Mechanical circulatory support in coronavirus disease-2019-positive patients with severe respiratory failure

Determinants of survival in patients on extracorporeal membrane oxygenation therapy due to severe covid-19

BACKGROUND

Severe acute respiratory distress syndrome (ARDS) due to Coronavirus Disease-19 (COVID-19) is associated with high mortality. Although survival on mechanical circulatory support has improved, determinants for better prognosis are still unclear. Here, we report on the outcome of our patient population with the need for mechanical circulatory support due to severe COVID-19 (sCOVID-19) induced ARDS.

METHODS

All patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS due to sCOVID-19 were analysed. Patients > 18 years of age at the time of initiation of ECMO were included. Pre-existing comorbidities, complications during ECMO implantation, and ECMO runtime were reviewed. The latency to intubation, proning, tracheotomy, and ECMO implantation was analysed. Furthermore, the survival and non-survival population were compared to determine factors in favour of a better outcome.

RESULTS

In total, 85 patients were treated with veno-venous membrane oxygenation (vv-ECMO) for severe ARDS in our medical centre. The patient population was predominantly male (83.5%) with a mean patient age of 54.9 years. A history of cardiovascular disease (p = .01), smoking (p < .05), need for vasopressor- (p < .05), and renal replacement therapy (p < .001) was associated with a worse prognosis. Overall survival was 50%. The survival population was significantly younger (p = .004), had a significantly higher body weight (p = .02) and body mass index (BMI) (p = .01). Furthermore, survival was significantly better when vv-ECMO was initiated within 48 h after admission (p < .001).

CONCLUSIONS

Pre-existing cardiovascular disease, higher age, history of nicotine abuse, and development of renal failure are associated with poor outcome. Early start of vv-ECMO therapy may lead to better survival in sCOVID-19 patients, although complications during ECMO therapy are associated with a worse prognosis.

Venovenous extracorporeal membrane oxygenation for coronavirus disease 2019 patients: A systematic review and meta-analysis

OBJECTIVE

Although the application of venovenous extracorporeal membrane oxygenation (VV-ECMO) in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS) is accumulating, the feasibility and safety of this therapy remain controversial. We aimed to evaluate the effect of VV-ECMO in the treatment of these patients.

METHODS

A comprehensive literature search was performed using PubMed, Embase, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2021. According to the inclusion and exclusion criteria, the included studies were screened, and meta-analysis was performed by R software (version 4.0.2).

RESULTS

Forty-two studies including 2037 COVID-19 patients supported with VV-ECMO due to ARDS were identified. The pooled analysis revealed that 30-, 60-, and 90-day mortality among patients were respectively 46% (95% CI 37%-57%, I2 = 66%), 46% (95% CI 30%-70%, I2 = 93%), and 49% (95% CI 43%-58%, I2 = 52%), and the pooled incidence rate of in-hospital mortality, major bleeding, hemorrhagic stroke, thrombosis, pulmonary embolism, deep venous thrombosis, and renal replacement therapy were respectively 35%, 39%, 11%, 40%, 15%, 21%, and 44%.

CONCLUSION

Although COVID-19 patients may have a higher risk of bleeding, hemorrhagic stroke, and acute kidney injury during ECMO therapy, the survival rate was more than half of the cases. Our data may support the application of VV-ECMO in COVID-19 patients.

Polypropylene Hollow Fiber Membrane by Dissolution-Inducing Pore Methods

Plasma leakage limits the development of polypropylene membranes as oxygenated membranes. Here, a new method named the dissolution-induced pore method was adapted to prepare polypropylene hollow fiber membranes: after polypropylene and polyvinyl chloride were melt-blended and extruded, the polyvinyl chloride was removed by N, N-dimethylacetamide to obtain a porous polypropylene membrane material. The variation of membranes has been explored in detail with respect to the influence of different parameters on the flux and mechanical properties of membranes and the feasibility of the polyvinyl chloride recovery. The resulting polypropylene hollow fiber membrane shows that plasma penetration was zero within 6 h of test, gas flux can reach 189,000 L/(m2·h·0.1 MPa), and its strength at break reaches 65 MPa and the elongation at break is 890%; polyvinyl chloride recovery achieves more than 99%. This research has developed a promising and low-cost extracorporeal membrane oxygenation material, which provides benefits for patients with less capacity for medical expenditure.