key: cord-255016-04tgo216
authors: Yang, Yang; Rali, Aniket S; Inchaustegui, Christian; Alakbarli, Javid; Chatterjee, Subhasis; Herlihy, James P; George, Joggy; Shafii, Alexis; Nair, Ajith; Simpson, Leo
title: Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019-associated Acute Respiratory Distress Syndrome: An Initial US Experience at a High-volume Centre
date: 2020-06-26
journal: Card Fail Rev
DOI: 10.15420/cfr.2020.16
sha: 
doc_id: 255016
cord_uid: 04tgo216

nan

ECMO is a well-established salvage therapy in the treatment of severe refractory ARDS. However, its role in the treatment of COVID-19associated ARDS currently remains unknown. Our report describes the clinical course of COVID-19 patients treated with ECMO at a major highvolume academic medical centre in the US. The key findings of our study are as follows. First, the majority of our patients were successfully weaned off ECMO and continue to show clinical improvement. Second, COVID-19 patients require a prolonged runtime on ECMO prior to being weaned off. Third, the RESP score appears to be a reliable measure in predicting outcomes among COVID-19 patients treated with ECMO. intensive care unit (ICU) patients. As previously mentioned, ECMO renders clinical benefit by allowing 'lung rest' ventilation, and thus minimising the risk of ventilator-induced lung injury in non-complaint lungs. Therefore, it is imperative that ECMO be initiated early on in the disease process before irreversible lung damage ensues. The average number of days on mechanical ventilation prior to ECMO in the Shanghai cohort was just over 10 days, whereas that of our cohort was significantly lower at 3.7 days. 3 The optimal selection of patients most likely to benefit from ECMO also appears to have contributed to the differences in outcomes between our cohort and the Shanghai cohort. In our study, we used the RESP score to calculate the probability of hospital survival and used 40% as our arbitrary cut-off for who was offered treatment with ECMO. On the contrary, ECMO was offered more broadly in the Shanghai cohort to any patient that met any of the following criteria, despite optimal mechanical ventilation: PaO 2 /FiO 2 <50 mmHg for >1 hour; PaO 2 /FiO 2 <80 mmHg for >2 hours; and the existence of uncompensated respiratory acidosis with PH <7.2 for >1 hour. It is crucial to appreciate that ECMO is a resource-intensive, highly-specialised and expensive form of life support, with the potential of significant complications, and thus should only be reserved for truly refractory cases that are most likely to benefit from it. While the RESP score has not been directly validated in the 

APACHE = Acute Physiology and Chronic Health Evaluation

ECMO = extracorporeal membrane oxygenation

SOFA = Sequential Organ Failure Assessment

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Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score