COVID-19 EKSTRAKORPOREAL MEMBRAN OKSİJENASYONU (ECMO): GÜNCELLENMİŞ 2021 ELSO KILAVUZ ÖZETİ

Öz

Bu makalede, Ekstrakorporeal Yaşam Destek Organizasyonu (ELSO) 2019 Koronavirüs hastalığı (COVID-19) nedeniyle ciddi kardiyopulmoner yetmezliği olan hastalarda ekstrakorporeal membran oksijenasyonunun (ECMO) rolüne ilişkin güncellenen kılavuz özetlenmektedir. • V-V ECMO, pandemi öncesinde V-V ECMO ile desteklenen hastalarla karşılaştırılabilir beklenen sonuçları olan COVID-19 ve ciddi solunum yetmezliği olan hastalarda kullanılabilir. • V-A ECMO, COVID-19 ve ciddi kalp yetmezliği olan hastalarda kullanılabilir; ancak deneyim daha sınırlıdır. • Mobil ECMO uygulanabilir ve COVID-19 hastaları için güvenli bir şekilde yürütülebilir. • ECMO merkezleri, mümkün olduğunca coğrafi bölgelerde hasta sevklerini koordine edecek şekilde düzenlenmelidir. • Bir coğrafi bölge genelinde mümkün olduğunca hasta seçim kriterleri birleştirilmelidir. • ECMO kapasitesi azaldıkça ECMO kullanımına yönelik kontrendikasyonlar daha katı hale gelmelidir. • Veri sunumu, COVID-19'lu hastalar için araştırmaları kolaylaştırmak ve optimal ECMO bakımına ilişkin anlayışı geliştirmek için çok önemlidir. • Bazı merkezler antikoagülasyon hedeflerini artırmış olsa da kanama bir endişe kaynağı olmaya devam etmektedir ve geleneksel antikoagülasyon hedeflerinden sapmayı önerecek hiçbir veri yoktur. • Kan ürünü transfüzyon eşikleri, trakeostomi, endotrakeal ekstübasyon, rehabilitasyon, kanülasyon konfigürasyonu veya ventilatör yönetimi gibi geleneksel ECMO uygulamalarından sapmayı önerecek veri yoktur. • Algılanan yararsızlık durumunda ECMO'nun potansiyel olarak kesilmesi, hastalar ve vekil karar vericiler ile açıkça tartışılmalıdır. • Nadiren, çocuklarda şiddetli ARDS, miyokardit veya multisistem inflamatuar hastalık için ECMO desteği gerektiğinde ECMO hasta seçimi ve yönetiminde geleneksel kılavuzlar izlenmelidir.

Anahtar Kelimeler

• ekstrakorporeal membran oksijenasyonu
• ARDS
• Covid-2019
• ELSO
• ECMO

EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) FOR COVID-19: UPDATED 2021 ELSO GUIDELINES SUMMARY

Öz

This article summarizes updated guidance on the role of extracorporeal membrane oxygenation (ECMO) in patients with severe cardiopulmonary failure due to the Extracorporeal Life Support Organization (ELSO) 2019 Coronavirus disease (COVID-19). • V-V ECMO can be used in patients with COVID-19 and severe respiratory failure with expected outcomes comparable to patients supported with V-V ECMO prior to the pandemic. • V-A ECMO can be used in patients with COVID-19 and severe heart failure; but experience is more limited. • Mobile ECMO can be implemented and conducted safely for COVID-19 patients. • ECMO centers should be organized to coordinate patient referrals in geographic areas wherever possible. • As far as possible, patient selection criteria should be combined across a geographic region. • Contraindications to ECMO use should become more stringent as ECMO capacity decreases. • Data presentation is crucial to facilitate research and improve understanding of optimal ECMO care for patients with COVID-19. • Although some centers have increased their anticoagulation targets, bleeding remains a concern and there are no data to suggest deviation from traditional anticoagulation targets. • There are no data to suggest deviations from traditional ECMO practices such as blood product transfusion thresholds, tracheostomy, endotracheal extubation, rehabilitation, cannulation configuration, or ventilator management. • The potential discontinuation of ECMO in the event of perceived futility should be openly discussed with patients and surrogate decision makers. • Rarely, when ECMO support is required for severe ARDS, myocarditis, or multisystem inflammatory disease in children, ECMO patient selection and management should follow conventional guidelines.

Anahtar Kelimeler

• ARDS
• Covid-2019
• ELSO
• ECMO
• Extracorporeal Membrane Oxygenation

Kaynakça

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