From the Department of Clinical Engineering, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
ECMO Team, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
ASAIO J. 2021 May 1;67(5):511-516. doi: 10.1097/MAT.0000000000001402.
Patients with the coronavirus disease 2019 (COVID-19) sometimes develop refractory respiratory failure and may require venovenous extracorporeal membrane oxygenation (VV-ECMO). It is known that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is sometimes present in the blood of COVID-19 patients. VV-ECMO is often used for several weeks, and plasma leaks can occur, albeit rarely. Hence, in terms of infection control, a concern is that SARS-CoV-2 may leak from the gas outlet port of the oxygenator during ECMO support of critically ill COVID-19 patients. The aim of this study was to clarify whether SARS-CoV-2 leaks from the oxygenator during ECMO support. Five patients with critical COVID-19 pneumonia were placed on VV-ECMO. Silicone-coated polypropylene membrane oxygenators were used in the ECMO circuits for these patients. SARS-CoV-2 ribonucleic acid (RNA) was measured by quantitative reverse transcription polymerase chain reaction in serum and at the gas outlet port of the ECMO circuit at the time of circuit replacement or liberation from ECMO. SARS-CoV-2 RNA was detected in the gas outlet port of the ECMO circuit for three of the five patients. None of the medical staff involved in the care of these five patients has been infected with COVID-19. In conclusion, SARS-CoV-2 could leak to the gas outlet port of the ECMO circuit through silicone-coated polypropylene membranes during ECMO support of critically ill COVID-19 patients.
新型冠状病毒病 (COVID-19) 患者有时会出现难治性呼吸衰竭，可能需要静脉-静脉体外膜肺氧合 (VV-ECMO)。已知严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 有时存在于 COVID-19 患者的血液中。VV-ECMO 通常使用数周，尽管很少见，但会发生血浆泄漏。因此，从感染控制的角度来看，人们担心 SARS-CoV-2 可能会在危重症 COVID-19 患者接受 ECMO 支持期间从体外膜肺氧合器的气体出口端泄漏。本研究旨在阐明 SARS-CoV-2 是否会在 ECMO 支持期间从体外膜肺氧合器中泄漏。五名危重症 COVID-19 肺炎患者接受 VV-ECMO。这些患者的 ECMO 回路中使用了涂有硅酮的聚丙烯膜式氧合器。在更换 ECMO 回路或从 ECMO 中解脱时，通过定量逆转录聚合酶链反应在血清中和 ECMO 回路的气体出口端测量 SARS-CoV-2 核糖核酸 (RNA)。在五名患者中的三名患者的 ECMO 回路的气体出口端检测到 SARS-CoV-2 RNA。未发现参与这五名患者护理的医务人员感染 COVID-19。总之，在危重症 COVID-19 患者接受 ECMO 支持期间，SARS-CoV-2 可能会通过涂有硅酮的聚丙烯膜泄漏到 ECMO 回路的气体出口端。
