ECMO in COVID-19
Last updated 3/24/2020
Overview:
ELSO is providing this website as a resource for centers who may be called on to manage COVID-19 patients. As this is an emerging infectious disease, the scientific data is constantly evolving. The contents of this page will change rapidly as new information develops. For real time updates, please follow ELSO’s social media accounts at Twitter (@ELSOOrg and @ECMOed) and Facebook (https://www.facebook.com/ELSO.Org) as well as the ECMOed COVID-19 page (https://ecmoed.blog/category/2019ncov-2/)
ECMO in COVID-19 infection
The WHO is distributing an Interim Guidance document for the
"Clinical management of severe acute respiratory infection when Novel coronavirus (nCoV) infection is suspected. (https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected)" The WHO guidance document includes a statement to "consider referral patients with refractory hypoxemia despite lung-protective ventilation in settings with access to expertise in ECLS." Similarly, the United States Center for Disease Control provides interim guidance (https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html) for clinical management of COVID-19 patients with and without acute respiratory distress syndrome (ARDS). Where ECLS expertise is available, ECLS should be considered according to the standard management algorithm for ARDS in supporting patients with viral lower respiratory tract infection. However, clearly, at this time, there is little worldwide experience with using ECLS to support COVID-19 patients. ELSO leaders have discussed the potential role of ECMO for COVID-19 patients in a recent Journal of the American Medical Association Viewpoint (https://jamanetwork.com/journals/jama/articlepdf/2761778/jama_maclaren_2020_vp_200024.pdf). ELSO will continue to collect data through our member centers through the ELSO Registry and provide recommendations as additional information becomes available.
Reporting COVID-19 Cases into the ELSO Registry
Confirmed COVID-19 cases should utilize the ICD-10 emergency code U07.1, 2019-nCoV acute respiratory disease as the primary diagnosis. In an effort to better understand the impact of COVID-19 on ECMO we have also added a question asking if a patient has COVID-19.
There are 4 response options:
COVID Cases on ECMO in the ELSO Registry:
COVID-19 suspected or confirmed -
COVID-19 confirmed -
ECMO Related COVID-19 Research
ExtraCorporeal Membrane Oxygenation for 2019 novel Coronavirus Acute Respiratory Disease (ECMOCard) is a prospective/retrospective multi-center short period incidence observational study of intensive care unit patients with COVID-19. This study is being led by Asia Pacific ELSO leaders, Gianluigi Li Bassi, Jacky Suen, and John Fraser in collaboration with ELSO, ISARIC (https://isaric.tghn.org/), SPRINT-SARI (https://isaric.tghn.org/sprint-sari/), and > 30 worldwide centers.
The study’s Aim and Objectives are to describe clinical features, the severity of pulmonary dysfunction, ECMO technical characteristics, duration of ECMO, complications, and survival of patients with COVID-19. The study period will comprise a 28-day cohort study in which patients with confirmed COVID-19 infection, who are newly admitted to the hospitals/ICUs at participating sites, will be included in the study. The study will be conducted in all collaborating hospitals/ICU-based research networks globally. All clinical information and sample data will only be recorded if taken as part of the routine clinical practice at each site and only fully anonymized and de-identified data will be submitted centrally.
For additional information or to participate in the study, please contact covid19@elso.org.
Caregivers Resources
https://www.cstsonline.org/assets/media/documents/CSTS_FS_Sustaining_Well_Being_Healthcare_Personnel_during.pdf.pdf
Podcast
COVID-19 Experience in Italy
Listen to Italian COVID19 experience from Pediatrica intensiva on Apple Podcasts.
https://podcasts.apple.com/us/podcast/pediatrica-intensiva/id1502496721?i=1000468384785
Webinar:
Preparing to support #COVID19 patients on #ECMO: first ELSO webinar dedicated to the role of extracorporeal support in patients with #SARSCoV2 infection, speakers:
Dr. Ram Ramanathan
Dr. Kiran Shekar
Dr. Michael Matthay
Scientific Literature regarding ECMO Use for COVID-19:
ECMO Related
Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) - https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf Published February 29, 2020.
