study. Hence, there is a lack of knowledge about the outcome in the absence of ECMO support. Additionally, there were different timespan of patients with and without COVID-19 on ECMO. Lastly, no data were collected regarding functional outcomes.
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