In:
Artificial Organs, Wiley
Abstract:
Extracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS‐CoV‐2 infection. While veno‐venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes. Methods We conducted an observational retrospective study based on a single‐center institutional registry including all consecutive cases of COVID‐19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed. Results Of 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 ± 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 ± 0.44 to 5.94 ± 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 ± 258 to 3673 ± 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO 2 and a raise in PaO 2 to FiO 2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully. Conclusions The use of an additional drainage cannula in severe ARDS associated with COVID‐19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung‐protective ventilation and poor survival.
Type of Medium:
Online Resource
ISSN:
0160-564X
,
1525-1594
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
2003825-2
