COVID-19 and Extracorporeal Membrane Oxygenation

Gennaro Martucci; Artur Słomka; Steven Eric Lebowitz; Giuseppe Maria Raffa; Pietro Giorgio Malvindi; Valeria Lo Coco; Justyna Swol; Ewa Żekanowska; Roberto Lorusso; Waldemar Wierzba; Piotr Suwalski; Mariusz Kowalewski; Thoracic Research Centre

doi:10.1007/978-3-030-85113-2_10

COVID-19 and Extracorporeal Membrane Oxygenation

Gennaro Martucci, Artur Słomka, Steven Eric Lebowitz, Giuseppe Maria Raffa, Pietro Giorgio Malvindi, Valeria Lo Coco, Justyna Swol, Ewa Żekanowska, Roberto Lorusso, Waldemar Wierzba, Piotr Suwalski, Mariusz Kowalewski, Thoracic Research Centre

Research output: Chapter in Book/Report/Conference proceeding › Chapter › Academic

Abstract

INTRODUCTION: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention.

METHODS: This review summarizes the evidence gathered until June 12, 2020; electronic databases were screened for pertinent reports on coronavirus and V-V ECMO. Search was conducted by two independent investigators; keywords used were SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS).

RESULTS: Many patients with COVID-19 experience moderate symptoms and a relatively quick recovery, but others must be admitted into the intensive care unit due to severe respiratory failure and often must be mechanically ventilated. Further deterioration may require institution of extracorporeal oxygenation. Infection mechanisms may trigger "cytokine storm," an inflammatory disorder notable for multi-organ system failure; together with other metabolic and hematological changes, these amplify the changes pertinent to ECMO therapy, often exaggerating blood coagulation disorders. Thirty-two studies were found describing experiences with ECMO in the treatment of COVID-19. Of 4,912 COVID-19 patients, 2,119 (43%) developed ARDS and 2,086 (42%) were transferred to the ICU; 1,015 patients (21%) were treated with ECMO. While in an overall cohort, observed mortality was 640 (13%), the mortality within ECMO subgroups reached up to 34.6% (range 0-100%).

CONCLUSION: The efficacy of ECMO treatment for COVID-19 is largely dependent on the expertise of the center in ECLS due to the interplay between the changes in hematological and inflammatory modulators associated with both COVID-19 and ECMO. In order to support gas exchange during early infection with SARS-CoV-2, ECMO has a strong rationale for the treatment of the most critically ill patients. Due to the limited resources during a global pandemic, ECMO should be reserved for only the most severe cases of COVID-19.

Original language	English
Title of host publication	Coronavirus Therapeutics
Subtitle of host publication	Volume II
Publisher	Springer, Cham
Pages	173-195
Number of pages	23
Volume	1353
ISBN (Electronic)	978-3-030-85113-2
ISBN (Print)	978-3-030-85112-5
DOIs	https://doi.org/10.1007/978-3-030-85113-2_10
Publication status	Published - 2021

Publication series

Series	Advances in Experimental Medicine and Biology
ISSN	0065-2598

Keywords

COVID-19
Extracorporeal Membrane Oxygenation
Humans
Pandemics
Respiratory Insufficiency/therapy
SARS-CoV-2

Access to Document

10.1007/978-3-030-85113-2_10

Cite this

Martucci, G., Słomka, A., Lebowitz, S. E., Raffa, G. M., Malvindi, P. G., Coco, V. L., Swol, J., Żekanowska, E., Lorusso, R., Wierzba, W., Suwalski, P., Kowalewski, M., & Thoracic Research Centre (2021). COVID-19 and Extracorporeal Membrane Oxygenation. In Coronavirus Therapeutics: Volume II (Vol. 1353, pp. 173-195). Springer, Cham. https://doi.org/10.1007/978-3-030-85113-2_10

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abstract = "INTRODUCTION: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention.METHODS: This review summarizes the evidence gathered until June 12, 2020; electronic databases were screened for pertinent reports on coronavirus and V-V ECMO. Search was conducted by two independent investigators; keywords used were SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS).RESULTS: Many patients with COVID-19 experience moderate symptoms and a relatively quick recovery, but others must be admitted into the intensive care unit due to severe respiratory failure and often must be mechanically ventilated. Further deterioration may require institution of extracorporeal oxygenation. Infection mechanisms may trigger {"}cytokine storm,{"} an inflammatory disorder notable for multi-organ system failure; together with other metabolic and hematological changes, these amplify the changes pertinent to ECMO therapy, often exaggerating blood coagulation disorders. Thirty-two studies were found describing experiences with ECMO in the treatment of COVID-19. Of 4,912 COVID-19 patients, 2,119 (43%) developed ARDS and 2,086 (42%) were transferred to the ICU; 1,015 patients (21%) were treated with ECMO. While in an overall cohort, observed mortality was 640 (13%), the mortality within ECMO subgroups reached up to 34.6% (range 0-100%).CONCLUSION: The efficacy of ECMO treatment for COVID-19 is largely dependent on the expertise of the center in ECLS due to the interplay between the changes in hematological and inflammatory modulators associated with both COVID-19 and ECMO. In order to support gas exchange during early infection with SARS-CoV-2, ECMO has a strong rationale for the treatment of the most critically ill patients. Due to the limited resources during a global pandemic, ECMO should be reserved for only the most severe cases of COVID-19.",

keywords = "COVID-19, Extracorporeal Membrane Oxygenation, Humans, Pandemics, Respiratory Insufficiency/therapy, SARS-CoV-2",

author = "Gennaro Martucci and Artur S{\l}omka and Lebowitz, {Steven Eric} and Raffa, {Giuseppe Maria} and Malvindi, {Pietro Giorgio} and Coco, {Valeria Lo} and Justyna Swol and Ewa {\.Z}ekanowska and Roberto Lorusso and Waldemar Wierzba and Piotr Suwalski and Mariusz Kowalewski and {Thoracic Research Centre}",

