key: cord-321419-ndlw9gk2
authors: Sultan, Ibrahim; Habertheuer, Andreas; Usman, Asad A.; Kilic, Arman; Gnall, Eric; Friscia, Michael E.; Zubkus, Dmitriy; Hirose, Hitoshi; Sanchez, Pablo; Okusanya, Olugbenga; Szeto, Wilson Y.; Gutsche, Jacob
title: The role of extracorporeal life support for patients with COVID‐19: Preliminary results from a statewide experience
date: 2020-04-25
journal: J Card Surg
DOI: 10.1111/jocs.14583
sha: 
doc_id: 321419
cord_uid: ndlw9gk2

OBJECTIVE: There is a paucity of clinical data on critically ill patients with COVID‐19 requiring extracorporeal life support. METHODS: A statewide multi‐institutional collaborative for COVID‐19 patients was utilized to obtain clinical data on the first 10 critically ill COVID‐19 patients who required extracorporeal membrane oxygenation (ECMO). RESULTS: Of the first 10 patients that required ECMO for COVID‐19, the age ranged from 31 to 62 years with the majority (70%) being men. Seven (70%) had comorbidities. The majority (80%) of patients had known sick contact and exposure to COVID‐19 positive patients or traveled to pandemic areas inside the United States within the 2 weeks before symptom onset. None of the patients were healthcare workers. The most common symptoms leading to the presentation were high fever ≥103°F (90%), cough (80%) and dyspnea (70%), followed by fatigue and gastrointestinal symptoms (both 30%), myalgia, loss of taste, pleuritic chest pain, and confusion (all 10%). All patients had bilateral infiltrates on chest X‐rays suggestive of interstitial viral pneumonia. All patients were cannulated in the venovenous configuration. Two (20%) patients were successfully liberated from ECMO support after 7 and 10 days, respectively, and one (10%) patient is currently on a weaning course. One patient (10%) died after 9 days on ECMO from multiorgan dysfunction. CONCLUSIONS: These preliminary multi‐institutional data from a statewide collaborative offer insight into the clinical characteristics of the first 10 patients requiring ECMO for COVID‐19 and their initial clinical course. Greater morbidity and mortality is likely to be seen in these critically ill patients with longer follow‐up.

All patients were on venovenous support, the majority had bicaval configuration. Of note, 40% of patients received the Ebola antiviral remdesivir and 100% received hydroxychloroquine, a substance effective in the treatment of malaria with immunosuppressive and antiviral properties. In addition, 30% of patients received IL-6 inhibitors for cytokine storm. With this maximal effort, one mortality occurred, two patients were successfully weaned from ECMO and one patient is on a weaning course.

with the primary goal of using lung-protective strategy while oxygenating and ventilating adequately. Prone positioning was utilized aggressively before the institution of ECMO unless rapid deterioration occurred at which point ECMO was initiated. 5 Providing complex therapies such as rescue ECMO during outbreaks of infectious diseases has unique challenges. 4 ECMO is resource-intensive, a scarce resource in times of high demand 4 highly specialized and expensive with the potential for serious complications such as hemorrhage, thrombosis, and propagation of infection. 6 Apart from infectious disease outbreaks, ECMO is an evidence-based service, 4 Because of the rapidly evolving nature of the disease, no comprehensive report exists in the context of COVID-19. Such data, when reported, would be critical to guide critical care management and the allocation of ICU resources and ECMO infrastructure. As the world is bracing for the COVID-19 outbreak preparation should include the provision of ECMO and our report is an attempt at characterizing this novel patient population to aid in the establishment of selection criteria.

Our report has multiple limitations. First, this is a case series in one state that may not represent what is seen in most of North America. Second, since the COVID-19 pandemic has clustered in certain areas when compared to others, ECMO may not be utilized as liberally in highly affected areas with limited resources and personnel. 10 Third, these data present an initial experience and do not reflect the complete clinical course of most of these patients.

The authors declare that there are no conflict of interests. 

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The role of extracorporeal life support for patients with COVID-19: Preliminary results from a statewide experience