ECMO Support and Operator Safety in the Context of COVID-19 Outbreak: A Regional Center Experience

Abstract

Since the beginning of the COVID-19 emergency, the referral Intensive Care Unit for the Extracorporeal Membrane Oxygenation (ECMO) support of Piedmont Region (Italy), in cooperation with infectious disease specialists, perfusionists and cardiac surgeons, developed a protocol to guarantee operator safety during invasive procedures, among which the ECMO positioning or inter-hospital transport. The use of powered air-purifying respirators, filtering facepiece particles (FFP) 2-3 masks, protective suits, disposable sterile surgical gowns, and two pairs of sterile gloves as a part of a protocol seemed effective and feasible for trained healthcare workers and allow all the complex activities connected with the positioning of the ECMO support to be completed effectively. The simulation training on donning and doffing procedures and the presence of a dedicated team member to verify the compliance with the safety procedure effectively reassured operators and likely reduced the risk of self-contamination. From 1 March to 31 December 2020, we used the procedure in 35 severe acute respiratory distress syndrome (ARDS) patients and one acute respiratory failure caused by neoplastic total tracheal obstruction, all positive to COVID-19, to be connected to veno-venous ECMO in peripheral hospitals and centralized for ECMO management. This preliminary experience seems to confirm that the use of ECMO during COVID-19 outbreaks is feasible and the risks associated with its positioning and management are sustainable for the health-care workers and safe for patients.

Keywords: COVID-19; extracorporeal membrane oxygenation; pandemic; personal protective equipment; severe acute respiratory syndrome coronavirus 2.

Figure 1

Enhanced droplet/airborne Personal Protective Equipment incorporating use of Powered Air Purifying Respirator (PAPR) for ECMO positioning. The healthcare staff wear impermeable disposable coveralls with impermeable overshoes and special waterproof hoods and surgical masks, which are worn over the headgear and FFP2-3 mask (A). The PAPR system is worn over the hood of the suit and PAPR blower unit, made by plastic helmet (B) with battery on belt (C) and covered by a hood with a filter material (D). Completed PPE includes a sterile gown and sterile gloves (E).