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year = "2021",

doi = "10.1007/978-3-030-85113-2_10",

language = "English",

isbn = "978-3-030-85112-5",

volume = "1353",

series = "Advances in Experimental Medicine and Biology",

publisher = "Springer, Cham",

pages = "173--195",

booktitle = "Coronavirus Therapeutics",

address = "Switzerland",

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Martucci, G, Słomka, A, Lebowitz, SE, Raffa, GM, Malvindi, PG, Coco, VL, Swol, J, Żekanowska, E, Lorusso, R, Wierzba, W, Suwalski, P, Kowalewski, M & Thoracic Research Centre 2021, COVID-19 and Extracorporeal Membrane Oxygenation. in Coronavirus Therapeutics: Volume II. vol. 1353, Springer, Cham, Advances in Experimental Medicine and Biology, pp. 173-195. https://doi.org/10.1007/978-3-030-85113-2_10

TY - CHAP

T1 - COVID-19 and Extracorporeal Membrane Oxygenation

AU - Martucci, Gennaro

AU - Słomka, Artur

AU - Lebowitz, Steven Eric

AU - Raffa, Giuseppe Maria

AU - Malvindi, Pietro Giorgio

AU - Coco, Valeria Lo

AU - Swol, Justyna

AU - Żekanowska, Ewa

AU - Lorusso, Roberto

AU - Wierzba, Waldemar

AU - Suwalski, Piotr

AU - Kowalewski, Mariusz

AU - Thoracic Research Centre

PY - 2021

Y1 - 2021

N2 - INTRODUCTION: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention.METHODS: This review summarizes the evidence gathered until June 12, 2020; electronic databases were screened for pertinent reports on coronavirus and V-V ECMO. Search was conducted by two independent investigators; keywords used were SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS).RESULTS: Many patients with COVID-19 experience moderate symptoms and a relatively quick recovery, but others must be admitted into the intensive care unit due to severe respiratory failure and often must be mechanically ventilated. Further deterioration may require institution of extracorporeal oxygenation. Infection mechanisms may trigger "cytokine storm," an inflammatory disorder notable for multi-organ system failure; together with other metabolic and hematological changes, these amplify the changes pertinent to ECMO therapy, often exaggerating blood coagulation disorders. Thirty-two studies were found describing experiences with ECMO in the treatment of COVID-19. Of 4,912 COVID-19 patients, 2,119 (43%) developed ARDS and 2,086 (42%) were transferred to the ICU; 1,015 patients (21%) were treated with ECMO. While in an overall cohort, observed mortality was 640 (13%), the mortality within ECMO subgroups reached up to 34.6% (range 0-100%).CONCLUSION: The efficacy of ECMO treatment for COVID-19 is largely dependent on the expertise of the center in ECLS due to the interplay between the changes in hematological and inflammatory modulators associated with both COVID-19 and ECMO. In order to support gas exchange during early infection with SARS-CoV-2, ECMO has a strong rationale for the treatment of the most critically ill patients. Due to the limited resources during a global pandemic, ECMO should be reserved for only the most severe cases of COVID-19.

AB - INTRODUCTION: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention.METHODS: This review summarizes the evidence gathered until June 12, 2020; electronic databases were screened for pertinent reports on coronavirus and V-V ECMO. Search was conducted by two independent investigators; keywords used were SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS).RESULTS: Many patients with COVID-19 experience moderate symptoms and a relatively quick recovery, but others must be admitted into the intensive care unit due to severe respiratory failure and often must be mechanically ventilated. Further deterioration may require institution of extracorporeal oxygenation. Infection mechanisms may trigger "cytokine storm," an inflammatory disorder notable for multi-organ system failure; together with other metabolic and hematological changes, these amplify the changes pertinent to ECMO therapy, often exaggerating blood coagulation disorders. Thirty-two studies were found describing experiences with ECMO in the treatment of COVID-19. Of 4,912 COVID-19 patients, 2,119 (43%) developed ARDS and 2,086 (42%) were transferred to the ICU; 1,015 patients (21%) were treated with ECMO. While in an overall cohort, observed mortality was 640 (13%), the mortality within ECMO subgroups reached up to 34.6% (range 0-100%).CONCLUSION: The efficacy of ECMO treatment for COVID-19 is largely dependent on the expertise of the center in ECLS due to the interplay between the changes in hematological and inflammatory modulators associated with both COVID-19 and ECMO. In order to support gas exchange during early infection with SARS-CoV-2, ECMO has a strong rationale for the treatment of the most critically ill patients. Due to the limited resources during a global pandemic, ECMO should be reserved for only the most severe cases of COVID-19.

KW - COVID-19

KW - Extracorporeal Membrane Oxygenation

KW - Humans

KW - Pandemics

KW - Respiratory Insufficiency/therapy

KW - SARS-CoV-2

U2 - 10.1007/978-3-030-85113-2_10

DO - 10.1007/978-3-030-85113-2_10

M3 - Chapter

C2 - 35137374

SN - 978-3-030-85112-5

VL - 1353

T3 - Advances in Experimental Medicine and Biology

SP - 173

EP - 195

BT - Coronavirus Therapeutics

PB - Springer, Cham

ER -