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

Yıl 2022, Cilt: 6 Sayı: 1, 29 - 38, 28.03.2022

Çevirmen: Edanur Akpınar

https://doi.org/10.29228/JOHSE.18

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

• Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization. ASAIO J. 2021.1;67(5)485-495. doi: 10.1097/MAT.0000000000001422.
• Ramanathan K, Antognini D, Combes A, Paden M, Zakhary B, Ogino M, MacLaren G, Brodie D, Shekar K. Planning and provision of ECMO services for severe ARDS during the COVID-19 pandemic and other outbreaks of emerging infectious diseases. Lancet Respir Med. 2020; 8: 518–526.
• COVID-19 Critical Care Consortium. Available at: https://www. covid-critical.com/ Li Bassi G, Suen J, Barnett AG, Corley A, Millar J, Fanning J, Lye I, Colombo S, Wildi K, Livingstone S, Abbate G, Hinton S, Liquet B, Shrapnel S, Heidi Daltoni John FF. COVID-19 Critical Care Consortium Investigators: Design and rationale of the COVID19 Critical Care Consortium international, multicentre, observational study. BMJ Open. 2020; 10(12): e041417.
• Warren A, Camporota L, Vuylsteke A. Surge capacity and updated admission criteria: Response of the NHS-commissioned national respiratory extracorporeal membrane oxygenation network to the COVID-19 pandemic. Br J Anaesth. , 2020; 125: e282– e283. Takeda S. Nationwide system to centralize decisions around extracorporeal membranous oxygenation use for severe COVID-19 pneumonia in Japan. Acute Med Surg. 2020; 7: e510.
• Daniela M, Felipe S, Van Nicolette SJ, Tomas R, Eli V, Jorge R, Christian F, Roberto C, Jose I, Luisa D, Rodrigo D. Mobile ECMO in COVID-19 patient: Case report. J Artif Organs. 2021;24(2):287-292.
• Rafiq MU, Valchanov K, Vuylsteke A, Taghavi FJ, Iyer SB, Sudarshan CD, Fowles JA, Anderson S, Govender P, Holmes M, White A, Mishra A, Mwaura L, Penkins DP. Regional extracorporeal membrane oxygenation retrieval service during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic: An interdisciplinary team approach to maintain service provision despite increased demand. Eur J Cardiothorac Surg. 2020; 58: 875–880.
• Gerall C, Cheung EW, Klein-Cloud R, Kreines E, Brewer M, Middlesworth W. Allocation of resources and development of guidelines for extracorporeal membrane oxygenation (ECMO): Experience from a pediatric center in the epicenter of the COVID-19 pandemic. J Pediatr Surg. 2020; 55: 2548–2554.
• Barbaro RP, Odetola FO, Kidwell KM, Paden ML, Barlett RH, Davis MM, Annich GM. Association of hospital-level volume of extracorporeal membrane oxygenation cases and mortality. Analysis of the extracorporeal life support organization registry. Am J Respir Crit Care Med. 2015;191: 894–901.
• MacLaren G, Fisher D, Brodie D. Preparing for the most critically ill patients with COVID-19: The potential role of extracorporeal membrane oxygenation. JAMA. 2020;323:1245–1246.
• Lopez-Magallon AJ, Saenz L, Lara Gutierrez J, Florez CX, Althouse AD, Sharma SM, Duran A, Salazar L, Munoz R. Telemedicine in pediatric critical care: A retrospective study in an international extracorporeal membrane oxygenation program. Telemed J E Health. 2018; 24: 489–496.
• Abrams D, Lorusso R, Vincent JL, Brodie D. ECMO during the COVID-19 pandemic: When is it unjustified? Crit Care. 2020; 24: 507.
• Sromicki J, Schmiady M, Maisano F, Mestres CA. ECMO therapy in COVID-19: An experience from Zurich [published online ahead of print October 30, 2020]. J Card Surg doi: 10.1111/jocs.15147.
• Di Nardo M, Dalle Ore A, Starr J, Cecchetti C, Amodeo A, Testa G. Ethics and extracorporeal membrane oxygenation during coronavirus disease 2019 outbreak. Perfusion. 2020; 35: 562–564.
