Soroksky A, Tocut M, Rosman Z, Dekel H
Intensive Care Unit, Department of Medicine, Department of Cardiothoracic Surgery; Wolfson Medical Center; The Center for Autoimmune Diseases, Sheba Medical Center; Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Eur Rev Med Pharmacol Sci. 2022 Mar;26(5):1761-1764. doi: 10.26355/eurrev_202203_28246.
In the past few years, extracorporeal membrane oxygenation (ECMO) has been increasingly used in patients with severe respiratory insufficiency in whom mechanical ventilation (MV) had failed. MV in severe COVID-19 patients is often accompanied by high respiratory pressures and high oxygen concentrations. Thus, by "placing the lungs at rest" ECMO might spare severe COVID-19 patients from being subjected to aggressive MV. Awake ECMO is another therapeutic alternative for providing extracorporeal oxygenation and ventilation by avoiding the complications of MV.
A 65-year-old male diagnosed with COVID-19 pneumonia was admitted to the intensive care unit (ICU) after deteriorating to hypoxemic respiratory failure with acute respiratory distress disorder (ARDS). Awake veno-venous (VV) ECMO was considered after receiving patient consent and was successfully implemented as an attempt to avoid invasive MV. This is one of the first cases described during the COVID-19 pandemic, in which awake VV-ECMO was used in a critically ill COVID-19 patient as a replacement therapy to conventional MV.
Under the appropriate conditions, awake ECMO might be a suitable alternative approach to avoid complications of aggressive MV in selected critically ill COVID-19 ARDS patients.
在过去几年中，体外膜肺氧合（ECMO）越来越多地用于机械通气（MV）失败的严重呼吸功能不全患者。重症 COVID-19 患者的机械通气常伴有高呼吸压力和高氧浓度。因此，通过“让肺休息”，ECMO 可能使重症 COVID-19 患者避免接受激进的机械通气。清醒体外膜肺氧合是另一种治疗选择，可通过避免机械通气的并发症来提供体外氧合和通气。
一名 65 岁男性被诊断为 COVID-19 肺炎，在恶化为伴有急性呼吸窘迫综合征（ARDS）的低氧性呼吸衰竭后入住重症监护病房（ICU）。在获得患者同意后考虑采用清醒静脉 - 静脉（VV）ECMO，并成功实施，以尝试避免有创机械通气。这是 COVID-19 大流行期间描述的首批病例之一，其中清醒 VV-ECMO 被用于一名重症 COVID-19 患者，作为传统机械通气的替代疗法。
在适当条件下，清醒体外膜肺氧合可能是一种合适的替代方法，可避免在选定的重症 COVID-19 ARDS 患者中采用激进机械通气的并发症。
