Potential Role for Extracorporeal Membrane Oxygenation Support in Severe COVID-19

Critically ill patients with severe coronavirus disease 2019 (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) therapy, according to the results of a recent study published in the Annals of Thoracic Surgery.

Researchers retrospectively reviewed medical records from patients intubated for severe COVID-19 who received ECMO therapy. ECMO therapy was administered to patients who exhibited arterial partial pressure of oxygen to fraction of inspired oxygen ratio <150 mm Hg and an arterial partial pressure of carbon dioxide >60 mm Hg. Outcomes were evaluated to determine whether ECMO therapy could be clinically beneficial in patients with COVID-19.

Of the 321 patients intubated for COVID-19, 77 were evaluated for ECMO support, and 27 of those patients were ultimately placed on ECMO therapy. Of those 27 patients placed on ECMO therapy, 26 survived. However, only 11 patients to date have been weaned from ECMO support, mechanical ventilation and supplemental oxygen. Two patients have been weaned and decannulated from ECMO, but remain on mechanical ventilation. A total of 7 patients have been discharged from the hospital, while 13 remain on ECMO therapy.

Importantly, there was no identified transmission of COVID-19 to healthcare workers who participated in cannulation. The researchers noted that this was likely the result of the combination of personal protective equipment worn by healthcare workers, the ECMO cannulation strategy that minimized the duration spent in patients’ rooms, and the use of single-bed negative pressure rooms.

“Although limited by its early outcomes, this report demonstrates the life-saving capability of ECMO support in appropriately selected patients with severe COVID-19,” the study authors wrote.

Reference

Kon ZN, Smith DE, Chang SH, et al. Extracorporeal membrane oxygenation support in severe COVID-19. Ann Thorac Surg. Published online July 17, 2020. doi:10.1016/j.athoracsur.2020.07.002