Serdar BADEM, Nail KAHRAMAN, Temmuz TANER

Covid-19 Hastalarında Gelişen Solunum Yetmezliğinde Veno-venöz Ekstrakorporeal Membran Oksijenasyonu; Güney Marmara Bölgesi Tek Merkez Deneyimi

Giriş ve Amaç: Covid-19 hastalığında gelişen Akut Respiratuar Distres Sendromu (ARDS) sonucunda mekanik ventilasyon ihtiyacı ve mortalite oranları artmaktadır. Covid-19 pandemisinde, Ekstrakorporeal Membran Oksijenasyon (ECMO) destek tedavisinin rolü hala tam olarak bilinmemektedir. Bu retroprespektif çalışmada, Covid-19 nedeniyle ARDS gelişen hastalarda uyguladığımız ECMO destek tedavisinin etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bursa Şehir Hastanesi Anestezi ve Reanimasyon Yoğun Bakım ünitesinde Mart 2021-Eylül 2021 tarihleri arasında ECMO desteği alan hastalar geriye dönük olarak değerlendirildi. Çalışma süresinde 12 hastada ARDS nedeniyle ECMO destek tedavisi uygulandı. Bulgular: 12 hastaya veno-venöz ECMO (vv-ECMO) uygulandı. Hastaların dokuzu (%75) erkek, üçü (%25) kadın ve ortalama yaş 49.4 (35-70) olarak bulundu. Hastaların hastaneye yatışından entübasyon için geçen süre ortalama 8.08 (1-23) gündü. Entübasyon gününden ECMO desteğinin başlangıcına kadar geçen süre ortalama 3.08 (1-7) gün ve ECMO desteğinin ortalama süresi 12.3 (1-23) gün olarak bulundu. Sadece 1 hasta (%8,3) dekanüle edildikten sonra taburcu oldu. Sonuç: ECMO destek tedavisi, Covid-19 hastalığına sekonder gelişen ARDS hastalarında yüksek mortalite ile ilişkilidir. Ancak Covid-19 hastalığında ECMO, erken dönemde uygulandığı zaman hayat kurtarıcı bir destek yöntemidir. ECMO'nun Covid-19 nedeniyle ARDS tablosundaki kritik hastalarda kurtarma tedavisi olarak faydası şu ana kadar sınırlıdır ve bu hasta grubunda kullanımını için daha çok çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

covid-19, akut respiratuar distres sendromu, ekstrakorporeal membran oksijenasyon (ECMO)

Veno-venous Extracorporeal Membrane Oxygenation in Respiratory Failure in Covid-19 Patients; Southern Marmara Region Single Center Experience

Objective: The need for mechanical ventilation and mortality rates increase as a result of Acute Respiratory Distress Syndrome (ARDS) developing in Covid-19 disease. The role of Extracorporeal Membrane Oxygenation (ECMO) supportive therapy in the Covid-19 pandemic is still not fully understood. In this retrospective study, we aimed to evaluate the effectiveness of ECMO supportive treatment in patients who developed ARDS due to Covid-19. Materials and Methods: Patients who received ECMO support between March 2021 and September 2021 in Bursa City Hospital Anesthesia and Reanimation Intensive Care Unit were evaluated retrospectively. During the study period, ECMO supportive treatment was applied for ARDS in 12 patients. Results: 12 patients underwent veno-venous ECMO (vv-ECMO). Nine (75%) of the patients were male, three (25%) were female, and the mean age was 49.4 (35-70) years. The mean time from hospital admission to intubation was 8.08 (1-23) days. The mean time from the day of intubation to the start of ECMO support was 3.08 (1-7) days, and the mean duration of ECMO support was found to be 12.3 (1-23) days. Only 1 patient (8.3%) was discharged after being decannulated. Conclusion: ECMO supportive therapy is associated with high mortality in ARDS patients developing secondary to Covid-19 disease. However, in Covid-19 disease, ECMO is a life-saving support method when applied in the early period. The benefit of ECMO as a rescue therapy in critically ill patients with ARDS due to Covid-19 is limited so far and more studies are needed for its use in this patient group.

