ECMO may offer sickest COVID patients chance for 'exceptional survival',
study finds
Patient selection and management strategies help improve outcomes
Date:
March 10, 2022
Source:
The Society of Thoracic Surgeons
Summary:
Some patients with severe COVID-19 who are treated with
extracorporeal membrane oxygenation (ECMO) may experience
significant lung recovery and return to normal lives with
'meaningful' long-term outcomes, according to research.
FULL STORY ==========================================================================
Some patients with severe COVID-19 who are treated with extracorporeal
membrane oxygenation (ECMO) may experience significant lung recovery and
return to normal lives with "meaningful" long-term outcomes, according
to research published online today in The Annals of Thoracic Surgery.
==========================================================================
"Our work suggests that with appropriately selected patients and
aggressive management strategies, the use of ECMO support for severe
COVID-19 can result in exceptional early survival, and these patients
who leave the hospital without the need for oxygen therapy are very
likely to remain alive and well 1 year later," said Deane E. Smith, MD,
from NYU Langone Health in New York City, New York.
Dr. Smith and colleagues identified 415 patients who were admitted
to the intensive care unit (ICU) of NYU Langone Health from March 10,
2020, through May 1, 2020, with confirmed COVID-19 infection. Of these patients, 30 (7.2%) received venovenous (VV) ECMO -- an advanced life
support machine that takes over the function of damaged lungs.
Most of the ICU patients -- 323 (77.8%) -- were intubated for mechanical ventilatory support. However, according to Dr. Smith, the ventilator may
damage the lungs further and "create a vicious cycle" for patients with
severe lung disease or damage who are intubated. In some cases, VV-ECMO
may result in decreased support from the ventilator, minimizing damage to
the lungs and allowing them to begin healing. Thus, 80 patients (19.3%)
were evaluated for VV-ECMO, with 30 (7.2%) eventually receiving it.
"These patients received ECMO for severe COVID-19 during the height of
the pandemic in New York City -- at a time when very little was known
about the likelihood for success," said Dr. Smith.
The researchers reported that 28 patients (93.3%) survived VV-ECMO. These patients were hospitalized for a median of 45 days and supported on
VV-ECMO for a median of 19 days. Importantly, 27 patients (90%) were
discharged home or to acute rehabilitation. No patients left the hospital dependent on a ventilator, and only one patient required supplemental
oxygen.
========================================================================== According to Dr. Smith, patient selection was a significant factor that impacted the success of VV ECMO. The selection philosophy was that this
was not a "bailout" or salvage therapy to be employed in the absence of
other options.
Instead, VV-ECMO was offered to patients believed to have a reasonable
chance for survival with this support.
"We were struck by the number of young, otherwise healthy patients who
were dying from the disease. Because of this, we felt patient selection
was very important," he said.
Dr. Smith further explained that the decision to offer ECMO support
also was impacted by the severity of lung disease and potential for
survival. "If there was one theme throughout our experience, it was
how we would define success. We did not feel that using ECMO to have
patients survive simply to go to long-term facilities debilitated and vent-dependent was successful, or not as successful as it could be. In
other words, we began with the end in mind. If we were going to offer
patients ECMO for severe COVID-19, it was because we believed that we
could protect the lungs and allow patients to return to their normal
lives at the end of it." While patient selection was important, a
standardized approach to patient management and protecting the lungs
was equally valuable. This included: not deviating from lung protective ventilation strategies, early tracheostomy (an opening surgically
created through the neck into the trachea) and frequent bronchoscopy
(a procedure to look directly at the airways in the lungs using a thin,
lighted tube), treatment of coinfection, and standardization of an anticoagulation regimen (to help prevent blood clots). In addition,
to help improve oxygenation, the team frequently positioned patients
who were not recovering as quickly as expected on their abdomens, also
known as "proning." "It's worth noting that most of these things such as bronchoscopy or tracheostomy were not considered safe in patients with
COVID-19 at the start of the pandemic," said Dr. Smith. "Our team was aggressive with these interventions much earlier than most hospitals." Importantly, at a median follow-up of 10.8 months since the patients
were treated with VV-ECMO, survival was 86.7%, including one patient who underwent lung transplantation. A 6-minute walk test was performed in 16 patients (59.3%) with a median value of 350 meters, which the researchers called "encouraging." "We learned that lung recovery was actually
possible. When the pandemic started, that was not clear," said Dr. Smith.
========================================================================== Story Source: Materials provided by
The_Society_of_Thoracic_Surgeons. Note: Content may be edited for style
and length.
========================================================================== Journal Reference:
1. Deane E. Smith, Stephanie H. Chang, Travis C. Geraci, Les James,
Zachary
N. Kon, Julius A. Carillo, Marjan Alimi, David Williams, Joshua A.
Scheinerman, Robert J. Cerfolio, Eugene A. Grossi, Nader Moazami,
Aubrey C. Galloway. One-Year Outcomes With Venovenous Extracorporeal
Membrane Oxygenation Support for Severe COVID-19. The Annals of
Thoracic Surgery, 2022; DOI: 10.1016/j.athoracsur.2022.01.003 ==========================================================================
Link to news story:
https://www.sciencedaily.com/releases/2022/03/220310143727.htm
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