Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Mohammed S Alshahrani¹, Anees Sindi², Fayez Alshamsi³, Awad Al-Omari⁴, Mohamed El Tahan⁵, Bayan Alahmadi⁶, Ahmed Zein⁷, Naif Khatani⁶, Fahad Al-Hameed^{8

9}, Sultan Alamri¹⁰, Mohammed Abdelzaher¹¹, Amenah Alghamdi¹², Faisal Alfousan¹², Adel Tash¹³, Wail Tashkandi¹⁴, Rajaa Alraddadi¹⁵, Kim Lewis¹⁶, Mohammed Badawee¹⁷, Yaseen M Arabi¹⁸, Eddy Fan¹⁹, Waleed Alhazzani²⁰

Affiliations

¹ Department of Emergency and Critical Care, King Fahad Hospital of the University-Dammam University, PO Box 40236, Al Khobar, 31952, Saudi Arabia. msshahrani@uod.edu.sa.
² Department of Medicine/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia.
³ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
⁴ Medical Director of Critical Care, Dr. Suliman Al-Habib Group, AlFaisal University, Riyadh, Saudi Arabia.
⁵ Department of Anesthesiology, Dammam University, Dammam, Saudi Arabia.
⁶ King Abdulaziz University, Jeddah, Saudi Arabia.
⁷ Department of ICU, King Fahad Hospital, Jeddah, Saudi Arabia.
⁸ King Abdulaziz Medical City, NGHA, Jeddah, Saudi Arabia.
⁹ Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
¹⁰ Department of ICU National Hospital, Internal Medicine and Critical Care, Riyadh, Saudi Arabia.
¹¹ Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt.
¹² Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
¹³ Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia.
¹⁴ Department of Surgery/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia.
¹⁵ Community Medicine Department, Ministry of Health, Jeddah, Saudi Arabia.
¹⁶ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada.
¹⁷ Department of Critical Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
¹⁸ King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
²⁰ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.

PMID: 29330690
PMCID: PMC5768582
DOI: 10.1186/s13613-017-0350-x

Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Mohammed S Alshahrani et al. Ann Intensive Care. 2018.

. 2018 Jan 10;8(1):3.

doi: 10.1186/s13613-017-0350-x.

Authors

Affiliations

¹ Department of Emergency and Critical Care, King Fahad Hospital of the University-Dammam University, PO Box 40236, Al Khobar, 31952, Saudi Arabia. msshahrani@uod.edu.sa.
² Department of Medicine/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia.
³ Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.
⁴ Medical Director of Critical Care, Dr. Suliman Al-Habib Group, AlFaisal University, Riyadh, Saudi Arabia.
⁵ Department of Anesthesiology, Dammam University, Dammam, Saudi Arabia.
⁶ King Abdulaziz University, Jeddah, Saudi Arabia.
⁷ Department of ICU, King Fahad Hospital, Jeddah, Saudi Arabia.
⁸ King Abdulaziz Medical City, NGHA, Jeddah, Saudi Arabia.
⁹ Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
¹⁰ Department of ICU National Hospital, Internal Medicine and Critical Care, Riyadh, Saudi Arabia.
¹¹ Critical Care Medicine Department, Cairo University Hospitals, Cairo, Egypt.
¹² Department of Internal Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
¹³ Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia.
¹⁴ Department of Surgery/Intensive Care, King Abdulaziz University, Jeddah, Saudi Arabia.
¹⁵ Community Medicine Department, Ministry of Health, Jeddah, Saudi Arabia.
¹⁶ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Canada.
¹⁷ Department of Critical Care, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
¹⁸ King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
¹⁹ Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
²⁰ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.

PMID: 29330690
PMCID: PMC5768582
DOI: 10.1186/s13613-017-0350-x

Abstract

Background: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies.

Methods: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay.

Results: Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05).

Conclusions: ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.

Keywords: Coronavirus infection; Extracorporeal membrane oxygenation; Rescue therapy; Signs and symptoms respiratory.

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Figures

**Fig. 1**
Kaplan–Meier survival curves of the two studied groups. P value for log-rank test is shown

See this image and copyright information in PMC

Comment in

Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): Pooled analysis of early reports.
Henry BM, Lippi G. Henry BM, et al. J Crit Care. 2020 Aug;58:27-28. doi: 10.1016/j.jcrc.2020.03.011. Epub 2020 Apr 1. J Crit Care. 2020. PMID: 32279018 Free PMC article. No abstract available.

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Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Affiliations

Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus

Authors

Affiliations

Abstract

Figures

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