TY - JOUR
T1 - Effects of adding the second drainage cannula in severely hypoxemic patients supported with VV ECMO due to COVID-19-associated ARDS
AU - Szuldrzynski, Konstanty
AU - Kowalewski, Mariusz
AU - Jankowski, Milosz
AU - Staromlynski, Jakub
AU - Prokop, Joanna
AU - Pasierski, Michal
AU - Chudzinski, Kamil
AU - Drobinski, Dominik
AU - Martucci, Gennaro
AU - Lorusso, Roberto
AU - Wierzba, Waldemar
AU - Zaczynski, Artur
AU - Krol, Zbigniew
AU - Suwalski, Piotr
PY - 2023/10
Y1 - 2023/10
N2 - Background: Extracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 infection. While veno-venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes.Methods: We conducted an observational retrospective study based on a single-center institutional registry including all consecutive cases of COVID-19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed.Results: Of 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 +/- 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 +/- 0.44 to 5.94 +/- 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 +/- 258 to 3673 +/- 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully.Conclusions: The use of an additional drainage cannula in severe ARDS associated with COVID-19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung-protective ventilation and poor survival.
AB - Background: Extracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 infection. While veno-venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes.Methods: We conducted an observational retrospective study based on a single-center institutional registry including all consecutive cases of COVID-19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed.Results: Of 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 +/- 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 +/- 0.44 to 5.94 +/- 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 +/- 258 to 3673 +/- 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully.Conclusions: The use of an additional drainage cannula in severe ARDS associated with COVID-19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung-protective ventilation and poor survival.
KW - additional venous cannula
KW - conversion
KW - COVID-19
KW - drainage cannula
KW - ECMO
KW - EXTRACORPOREAL MEMBRANE-OXYGENATION
KW - BLOOD-CELL TRANSFUSIONS
KW - LIFE-SUPPORT
KW - DETERMINANTS
U2 - 10.1111/aor.14591
DO - 10.1111/aor.14591
M3 - Article
C2 - 37218216
SN - 0160-564X
VL - 47
SP - 1622
EP - 1631
JO - Artificial Organs
JF - Artificial Organs
IS - 10
ER -