Keywords:

covid-19, acute respiratory distress syndrome, extracorporeal membrane oxygenation (ECMO),

PDF

___

Kang, Y, Chen, T, Mui, D, Ferrari, V, Jagasia, D, Scherrer-Crosbie M, et al., Cardiovascular manifestations and treatment considerations in COVID-19, Heart, 2020, 106(15), 1132-1141.
World Health Organization, WHO announces COVID- 19 outbreak as a pandemic, http://www.euro.who.int/en/ health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/who-announces-covid-19-outbreak-apandemic, (accessed: 02.04.2020).
WHO Coronavirus (COVİD19) dashboard, https://covid19.who.int/
WHO: Rolling Updates on Coronavirus Disease (COVID-19), https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen, (accessed 05.04. 2020).
ELSO: COVID-19 Cases on ECMO in the ELSO Registry, https://www.elso.org/COVID19.aspx. (accessed 05.04. 2020).
Badulak, J, Antonini, M.V, Stead, C.M, Shekerdemian, L, Raman, L, Paden, M.L, et al., ELSO COVID-19 Working Group Members. Extracorporeal Membrane Oxygenation for COVID-19, Updated 2021 Guidelines from the Extracorporeal Life Support Organization, Asaıo Jouransl, 2021, 1, 67(5), 485-495.
Papazian, L, Herridge, M, Combes, A, Focus on veno-venous ECMO in adults with severe ARDS, Intensive Care Medicine, 2016, 42(11), 1655-1657.
Jayaraman, A.L, Cormican. D, Shah. P, Ramakrishna. H, Cannulation strategies in adult veno-arterial and veno-venous extracorporeal membrane oxygenation: Techniques, limitations, and special considerations, Annals of Cardiac Anaesthesiology, 2017, 20,11-18.
Millar. J.E, Fanning, J.P, McDonald, C.I, McAuley, D.F, Fraser, J.F, The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology, Critical Care, 2016, 28;20(1):387.
Ko, H.K, Yu, W.K, Pan, S.W, Chen, W.C, Yang, K.Y, Lin, Y.T, et al., Research Center for Epidemic Prevention—National Yang Ming Chiao Tung University (RCEP-NYCU). Consensus statement and recommendations on the treatment of COVID-19, Journal of Chinese Medical Association, 2022, 1;85(1):5-17.
Jäckel, M, Rilinger, J, Lang, C.N, Zotzmann, V, Kaier, K, Stachon, P, et al., Outcome of acute respiratory distress syndrome requiring extracorporeal membrane oxygenation in Covid-19 or influenza: A single-center registry study, Artificial Organs, 2021, 45(6):593-601.
Jacobs, J.P, Stammers, A.H, St Louis, J, Hayanga, J.W.A, Firstenberg, M.S, Mongero, L.B, et al., Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in Coronavirus Disease 2019: Experience with 32 Patients, Asaıo Journal, 2020, 66(7), 722-730.
Extracorporeal Life Support Organization (ELSO), COVID-19 Registry Dashboard, https://www.elso.org/Registry/FullCOVID19RegistryDashboard.aspx , 2020, (accessed 29.05. 2020).
Taniguchi, H, Ogawa, F, Honzawa, H, Yamaguchi, K, Niida, S, Shinohara, M, et al., Veno-venous extracorporeal membrane oxygenation for severe pneumonia: COVID-19 case in Japan, Acute medicine & surgery, 2020, 14, 7(1):e509.
Ozdemir, I.H, Ozen, M.B, Gündüz, R, Antikoagülan Tedavi ve COVID-19, Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2022, 9(1), 1-4.
Arslan, Y, Yilmaz, G, Dogan, D, Hasirci, M, Cetindogan, H, Ocal, N, Savasci, U, Fidan, G, Tasci, C, The effectiveness of early anticoagulant treatment in Covid-19 patients, Phlebology, 2021, 36(5), 384-391.
Akar, A.R, Ertugay, S, Kervan, Ü, İnan, M.B, Sargın, M, Engin, Ç, Özatik, M.A, Turkish Society of Cardiovascular Surgery (TSCVS) Proposal for use of ECMO in respiratory and circulatory failure in COVID-19 pandemic era, Turk Gogus Kalp Damar Cerrahisi Dergisi, 2020, 30, 28(2), 229-235.
Alhazzani, W, Moller M.H., Arabi, Y.M, et al., Surviving Sepsis Campaign: Guidelines on the management of critically Ill adults with coronavirus disease 2019 (COVID-19), Intensive Care Medicine, 2020, 46, 854-87.
Pineton de Chambrun, M, Bréchot, N, Combes, A, Venoarterial extracorporeal membrane oxygenation in cardiogenic shock: indications, mode of operation, and current evidence, Current Opinion in Critical Care, 2019, 25(4), 397-402.