• Supady A, Curtis JR, Abrams D, Lorusso R, Thomas B, Boldt J, Brown CE, Duerschmied D, Metaxa V, Brodie D. Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks. Lancet Respir Med. 2021; 9(4):430-434.
• Extracorporeal Life Support Organization: ECMO and ECLS > Resources > Guidelines. Available at: https://www.elso.org/ Resources/Guidelines.aspx. Accessed December 27, 2019.
• Shekar K, Badulak J, Peek G, Boeken U, Dalton HJ, Arora L, Zakhary B, Ramanathan K, Starr J, Akkanti B, Antonini MV, Ogino MT, Raman L, Barret N, Brodie D, Combes A, Lorusso R, MacLaren G, Müller T, Paden M, Pellegrino V, ELSO Guideline Working Group. Extracorporeal life support organization COVID-19 interim guidelines: A consensus document from an International Group of Interdisciplinary Extracorporeal Membrane Oxygenation Providers. ASAIO J. 2020; 66: 707–721.
• MacLaren G, Combes A, Brodie D. What’s new in ECMO for COVID-19? Intensive Care Med. 2021; 47: 107–109.
• Brodie D, Slutsky AS, Combes A. Extracorporeal life support for adults with respiratory failure and related indications: A review. JAMA. 2019; 322: 557–568.
• Camporota L, Meadows C, Ledot S, Scott I, Harvey C, Garcia M, Vuylsteke A, NHS England ECMO Service. NHS England ECMO Service: Consensus on the referral and admission of patients with severe respiratory failure to the NHS ECMO service. Lancet Respir Med. 2021; 9: e16–e17.
• Fan E, Beitler JR, Brochard L, Calfee CS, Ferguson ND, Slutsky AS, Brodie D. COVID-19-associated acute respiratory distress syndrome: Is a different approach to management warranted? Lancet Respir Med. 2020; 8: 816–821.
• Combes A, Hajage D, Capellier G, Demoule A, Lavoue S, Guervilly C, Silva DD, Zafrani L, Tirot P, Veber B, Maury E, Levy B, Cohen Y, Richard C, Kalfon P, Bouadma L, Mehdaoui H, Beduneau G, Lebreton G, Brochard L, Ferguson ND, Fan E, Slutsky AS, Brodie D, Mercat A, EOLIA Trial Group, REVA, and ECMONet. EOLIA Trial Group, REVA, and ECMONet: Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018; 378: 1965–1975.
• Schmidt M, Bailey M, Sheldrake J, Hodgson C, Aubron C, Rycus PT, Scheinkestel C, Cooper DJ, Brodie D, Pellegrino V, Combes A, Pilcher D. Predicting survival after extracorporeal membrane oxygenation for severe acute respiratory failure. The Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) score. Am J Respir Crit Care Med.2014; 189: 1374–1382.
• Lorusso R, Combes A, Lo Coco V, De Piero ME, Belohlavek J. EuroECMO COVID-19 WorkingGroup; Euro-ELSO Steering Committee: ECMO for COVID-19 patients in Europe and Israel [published online ahead of print January 9, 2021]. Intensive Care Med doi: 10.1007/s00134-020-06272-3.
• Extracorporeal Life Support Organization: ECMO and ECLS > Registry > Statistics > International Summary. https://www.elso.org/ Registry /Statistics / InternationalSummary. aspx. Accessed November 18, 2020.
• Jäckel M, Rilinger J, Lang CN, Zotzmann V, Kaier K, Stachon P, Biever PM, Wengenmayer T, Duerschmied D, Bode C, Staudacher DL, Supady A. Outcome of acute respiratory distress syndrome requiring extracorporeal membrane oxygenation in Covid-19 or influenza: A single-center registry study. Artif Organs. 2021;45:593-601.
• Mustafa AK, Tatooles AJ. Reply to Letters to the Editor for “Extracorporeal membrane oxygenation for patients with Covid-19 in severe respiratory failure.” JAMA Surg. 2020; E1.
• Christian MD, Devereaux AV, Dichter JR, Rubinson L, Kissoon N. Introduction and executive summary: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014; 146: 8S–34S.
• Barbaro RP, MacLaren G, Boonstra PS, Iwashyna TJ, Slutsky AS, Fan E, Barlett RH, Tonna JE, Hyslop R, Fanning JJ, Rycus PT, Hyer SJ, Enders MM, Agerstrand CL, Hryniewicz K, Diaz R, Lorusso R, Combes A, Brodie D, ELSO. Extracorporeal Life Support Organization: Extracorporeal membrane oxygenation support in COVID-19: An international cohort study of the Extracorporeal Life Support Organization registry. Lancet. 2020; 396: 1071–1078.
