The role of ECMO in the treatment of Covid-19

This is an automatically translated article.

Article by Master, Doctor Nguyen Ngoc Quang - Head of Cardiovascular - Thoracic Surgery - General Surgery - Intensive Care Unit - Vinmec Times City International Hospital

1.Overview

Acute respiratory infection caused by coronavirus 2019 (abbreviated COVID-19 ) is breaking out strongly around the world. The first cases were detected in China. On March 11 (the evening of March 11 in Vietnam time), the World Health Organization officially declared an outbreak of acute respiratory infection (COVID-19) caused by a new strain of Corona virus (SARS-CoV-2). CoV-2) is a global pandemic.

2.Documents on the treatment of COVID-19

There is currently no specific treatment for patients infected with COVID-19. The treatment measures being applied have the role of supporting the patient to overcome the attack stage of the disease and wait for the body's immunity to form so that it can control the virus. Therefore, supportive treatment measures are very important for patients infected with COVID-19. One of the most important supportive measures is to support respiratory failure when the disease is severe.
The World Health Organization WHO has announced an interim treatment regimen for COVID-19 and is continuing to refine it based on new studies and reports from many centers that are treating patients with Titled "Clinical management of severe acute respiratory infections when coronavirus infection is suspected. It includes the role of ECMO, specifically in the WHO guidance document, which contains a statement:" Consider transferring patients with severe respiratory failure despite a pulmonary protective ventilation strategy to facilities that can implement ECMO in patients.”
Similarly, US Centers for Disease Control (CDC) has also published guidelines for the clinical treatment of COVID-19 patients with or without acute respiratory distress syndrome (ARDS) which state: If an establishment has sufficient expertise, ECMO should be indicated according to the criteria of ARDS in the support of patients with lower respiratory tract infections caused by the COVID-19 virus. However, the authors also clearly emphasize that: “At t At this juncture, there is little experience worldwide with the use of ECMO to support COVID-19 patients.” The leaders of the world ECMO association (ELSO) discussed and raised the potential role of ECMO in COVID-19 patients published in the Journal of the American Medical Association. Along with that, ELSO commits to continue to collect data from member centers through the data collection center “ELSO Registry” and will provide additional recommendations when sufficient evidence is available.

3.Scientific literature on the use of ECMO for COVID-19

Reports of the WHO-China joint research group on coronavirus disease 2019 (COVID-19). A comprehensive summary of China's response has been provided. In it mentioning the use of ECMO in the treatment that “Application of intubation/artificial ventilation and ECMO techniques in critically ill patients can improve survival, a treatment group has reported that when ECMO was used in four patients at one hospital, there was only one death and the remaining three appeared to be improving. Clearly, although ECMO is expensive for any treatment, the indication should also be considered when assessing its potential benefits. “The application of intubation/invasive ventilation and ECMO in critically ill patients can improve survival. The Joint Mission Team was told of ECMO to use in four patients at one hospital with one death and three who appeared to be improving. Clearly, though ECMO is very resource consumptive, any health system would need to carefully weigh the benefits.”
Because of the limitations of high cost plus technical requirements, when it comes to developing treatment options for the most seriously ill patients due to COVID-19. JAMA magazine stated “The use of ECMO during the pandemic. ECMO is not chosen as a front-line therapy when all resources are lacking and the number of patients is too large during a pandemic.
About the preparation for the COVID-19 outbreak. A featured article in the journal Lancet Respiratory discusses the role of ECMO in the treatment of ICU patients with COVID-19.

4. ECMO technology deployed at Vinmec Times City

ECMO is a complex technique in resuscitation treatment for critically ill patients that has been deployed at Vinmec International General Hospital system. The ICU Department - Vinmec Times City International General Hospital has implemented ECMO technique to treat patients with severe respiratory failure (ARDS) due to pneumonia and severe heart failure since 4 years with about 19 cases with a rate of 10 patients. high success rate. Doctors at Vinmec Times City International General Hospital have been well-trained in ECMO techniques in the US and India, enough to respond to all serious situations. In 2018, Vinmec Times City International Hospital was certified as a member center of the world ELSO. Vinmec Times City International General Hospital is currently equipped with 3 most advanced ECMO machines, enough to support 3 patients at the same time.
To register for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide, or register online HERE.
References: jamanetwork.com, thelancet.com, who.int