TY - JOUR
T1 - Extracorporeal Membrane Oxygenation for COVID-19 Respiratory Distress Syndrome
T2 - An Italian Society for Cardiac Surgery Report
AU - Loforte, Antonio
AU - Di Mauro, Michele
AU - Pellegrini, Carlo
AU - Monterosso, Christian
AU - Pelenghi, Stefano
AU - Degani, Antonella
AU - Rinaldi, Mauro
AU - Stura, Erik Cura
AU - Sales, Gabriele
AU - Montrucchio, Giorgia
AU - Mangino, Domenico
AU - Terrini, Alberto
AU - Pacini, Davide
AU - Affronti, Alessandro
AU - Tarzia, Vincenzo
AU - Bottio, Tomaso
AU - Pantaleo, Antonio
AU - Donatelli, Francesco
AU - Miceli, Antonio
AU - Santini, Francesco
AU - Salsano, Antonio
AU - Colli, Andrea
AU - Ravenni, Giacomo
AU - Montalto, Andrea
AU - Musumeci, Francesco
AU - Salvador, Loris
AU - Gerosa, Gino
AU - Parolari, Alessandro
AU - Piciche, Marco
PY - 2021/4/1
Y1 - 2021/4/1
N2 - An increased need of extracorporeal membrane oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of the Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1 and September 15, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n = 26). Main causes of death were multiple organ failure (n = 14, 31.1%) and sepsis (n = 11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p = 0.048), elevated pre-ECMO C-reactive protein level (p = 0.048), higher positive end-expiratory pressure on ventilator (p = 0.036) and lower lung compliance (p = 0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.
AB - An increased need of extracorporeal membrane oxygenation (ECMO) support is going to become evident as treatment of SARS-CoV-2 respiratory distress syndrome. This is the first report of the Italian Society for Cardiac Surgery (SICCH) on preliminary experience with COVID-19 patients receiving ECMO support. Data from 12 Italian hospitals participating in SICCH were retrospectively analyzed. Between March 1 and September 15, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous ECMO in four (6%). Five patients required VA ECMO after initial weaning from VV ECMO. Thirty (42.2%) patients were weaned from ECMO, while 39 (54.9%) died on ECMO, and six (8.5%) died after ECMO removal. Overall hospital survival was 36.6% (n = 26). Main causes of death were multiple organ failure (n = 14, 31.1%) and sepsis (n = 11, 24.4%). On multivariable analysis, predictors of death while on ECMO support were older age (p = 0.048), elevated pre-ECMO C-reactive protein level (p = 0.048), higher positive end-expiratory pressure on ventilator (p = 0.036) and lower lung compliance (p = 0.032). If the conservative treatment is not effective, ECMO support might be considered as life-saving rescue therapy for COVID-19 refractory respiratory failure. However warm caution and thoughtful approaches for timely detection and treatment should be taken for such a delicate patients population.
KW - COVID-19
KW - pandemic
KW - acute respiratory distress syndrome
KW - extracorporeal membrane oxygenation
KW - Italy
U2 - 10.1097/MAT.0000000000001399
DO - 10.1097/MAT.0000000000001399
M3 - Article
SN - 1058-2916
VL - 67
SP - 385
EP - 391
JO - Asaio Journal
JF - Asaio Journal
IS - 4
ER -