TY - JOUR T1 - Veno-venous Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019: A Case Series JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00463-2020 SP - 00463-2020 AU - Joe Zhang AU - Blair Merrick AU - Genex L. Correa AU - Luigi Camporota AU - Andrew Retter AU - Andrew Doyle AU - Guy W. Glover AU - Peter B. Sherren AU - Stephen J. Tricklebank AU - Sangita Agarwal AU - Boris E. Lams AU - Nicholas A. Barrett AU - Nicholas Ioannou AU - Jonathan Edgeworth AU - Christopher I.S. Meadows Y1 - 2020/01/01 UR - http://openres.ersjournals.com/content/early/2020/09/17/23120541.00463-2020.abstract N2 - Rationale The use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in severe hypoxaemic respiratory failure from Coronavirus disease 2019 (COVID-19) has been described, but reported utilisation and outcomes are variable, and detailed information on patient characteristics is lacking. We aim to report clinical characteristics, management, and outcomes of COVID-19 patients requiring VV-ECMO, admitted over 2 months to a high-volume UK centre.Methods Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3rd March and 2nd May 2020. Clinical management is described. Data are reported for survivors and non-survivors.Results We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years [IQR 35.5–52.5], 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days [IQR 11–17.5]. All patients underwent computed tomography imaging, finding extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. 79.1% received immunomodulation with methylprednisolone for persistent maladaptive hyperinflammatory state. Vasopressors were used in 86%, and 44.2% received renal replacement therapy. Median duration on VV-ECMO was 13 days [IQR 8–20]. Fourteen patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Non-survivors had significantly higher d-dimer (38.2 versus 9.5 mg·L−1, Fibrinogen Equivalent Units; p=0.035) and creatinine (169 versus 73 umol·L−1; p=0.022) at commencement of ECMO.Conclusions Our data supports the use of VV-ECMO in selected COVID-19 patients. The cohort was characterised by high degree of alveolar consolidation, systemic inflammation, and intravascular thrombosis.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Dr. Zhang has nothing to disclose.Conflict of interest: Dr. Merrick has nothing to disclose.Conflict of interest: Dr. Correa has nothing to disclose.Conflict of interest: Dr. Camporota has nothing to disclose.Conflict of interest: Dr. Retter has nothing to disclose.Conflict of interest: Dr. Doyle has nothing to disclose.Conflict of interest: Dr. Glover has nothing to disclose.Conflict of interest: Dr. Sherren has nothing to disclose.Conflict of interest: Dr. Tricklebank has nothing to disclose.Conflict of interest: Dr. Agarwal has nothing to disclose.Conflict of interest: Dr. Lams has nothing to disclose.Conflict of interest: Dr. Barrett has nothing to disclose.Conflict of interest: Dr. Ioannou has nothing to disclose.Conflict of interest: Dr. Edgeworth has nothing to disclose.Conflict of interest: Dr. Meadows has nothing to disclose. ER -