Department of Anesthesia and Intensive Care, IRCCS-ISMETT, Palermo, Italy.
Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
Adv Exp Med Biol. 2021;1353:173-195. doi: 10.1007/978-3-030-85113-2_10.
Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention.
This review summarizes the evidence gathered until June 12, 2020; electronic databases were screened for pertinent reports on coronavirus and V-V ECMO. Search was conducted by two independent investigators; keywords used were SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS).
Many patients with COVID-19 experience moderate symptoms and a relatively quick recovery, but others must be admitted into the intensive care unit due to severe respiratory failure and often must be mechanically ventilated. Further deterioration may require institution of extracorporeal oxygenation. Infection mechanisms may trigger "cytokine storm," an inflammatory disorder notable for multi-organ system failure; together with other metabolic and hematological changes, these amplify the changes pertinent to ECMO therapy, often exaggerating blood coagulation disorders. Thirty-two studies were found describing experiences with ECMO in the treatment of COVID-19. Of 4,912 COVID-19 patients, 2,119 (43%) developed ARDS and 2,086 (42%) were transferred to the ICU; 1,015 patients (21%) were treated with ECMO. While in an overall cohort, observed mortality was 640 (13%), the mortality within ECMO subgroups reached up to 34.6% (range 0-100%).
The efficacy of ECMO treatment for COVID-19 is largely dependent on the expertise of the center in ECLS due to the interplay between the changes in hematological and inflammatory modulators associated with both COVID-19 and ECMO. In order to support gas exchange during early infection with SARS-CoV-2, ECMO has a strong rationale for the treatment of the most critically ill patients. Due to the limited resources during a global pandemic, ECMO should be reserved for only the most severe cases of COVID-19.
严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）的感染最近迅速发展成为全球大流行。在 SARS-CoV-2 导致的难治性呼吸衰竭患者中，静脉-静脉体外膜肺氧合（V-V ECMO）可能作为一种救命的抢救干预措施发挥作用。
本综述总结了截至 2020 年 6 月 12 日收集的证据；电子数据库对有关冠状病毒和 V-V ECMO 的相关报告进行了筛选。由两名独立的调查员进行搜索；使用的关键词是 SARS-CoV-2、COVID-19、ECMO 和体外生命支持（ECLS）。
许多 COVID-19 患者症状较轻，恢复较快，但也有一些患者因严重呼吸衰竭而必须入住重症监护病房，通常还需要机械通气。病情进一步恶化可能需要进行体外氧合。感染机制可能引发“细胞因子风暴”，这是一种以多器官系统衰竭为特征的炎症性疾病；再加上其他代谢和血液变化，这些会放大与 ECMO 治疗相关的变化，常常使血液凝固障碍恶化。共发现 32 项研究描述了 ECMO 在 COVID-19 治疗中的应用经验。在 4912 例 COVID-19 患者中，2119 例（43%）发生 ARDS，2086 例（42%）转入 ICU；1015 例（21%）患者接受 ECMO 治疗。在总体队列中，观察到的死亡率为 640 例（13%），而 ECMO 亚组的死亡率高达 34.6%（0-100%）。
由于 COVID-19 和 ECMO 相关的血液学和炎症调节剂的变化之间存在相互作用，因此 ECMO 治疗 COVID-19 的疗效在很大程度上取决于中心在 ECLS 方面的专业知识。为了在 SARS-CoV-2 早期感染期间支持气体交换，ECMO 为治疗最危重的患者提供了强有力的理由。由于在全球大流行期间资源有限，ECMO 应仅保留用于 COVID-19 最严重的病例。
