Mechanical circulatory support in coronavirus disease-2019-positive patients with severe respiratory failure. (5th April 2021)

• Record Type: Journal Article
• Authors: Natanov, Ruslan; Wiesner, Olaf; Haverich, Axel; Kühn, Christian
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 33:Number 3(2021)
• Page Start: 489
• Page End: 493
• Publication Date: 2021-04-05
• Subjects: ECMO -- COVID-19 -- Mechanical ventilation -- ARDS -- Immune system; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab087
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: Treatment of severe acute respiratory distress syndrome (ARDS) induced by severe acute respiratory syndrome coronavirus 2 has been heavily debated. Our goal was to describe our findings in patients with severe ARDS due to severe coronavirus disease 2019 (sCOVID-19) treated with venovenous extracorporeal membrane oxygenation (vv-ECMO). METHODS: We retrospectively examined all patients treated with vv-ECMO for severe ARDS due to acute respiratory syndrome coronavirus 2. RESULTS: In total, 13 patients were treated with vv-ECMO in our medical centre. The mean patient age was 48.1 years. Most patients were obese (69%) and male (85%). All patients were mechanically ventilated before ECMO. The mean time from intubation to proning was 16.6 h; the time from start of prone therapy to vv-ECMO implantation was 155.1 h. The mean total ECMO run time was 358 h. Significant reduction of positive end-expiratory pressure ( P = 0.02), peak pressure ( P = 0.001) and minute volume ( P = 0.03) could be achieved after implantation of vv-ECMO. All patients showed an inflammatory response. Overall mortality was 30.7%: 1 patient died of mesenteric ischaemia; 3 patients died of multiple organ failure. A worse prognosis was seen in patients with highly elevated concentrations of interleukin-6. CONCLUSIONS: The use of vv-ECMO in patients with sCOVID-19-induced ARDS is safe and associated with improved respiratory ventilation settings. The rate of immune system involvement plays a pivotal role in the development and outcome of sCOVID-19.