tetano
Editor, Senior Moderator
Crit Care Explor
. 2021 Jul 15;3(7):e0489.
doi: 10.1097/CCE.0000000000000489. eCollection 2021 Jul.
Awake Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Acute Respiratory Failure
Nawaporn Assanangkornchai[SUP] 1 2 3 [/SUP], Douglas Slobod[SUP] 1 3 [/SUP], Rayan Qutob[SUP] 1 3 4 [/SUP], May Tam[SUP] 5 [/SUP], Jason Shahin[SUP] 3 6 [/SUP], Gordan Samoukovic[SUP] 3 7 [/SUP]
Affiliations
Abstract
Implantation of venovenous extracorporeal membrane oxygenation as an alternative to invasive mechanical ventilation, an "awake approach," may facilitate a lung- and diaphragm-protective ventilatory strategies without the associated harms of endotracheal intubation, positive pressure ventilation, and continuous sedation. This report presents the characteristics and outcomes of the patients treated with the awake venovenous extracorporeal membrane oxygenation approach.
Design: Retrospective case series.
Setting: Monocenter study.
Patients: Severe acute respiratory syndrome coronavirus 2 patients with acute respiratory failure treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation from March 2020 to March 2021.
Interventions: None.
Measurements and main results: Physiologic and laboratory data were collected at admission to the ICU, prior to and after venovenous extracorporeal membrane oxygenation implantation, and at decannulation. Seven patients were treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation due to hypoxemia with a median Pao[SUB]2[/SUB]/Fio[SUB]2[/SUB] ratio at implantation of 76 (interquartile range, 59-92). Four patients in the awake group subsequently required invasive mechanical ventilation, and only one patient (14.3%) died. There were no significant complications attributed venovenous extracorporeal membrane oxygenation.
Conclusions: This report demonstrates that in a selected group of patients, an "awake" venovenous extracorporeal membrane oxygenation approach is feasible and may result in favorable outcomes.
Keywords: acute respiratory distress syndrome; coronavirus disease 2019; mechanical ventilation; mortality; noninvasive ventilation; venovenous extracorporeal membrane oxygenation.
. 2021 Jul 15;3(7):e0489.
doi: 10.1097/CCE.0000000000000489. eCollection 2021 Jul.
Awake Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Acute Respiratory Failure
Nawaporn Assanangkornchai[SUP] 1 2 3 [/SUP], Douglas Slobod[SUP] 1 3 [/SUP], Rayan Qutob[SUP] 1 3 4 [/SUP], May Tam[SUP] 5 [/SUP], Jason Shahin[SUP] 3 6 [/SUP], Gordan Samoukovic[SUP] 3 7 [/SUP]
Affiliations
- PMID: 34286281
- PMCID: PMC8284710
- DOI: 10.1097/CCE.0000000000000489
Abstract
Implantation of venovenous extracorporeal membrane oxygenation as an alternative to invasive mechanical ventilation, an "awake approach," may facilitate a lung- and diaphragm-protective ventilatory strategies without the associated harms of endotracheal intubation, positive pressure ventilation, and continuous sedation. This report presents the characteristics and outcomes of the patients treated with the awake venovenous extracorporeal membrane oxygenation approach.
Design: Retrospective case series.
Setting: Monocenter study.
Patients: Severe acute respiratory syndrome coronavirus 2 patients with acute respiratory failure treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation from March 2020 to March 2021.
Interventions: None.
Measurements and main results: Physiologic and laboratory data were collected at admission to the ICU, prior to and after venovenous extracorporeal membrane oxygenation implantation, and at decannulation. Seven patients were treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation due to hypoxemia with a median Pao[SUB]2[/SUB]/Fio[SUB]2[/SUB] ratio at implantation of 76 (interquartile range, 59-92). Four patients in the awake group subsequently required invasive mechanical ventilation, and only one patient (14.3%) died. There were no significant complications attributed venovenous extracorporeal membrane oxygenation.
Conclusions: This report demonstrates that in a selected group of patients, an "awake" venovenous extracorporeal membrane oxygenation approach is feasible and may result in favorable outcomes.
Keywords: acute respiratory distress syndrome; coronavirus disease 2019; mechanical ventilation; mortality; noninvasive ventilation; venovenous extracorporeal membrane oxygenation.