• Schmidt M, Burrell A, Roberts L, Bailey M, Sheldrake J, Rycus PT, Hodgson C, Scheinkestel C, Cooper DJ, Thiagarajan RR, Brodie D, Pellegrino V, Pilcher D. Predicting survival after ECMO for refractory cardiogenic shock: The survival after venoarterial-ECMO (SAVE)-score. Eur Heart J. 2015; 36: 2246–2256.
• Worku E, Gill D, Brodie D, Lorusso R, Combes A, Shekar K. Provision of ECPR during COVID-19: Evidence, equity, and ethical dilemmas. Crit Care. 2020; 24: 462.
• Mustafa AK, Alexander PJ, Joshi DJ, Tabachnick DR, Cross CA, Pappas PS, Tatooles AJ. Extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure. JAMA Surg. 2020;155: 990–992.
• Combes A, Schmidt M, Hodgson CL, Fan E, Ferguson ND, Fraser JF, Jaber S, Pesenti A, Ranieri M, Rowan K, Shekar K, Slutsky AS, Brodie D. Extracorporeal life support for adults with acute respiratory distress syndrome. Intensive Care Med. 2020; 46: 2464–2476. Combes A, Price S, Slutsky AS, Brodie D. Temporary circulatory support for cardiogenic shock. Lancet. 2020;396: 199–212.
• Abrams D, Schmidt M, Pham T, Beitler RJ, Fan E, Goligher EC, McNamee JJ, Patroniti N, Wilcox ME, Combes A, Ferguson ND, AcAuley DF, Pesenti A, Quintel M, Frase J, Hodgson CL, Hough CL, Mercat A, Mueller T, Pellegrino V, Ranieri VM, Rowan K, Shekar K, Brochard L, Brodie D. Mechanical ventilation for acute respiratory distress syndrome during extracorporeal life support. Research and practice. Am J Respir Crit Care Med. 2020;201:514–525.
• Rosano A, Martinelli E, Fusina F, Albani F, Caserta R, Morandi A, Dell’Agnolo P, Dicembrini A, Mansouri L, Marchini A, Schivalocchi V, Natalini G. Early percutaneous tracheostomy in coronavirus disease 2019: Association with hospital mortality and factors associated with removal of tracheostomy tube at ICU discharge. A cohort study on 121 patients. Crit Care Med. 2021;49: 261–270.
• Garcia B, Cousin N, Bourel C, Jourdain M, Poissy J, Duburcq T, Lille Intensive Care COVID-19 group. Prone positioning under VV-ECMO in SARS-CoV-2-induced acute respiratory distress syndrome. Crit Care.2020;24: 428.
• Guervilly C, Prud’homme E, Pauly V, Bourenne J, Hraiech S, Daviet F, Adda M, Coiffard B, Forel JM, Roch A, Persico N, Papazian L. Prone positioning and extracorporeal membrane oxygenation for severe acute respiratory distress syndrome: Time for a randomized trial? Intensive Care Med. 2019;45:1040–1042.
• Guo Z, Sun L, Li B, Tian R, Zhang X, Zhang Z, Clifford SP, Liu Y, Huang J, Li X. Anticoagulation management in severe coronavirus disease 2019 patients on extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth. 2021;35:389–397.
• Masur J, Freeman CW, Mohan S. A double-edged sword: Neurologic complications and mortality in extracorporeal membrane oxygenation therapy for COVID-19–related severe acute respiratory distress syndrome at a tertiary care center. AJNR Am J Neuroradiol. 2020;41: 2009–2011.
• Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen FJ, Doerschug K, Holley AB, Jimenez D, Gal GL, Rali P, Wells P. Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019: CHEST guideline and expert panel report. Chest. 2020;158: 1143–1163.
• Parzy G, Daviet F, Persico N, Rambaud R, Scemama U, Adda M, Guervilly C, Hraiech S, Chaumoitre K, Roch A, Papazian L, Forel JM. Prevalence and risk factors for thrombotic complications following venovenous extracorporeal membrane oxygenation: A CT scan study. Crit Care Med. 2020;48:192–199.
