Abstract
Objectives: To assess the efficacy of an awake venovenous extracorporeal membrane oxygenation (VV-ECMO) management strategy in preventing clinically relevant barotrauma in patients with coronavirus disease 2019 (COVID-19) with severe acute respiratory distress syndrome (ARDS) at high risk for pneumothorax (PNX)/pneumomediastinum (PMD), defined as the detection of the Macklin-like effect on chest computed tomography (CT) scan.
Design: A case series.
Setting: At the intensive care unit of a tertiary-care institution.
Participants: Seven patients with COVID-19-associated severe ARDS and Macklin-like radiologic sign on baseline chest CT.
Interventions: Primary VV-ECMO under spontaneous breathing instead of invasive mechanical ventilation (IMV). All patients received noninvasive ventilation or oxygen through a high-flow nasal cannula before and during ECMO support. The study authors collected data on cannulation strategy, clinical management, and outcome. Failure of awake VV-ECMO strategy was defined as the need for IMV due to worsening respiratory failure or delirium/agitation. The primary outcome was the development of PNX/PMD.
Measurements and main results: No patient developed PNX/PMD. The awake VV-ECMO strategy failed in 1 patient (14.3%). Severe complications were observed in 4 (57.1%) patients and were noted as the following: intracranial bleeding in 1 patient (14.3%), septic shock in 2 patients (28.6%), and secondary pulmonary infections in 3 patients (42.8%). Two patients died (28.6%), whereas 5 were successfully weaned off VV-ECMO and were discharged home.
Conclusions: VV-ECMO in awake and spontaneously breathing patients with severe COVID-19 ARDS may be a feasible and safe strategy to prevent the development of PNX/PMD in patients at high risk for this complication.
Keywords: COVID-19; Macklin effect; acute respiratory distress syndrome; barotrauma; extracorporeal membrane oxygenation; mechanical ventilation.
【저자키워드】 COVID-19, acute respiratory distress syndrome, mechanical ventilation, extracorporeal membrane oxygenation, Macklin effect, barotrauma, 【초록키워드】 coronavirus disease, Efficacy, ARDS, intensive care, severe COVID-19, mechanical ventilation, VV-ECMO, Noninvasive ventilation, oxygen, nasal, outcome, Chest computed tomography, Case series, Chest CT, management, Patient, bleeding, Septic shock, Complication, ECMO, Clinical management, membrane, Pulmonary infection, acute respiratory distress, Invasive mechanical ventilation, Safe, high risk, Support, Primary outcome, failure, severe ARDS, collected data, syndrome, worsening respiratory failure, measurement, Prevent, IMV, discharged home, defined, radiologic, died, clinically, Two patient, feasible, baseline, 【제목키워드】 ARDS, Extracorporeal,