Editor note: Comprehensive summary of the China response. Comments regarding ECMO use in the paper: “The application of intubation/invasive ventilation and ECMO in critically ill patients can improve survival. The Joint Mission Team was told of ECMO use in four patients at one hospital with one death and three who appeared to be improving. Clearly, though ECMO is very resource consumptive, any health system would need to carefully weigh the benefits.”
Min L, Gu S, Wu X, et al. Extracorporeal membrane oxygenation support in 2019 novel coronavirus disease: indications, timing, and implementation. Chinese Medical Journal. Published February 28, 2020. doi: 10.1097/CM9.0000000000000778.
Editor note: A guide with review of previous literature of ECMO patients, and clinical/technical points on cannulating while keeping staff safe. No patient level data.
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respiratory Medicine. Published February 24, 2020. doi: 10.1016/S2213-2600(20)30079-5. December-January Wuhan report. Editor note: Six ECMO patients – 1/6 survival.
MacLaren G, Fisher D, Brodie D. Preparing for the Most Critically Ill Patients With COVID-19The Potential Role of Extracorporeal Membrane Oxygenation. JAMA. Published online February 19, 2020. doi: 10.1001/jama.2020.2342
Editor note: Viewpoint in JAMA from ELSO leaders about the use of ECMO during the pandemic. “ECMO is not a therapy to be rushed to the frontline when all resources are stretched in a pandemic.”
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. Published Feburary 7, 2020. JAMA 2020. doi: 10.1001/jama.2020.1585. Editor note: Follow-up report of 138 patients from Wuhan. Four ECMO patients, no outcomes described.
Ronco C, Navalesi P, Vincent JL. Coronavirus epidemic: preparing for extracorporeal organ support in intensive care. Lancet Respiratory Medicine. Published February 6, 2020. doi: 10.1016/S2213-2600(20)30060-6
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-513. doi: 10.1016/S0140-6736(20)30211-7. Follow-up report of 99 patients from Wuhan. Editor note: Three ECMO patients, one described and died, no report on outcome of the other two.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.doi: 10.1016/S0140-6736(20)30183-5
Editor note: Initial report of 41 total patients from Wuhan. Two ECMO patients, no survival data given.
Clinical Management
Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA. Published online March 11, 2020. doi: 10.1001/jama.2020.3633
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. Published March 11, 2020. doi: 10.1016/S0140-6736(20)30566-3
Namendys-Silva SA. Respiratory support for patients with COVID-19 infection. Lancet Respiratory Medicine. Published March 05, 2020. doi: 10.1016/S2213-2600(20)30110-7
DelRio C, Nalani PN. COVID-19—New Insights on a Rapidly Changing Epidemic. JAMA. Published online February 28, 2020. doi: 10.1001/jama.2020.3072
Team Related
Adams JG, Walls RM. Supporting the Health Care Workforce During the COVID-19 Global Epidemic JAMA. Published online March 12, 2020. doi: 10.1001/jama.2020.3972.
Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. Published February 26, 2020. doi: 10.1016/S0140-6736(20)30460-8
Epidemiology
Ghinai I, McPherson TD, Hunter JC, et al. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet. Published March 13, 2020. doi: 10.1016/S0140-6736(20)30607-3
Chinazzi M, Davis JT, Ajelli M, et al. The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science. Published March 6, 2020. doi: 10.1126/science.aba9757
Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. Published March 5, 2020. N Engl J Med 2020; 382:929-936. doi: 10.1056/NEJMoa2001191
Guan Ej, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. Published February 28, 2020. doi: 10.1056/NEJMoa2002032
Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. Published January 29, 2020. doi: 10.1056/NEJMoa2001316