Extracorporeal Membrane Oxygenation for COVID-19 respiratory distress syndrome: an Italian Society for Cardiac Surgery Report

Antonio Loforte, Michele Di Mauro, Carlo Pellegrini, Christian Monterosso, Stefano Pelenghi, Antonella Degani, Mauro Rinaldi, Erik Cura Stura, Gabriele Sales, Giorgia Montrucchio, Domenico Mangino, Alberto Terrini, Davide Pacini, Alessandro Affronti, Vincenzo Tarzia, Tomaso Bottio, Antonio Pantaleo, Francesco Donatelli, Antonio Miceli, Francesco Santini, Antonio Salsano, Andrea Colli, Giacomo Ravenni, Andrea Montalto, Francesco Musumeci, Loris Salvador, Gino Gerosa, Alessandro Parolari, Marco Picichè
ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs 2021 January 18
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 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 1st and September 15th, 2020, a veno-venous (VV) ECMO system was installed in 67 patients (94%) and a veno-arterio-venous (VAV) 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.

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