key: cord-307609-nnvco1de
authors: Haye, Guillaume; Fourdrain, Alex; Abou-Arab, Osama; Berna, Pascal; Mahjoub, Yazine
title: COVID-19 outbreak in France: Setup and activities of a mobile Extra Corporeal Membrane Oxygenation (ECMO) team during the first 3 weeks
date: 2020-05-08
journal: J Cardiothorac Vasc Anesth
DOI: 10.1053/j.jvca.2020.05.004
sha: 
doc_id: 307609
cord_uid: nnvco1de

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The SARS-COV-2 related disease is mainly characterized by respiratory manifestations with approximately 15 to 30% of patients developing ARDS 1 . The World Health Organization guidelines recommended to proceed to veno-venous Extracorporeal membrane oxygenation (ECMO) for eligible patient with COVID-19 related ARDS only in centres with "sufficient cases volume to ensure clinical expertise" 2 . The Amiens ECMO center received many calls during the first weeks from several hospitals of the region for refractory ARDS secondary to COVID-19. Decision was rapidly made to set up a mobile ECMO team in order to start ECMO treatment on sites.

Located in the north of France, Picardy region has a population of 1.925 million inhabitants on a 19 399 km² territory. A network of 29 general hospitals is located on this regional territory, with 128 intensive care units (ICU) beds. The only ICU of Picardy with the ability to manage ECMO is the Cardiac Thoracic Vascular and Respiratory Unit of Amiens University medical Centre. The unit initiated about 60 ECMO treatments every year (one third of venovenous ECMO) for more than 10 years.

The outbreak occurred in Picardy at the end of February 2020 resulting in a rapid tension on ICU beds. Calls from peripheral centres for ECMO need increased rapidly. In one month (March 2020), 676 patients were admitted in the hospitals of the region for COVID-19 related disease. Among them 156 patients required ICU admission ( admission rate: 23.1%) 3 .

Clustering infected patients requiring ECMO within an expert centre was necessary in order to insure adequate care and resource management.

A unique phone number was publicized to all ICUs of the region in order to centralize request for ECMO. An on-call ECMO team member was able to give advice and to evaluate the need for ECMO. All ECMO team members were educated on the management and the eligibility criteria for ECMO initiation. The mobile ECMO team was composed by a specialized intensivist, a thoracic surgeon and a trained perfusion nurse. A roster was started in order to make the team available 24 hours a day and 7 days a week. Decision to initiate ECMO treatment was always a multi-consultant decision. The ECMO team was able to reach any hospital of the region in less than 45 minutes (by road or by air depending on the weather).

The ECMO team decided on arrival to retrieve the patient on conventional ventilation or to initiate ECMO on site and transfer the patient on ECMO support. Patients under ECMO were admitted in a specialized ICU with trained staff. The Cardiohelp® (Maquet Medical system, Wayne, USA) ECMO device was used for each transport because of its compact and light design (10kg).

During March 2020, 22 calls were received at our ECMO centre. The ECMO team initiated 8 veno-venous ECMO treatments on site and transferred 3 patients on conventional ventilation. For all patients, the drainage cannula (size of 25 Fr) was inserted in the right femoral vein and the return cannula (size of 19 Fr) was inserted in the right jugular vein.

Heparin treatment was started after the procedure with continuous perfusion of unfractioned heparin for an anti-XA level target of 0,2-0,4 UI.ml -1 . Despite this treatment, canula thrombosis occurred for 2 patients leading to procedure failure and death of the patients. This is probably due to the high inflammatory state that increases the risk of thrombosis as suggested in some reports 4 

Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in

Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance

COVID-19 Respiratory Failure: Targeting Inflammation on VV-ECMO Support

Extracorporeal Membrane Oxygenation for Coronavirus Disease

Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in COVID-19: Experience with 32 patients

First successful treatment of COVID-19 induced refractory cardiogenic plus vasoplegic shock by combination of pVAD and ECMO -a case report

The authors thanks all the nursing and perfusion staff for their commitment.

The authors have no conflict of interest to declare

Only institutional funds were used.