Veno-venous Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019: A Case Series

Zhang, Joe; Merrick, Blair; Correa, Genex L.; Camporota, Luigi; Retter, Andrew; Doyle, Andrew; Glover, Guy W.; Sherren, Peter B.; Tricklebank, Stephen J.; Agarwal, Sangita; Lams, Boris E.; Barrett, Nicholas A.; Ioannou, Nicholas; Edgeworth, Jonathan; Meadows, Christopher I.S.

RATIONALE: The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from Coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management, and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume UK centre. METHODS: Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3rd March and 2nd May 2020. Clinical management is described. Data are reported for survivors and non-survivors. RESULTS: We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years [IQR 35.5–52.5], 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days [IQR 11–17.5]. All patients underwent computed tomography imaging, finding extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days [IQR 8–20]. Fourteen patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Non-survivors had significantly higher d-dimer (38.2 versus 9.5 mg·L(−1), Fibrinogen Equivalent Units; p=0.035) and creatinine (169 versus 73 umol·L(−1); p=0.022) at commencement of ECMO. CONCLUSIONS: Our data supports the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation, and intravascular thrombosis.