A Single Tertiary Center Outcomes on Cannulation Strategies and Extracorporeal Membrane Oxygenation in the Treatment of Respiratory Failure During COVID- 19 Infection

Abstract

Aim:Extracorporeal membrane oxygenation (ECMO) is an important option for the management of severe acute respiratory distress syndrome (ARDS) in Coronavirus disease-2019 (COVID-19) cases. We aimed to present our experiences of ECMO in patients with respiratory failure secondary to COVID-19.Methods:Data of 22 consecutive COVID-19 patients with severe respiratory failure whom were supported with ECMO were collected from computer-based hospital software retrospectively. Patients were treated in a single medical center between April 23, 2020 and February 14, 2021. Patients were analyzed from the points of laboratory and inflammatory markers, ventilation and ECMO features.Results:The ages of patients were between 30 and 69 years (mean age: 56.3±10.63). All patients were under maximum ventilator support, with the prone position. All patients had elevated levels of inflammatory indicators as D-dimer and ferritin. The mean level of ferritin was 1,564±1,611 ng/mL. D-dimer value was maximum 10.000 mg/mL (mean: 5,215±3,104), CRP increased to 177 mg/L (mean: 159±71). Percent of lymphocytes decreased as low as 2% (mean: 4.16±2.10). The mean duration of veno-arterial (VA) ECMO was 1.6±0.94 days whereas, for veno-venous (VV) ECMO, it was 10.05±5 days. VA ECMO was decided due to cardiovascular collapse. Four patients with VA ECMO survived a maximum of 3 days. Four of (22.22%) of 18 VV ECMO supported patient’s blood gas values were at normal ranges, 3 of them needed tracheostomy, and all of could be discharged from the hospital.Conclusion:Although, ECMO support for severe respiratory failure patients with COVID-19 is more challenging than regular ECMO applications, especially VV ECMO usage should be reminded as a remedy.

Keywords

• covid-19
• extracorporeal membrane oxygenation
• multi-organ failure