• Leisman DE, Ronner L, Pinotti R, Taylor MD, Sinha P, Calfee CS, Hirayama AV, Mastroiani F, Turtle CJ, Harhay MO, Legrand M, Deutschman CS. Cytokine elevation in severe and critical COVID-19: A rapid systematic review, metaanalysis, and comparison with other inflammatory syndromes. Lancet Respir Med. 2020;8:1233–1244.
• Stockmann H, Keller T, Büttner S, Jörres A, Kindgen-Milles D, Kunz JV, Leebmann J, Spies C, Trager K, Treskatsch S, Uhrig A, Willam C, Enghard P, Slowinski T, CytoResc Trial Investigators. CytoResc - “CytoSorb” rescue for critically ill patients undergoing the COVID-19 Cytokine Storm: A structured summary of a study protocol for a randomized controlled trial. Trials. 2020;21: 577.
• Dres M, Burrel S, Boutolleau D, Voiriot G, Demoule A, Combes A, Lebreton G, Schmidt M. SARS-CoV-2 does not spread through extracorporeal membrane oxygenation or dialysis membranes. Am J Respir Crit Care Med. 2020;202: 458–460.
• Luyt CE, Sahnoun T, Gautier M, Vidal P, Burrel S, Chambrun MP, Chommeloux J, Desnos C, Arzoine J, Nieszkowska A, Brechot N, Schmidt M, Hekimian G, Boutolleau D, Robert J, Combes A, Chastre J. Ventilator-associated pneumonia in patients with SARS-CoV-2-associated acute respiratory distress syndrome requiring ECMO: A retrospective cohort study. Ann Intensive Care. 2020;10: 158.
• Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, Newburger JW, Kleinman LC, et al. Overcoming COVID19 Investigators; CDC COVID-19 Response Team: Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020;383: 334–346.
• Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, Heidemann SM, Kleinman LC, Sen AI, Hall MW, Priestley MA, McGuire JK, Boukas K, Sharron MP, Burns JP. International COVID-19 PICU Collaborative: Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units. JAMA Pediatr. 2020;174: 868–873.
• Di Nardo M, Hoskote A, Thiruchelvam T, Lillie J, Horan M, Hofheinz SB, Dupic L, Gimeno R, Piero ME, Coco VL, Roeleveld P, Davidson M, Jones T, Broman LM, Lorusso R, Belohlavek J. Extracorporeal membrane oxygenation in children with coronavirus disease 2019: Preliminary report from the Collaborative European Chapter of the Extracorporeal Life Support Organization Prospective Survey. ASAIO J. 2021;67: 121–124.
• Rimensberger PC, Kneyber MCJ, Deep A, Bansal M, Hoskote A, Javouhey E, Jourdain G, Latten L, MacLaren G, Morin L, Pons-Odena M, Ricci Z, Singh Y, Schlapbach LJ, et al. European Society of Pediatric and Neonatal Intensive Care (ESPNIC) Scientific Sections’ Collaborative Group: Caring for critically ill children with suspected or proven coronavirus disease 2019 infection: Recommendations by the Scientific Sections’ Collaborative of the European Society of Pediatric and Neonatal Intensive Care. Pediatr Crit Care Med. 2021; 22: 56–67.
• Schmidt M, Hajage D, Lebreton G, Monsel A, Voiriot G, Levy D, Baron E, Beurton A, Chommeloux, Meng P, Nemlaghi S, Bay P, Leprince P, Demoule A, Guidet B, Constantin JM, et al. Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE) Sorbonne Université; Paris-Sorbonne ECMO-COVID investigators: Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome associated with COVID-19: A retrospective cohort study. Lancet Respir Med. 2020;8: 1121–1131.
• Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, Dager WE, Deitelzweig SB, Ellsworth S, Garcia D, Kaatz S, Minichello T. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: Interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis. 2020;50:72–81.
• Wells CL, Forrester J, Vogel J, Rector R, Tabatabai A, Herr D. Safety and feasibility of early physical therapy for patients on extracorporeal membrane oxygenator: University of Maryland Medical Center Experience. Crit Care Med. 2018;46: 53–59.
• Liew MF, Siow WT, Yau YW, See KC. Safe patient transport for COVID-19. Crit Care. 2020;24: 94.