ECMO for Critically Ill COVID-19 with ARDS: A Case Series
Department
Internal Medicine
Document Type
Article
Publication Title
The Journal of Heart and Lung Transplantation
Abstract
Introduction
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) as bridge to recovery in critically ill COVID-19 continues to be commonly utilized strategy in cases with persistent respiratory failure refractory to traditional ventilation support
Case Report
We report 5 cases of severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2) who were treated with ECMO (Table 1). All 5 cases presented with fever, cough and shortness of breath and a positive nasopharyngeal swab for SARS-CoV-2 on admission. Case 1, 2, 3 and 5 patients were hypoxemic with saturation less than 90% on admission and decompensated rapidly, whereas Case 4 decompensated after day 14. Mechanical ventilation failed to provide adequate oxygenation in all 5 cases; case 2,3 and 5 were started on recruitment measures with proning while it was not possible for case 1 owing to morbid obesity. Proning was not possible in the case 4 as patient became severely hypoxemic while patient was undergoing mechanical thrombectomy. The case 1-4 remained on ECMO for 19, 17, 17 and 2 days respectively. All except case 2 had improvement in APACHEII and SOFA score after ECMO initiation. All 5 patients had elevated inflammatory markers of serum ferritin, D-dimer, Lactate dehydrogenase (LDH), C-reactive protein (CRP) which trended down after a few days of ECMO initiation All 5 patients received high dose steroids during their stay in the ICU. Case 4 and 5 passed away after compassionate extubation. Case 1-3 had prolonged hospital course with complication of hospital acquired pneumonia requiring multiple courses of broad-spectrum antibiotics.
Summary
Our observational report of 5 patients reports the use of ECMO in critically ill SARS-CoV-2 with ARDS and difficult to maintain saturation despite mechanical ventilation and proning with recovery for 3 patients. However, given the lack of ECMO centers; this is not a readily available option. Further studies are warranted to investigate the role of ECMO in SARRS-CoV-2 and careful identification of appropriate candidates.
DOI
10.1016/j.healun.2021.01.2133
Volume
40
Issue
Issue 4, Supplement
Publication Date
4-2021
Recommended Citation
Rai, D., Tahir, M., Pandey, R., Kharsa, A., Furqan, F., Thakkar, S., Zaheer, A., Khodjaev, S., Feitell, S., Lee, E., & Parikh, V. (2021). ECMO for Critically Ill COVID-19 with ARDS: A Case Series. The Journal of Heart and Lung Transplantation, 40 (Issue 4, Supplement) https://doi.org/10.1016/j.healun.2021.01.2133