Affiliation:
1. Department of Anaesthesiology and Intensive Care National Medical Institute of the Ministry of Interior and Administration Warsaw Poland
2. Thoracic Research Centre Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum Bydgoszcz Poland
3. Department of Cardiac Surgery and Transplantology National Medical Institute of the Ministry of Interior and Administration Warsaw Poland
4. Cardio‐Thoracic Surgery Department, Heart and Vascular Centre Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM) Maastricht The Netherlands
5. Department of Anesthesia and Intensive Care Istituto Mediterraneo per i trapianti e Terapie ad alta specializzazione (IRCCS‐ISMETT) Palermo Italy
6. National Medical Institute of the Ministry of the Interior and Administration Warsaw Poland
Abstract
AbstractBackgroundExtracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS‐CoV‐2 infection. While veno‐venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes.MethodsWe conducted an observational retrospective study based on a single‐center institutional registry including all consecutive cases of COVID‐19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed.ResultsOf 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 ± 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 ± 0.44 to 5.94 ± 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 ± 258 to 3673 ± 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully.ConclusionsThe use of an additional drainage cannula in severe ARDS associated with COVID‐19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung‐protective ventilation and poor survival.
Subject
Biomedical Engineering,General Medicine,Biomaterials,Medicine (miscellaneous),Bioengineering