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This is the largest study on ECMO transfer of COVID-19 patients published to date.
In a high percentage of severe COVID-19 patients, lack of oxygen or hypoxia is one of the most common complications. A study at the Vall d’Hebron University Hospital has shown that extracorporeal membrane oxygenation (ECMO) support is effective in certain patients with severe COVID-19. The results of this work, led by the Intensive Medicine Service of Vall d’Hebron University Hospital in collaboration with the Cardiac Surgery Service, are published in Critical Care Explorations.
From March 15 to June 15, ECMO team at Vall d’Hebron traveled 19 times to other centers in Catalonia to perform the procedure for connection to the ECMO machine and subsequent transfer. Once in the Vall d’Hebron ICU, as a reference center in ECMO, they received extracorporeal respiratory support. Before being assisted, all patients were in an extremely serious respiratory situation and the conventional support measures in the other centers had failed. The patients were between 31 and 64 years old and 16 of the total were men.
At the end of the study, 12 patients had been discharged. They were on ECMO support for an average of 10 days, with a range that varied from 2 to 33 days. Another patient received the support for 67 days and is currently and home. Compared with other studies carried out with a smaller number of participants, in this case the recovery rate is higher. “ECMO support allows to minimize the damage of mechanical ventilation in lungs, which are very inflamed because of the viral infection, while performing the respiratory function. Likewise, it allows the performance of important diagnostic-therapeutic tests for the good evolution of the patient with severe COVID-19”, explains Dr. Jordi Riera, specialist in the Intensive Medicine Service at Vall d’Hebron University Hospital, principal investigator at the research group in Shock, Organ Dysfunction and Resuscitation (SODIR) at Vall d’Hebron Institute of Research (VHIR), director of the Adult ECMO program and international referent in the matter. “There are certain contraindications to ECMO, such as advanced age or some previous pathologies. Finally, the transfer of these patients with ECMO is complex and has to be carried out by a well-trained team, but it is essential to be able to offer this healthcare possibility to the entire population”, he adds.
Thrombotic and bleeding complications were frequent among the patients included in the study. Specifically, 9 people had thrombotic complications and 13, hemorrhagic complications. These clotting problems have been associated with COVID-19 since the beginning, and it seems that ECMO could increase their frequency. Even so, these events do not have an impact on mortality. “These complications must be prevented, early identified and solved as soon as possible. In our center, we have been training our team for years. Without a doubt, this excellent level of our ECMO team has made it easier for us to become a reference center in the technique”, says Dr. Riera.
Although the sample is the largest one that has been published to date, it is not enough to draw definitive conclusions. “More research is needed, sharing data between centers to continue fighting in this war against the virus”, concludes Dr. Riera.
Intensive Care Medicine,
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