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 VL - 6 IS - 4 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 - 2020/10/01 UR - http://openres.ersjournals.com/content/6/4/00463-2020.abstract N2 - Background 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 centre in the UK.Methods Patient information, including baseline characteristics and clinical parameters, was collected retrospectively from electronic health records for COVID-19 VV-ECMO admissions between 3 March and 2 May 2020. Clinical management is described. Data are reported for survivors and nonsurvivors.Results We describe 43 consecutive patients with COVID-19 who received VV-ECMO. Median age was 46 years (interquartile range 35.5–52.5) and 76.7% were male. Median time from symptom onset to VV-ECMO was 14 days (interquartile range 11–17.5). All patients underwent computed tomography imaging, revealing extensive pulmonary consolidation in 95.3%, and pulmonary embolus in 27.9%. Overall, 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 (interquartile range 8–20). 14 patients died (32.6%) and 29 survived (67.4%) to hospital discharge. Nonsurvivors had significantly higher d-dimer (38.2 versus 9.5 mg·L−1, fibrinogen equivalent units; p=0.035) and creatinine (169 versus 73 μmol·L−1; p=0.022) at commencement of VV-ECMO.Conclusions Our data support 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.VV-ECMO, when offered to #COVID19 patients in refractory respiratory failure, can be associated with favourable outcomes. This is a detailed case series of 43 COVID-19 patients requiring VV-ECMO from a UK centre. 67.4% survived to hospital discharge. https://bit.ly/3ko9Ucu ER -