Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai, China

Abstract

Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.

Figure 1.

A coronavirus disease 2019 patient is supported with extracorporeal membrane oxygenation and mechanical ventilation support.

Figure 2.

Flowchart of ECMO weaning protocol in COVID-19 patients. ABG, arterial blood gas; COVID-19, coronavirus disease 2019; CT, computed tomography; ECMO, extracorporeal membrane oxygenation; EIT, electrical impedance tomography; FiO₂, fractional of inspired oxygen; HCT, hematocrit; PaCO₂, partial pressure of carbon dioxide; PaO₂, partial pressure of oxygen; RR, respiratory rate.