A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management
Author
Shah, AakashDave, Sagar
Galvagno, Samuel
George, Kristen
Menne, Ashley R
Haase, Daniel J
McCormick, Brian
Rector, Raymond
Dahi, Siamak
Madathil, Ronson J
Deatrick, Kristopher B
Ghoreishi, Mehrdad
Gammie, James S
Kaczorowski, David J
Menaker, Jay
Herr, Daniel
Tabatabai, Ali
Krause, Eric
Scalea, Thomas
Date
2021-04-21Journal
MembranesPublisher
MDPI AGType
Article
Metadata
Show full item recordAbstract
(1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients.Keyword
COVID-19acute respiratory distress syndrome
anticoagulation
extracorporeal membrane oxygenation
mechanical ventilation
pneumothorax
sedation
tracheostomy
Identifier to cite or link to this item
http://hdl.handle.net/10713/15572ae974a485f413a2113503eed53cd6c53
10.3390/membranes11050306
Scopus Count
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