ECMO in COVID-19: What we have learned thus far? Lot of interesting topics & points of view discussed during this ELSO webinar, on April 22! Speakers & topics:
Christian Bermudez & Holt Murray: regional coordination and collaboration on patients selection, cannulation, transfer, management strategies…
Erik Osborn: successful ECMO support experiences, general management & procedures on extracorporeal support
Troy Seelhammer & Tim Maul: hypercoagulable state of patients with Coronavirus infection & approaches to anticoagulation; circuits/devices shortage & potential alternatives.
Here the slides!
Christian Bermudez, Professor of Surgery and Director of Thoracic Transplantation – Department of Surgery – University of Pennsylvania: ECMO Center Organization and Regional Coordination
Holt Murray, Department of Critical Care Medicine, Chief of Service UPMC Mercy and Assistant Professor, Critical Care Medicine, University of Pittsburgh School of Medicine
Regional ECMO Coordination – 10 years in 10 minutes
Erik Osborn, Medical Director of Adult ECMO – Inova Health System,
COVID-19 & ECMO: Experiences and Management
Timothy M. Maul Perfusionist and Sr. Researcher – Nemours Children’s Hospital and Adjunct Asst. Professor, Biomedical Engineering, University of Pittsburgh
Inflammation & Coagulation for SARS-COV-2: Perfusionist’s Perspective
Troy Seelhammer, Assistant Professor of Anesthesiology & Critical Care Medicine & Adult ECMO Medical Director – Mayo Clinic, Rochester, MN
ECMO in COVID-19: Is There a Role for Bivalirudin?
Full video available on our youtube channel
The Extracorporeal Life Support Organization – ELSO COVID-19 Dashboard is now live! We are asking centers Worldwide to support us capture vital informations to assist in the fight against SARS-CoV-2 Coronavirus: here a video with easy step-by-step instructions on how to quickly add data into the Registry!
Non-ELSO Centers contact email@example.com for CenterID and login
Remember all red highlighted fields must be completed for your submission to be saved.
Direct link to Dashboard
The power of connection: at a time when social distancing is a universal necessity, connecting as a healthcare community has never been so vitally important to keeping our patients & colleagues safe. This ELSO webinar focused on sharing experiences from around the globe that are currently in the surge phase. Highlights:
Pearls from a COVID-19 dedicated WhatsApp chat: popular discussion topics, best practices & advices shared by ECLS experts.
Stories from the front lines: preparing for the surge, indication, selection criteria & configuration for ECMO support in SARS-CoV-2 related severe respiratory failure & hemodynamic impairment, with some numbers about extracorporeal support implementation so far:
Seattle Experience by Jenelle Badulak
New York City Experience by Cara Agerstrand
Paris Experience by Matthieu Schmidt.
Here full video
And here the slides!
Tammy Friedrich, MSN, RN, BSN, ECMO Specialist at Mayo Clinic in Rochester, MN
Amy Hackmann, MD, FACS, Associate Professor in the Department of Cardiovascular and Thoracic Surgery at UT Southwestern Medical Center
Holli Williams, RN, BSN, CCRN, ECMO and VAD Specialist and Preceptor – Innovative ECMO Concepts Inc
What Have We Learned from Each Other
Jenelle Badulak, MD, Emergency Medicine & Critical Care Medicine University of Washington, Seattle, WA
COVID ECMO Preparation & Experiences In Washington
Matthieu Schmidt, MD, PhD – Service de Réanimation iCAN, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris
Université Pierre et Marie Curie, Paris 6
ECMO and COVID-19: Experience from Paris
Current situation of ECMO use in Japan for COVID-19 associated ARDS: second ELSO webinar focused on the use of ECLS during the SARS-CoV-2 pandemics, run on March 30th. Highlights:
case presentation of patient from Diamond Princess cruise ship requiring ECLS
transport of patients on extracorporeal support
coagulopathy on ECMO
& more… Here full video, and the slides, available for download.
Shingo Ichiba, Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Tokyo, Japan.
ECMO for COVID-19-Experience in Japan
Keibun Liu, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan:
An assessment of aerosolization via membranous oxygenator and coagulopathy in COVID-19
Ryuzo Abe, Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan:
Multiple Organ Dysfunction in COVID-19 Cases
Ichiro Takeuchi, Advanced Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan:
How we treat Cruise Ship Diamond Princess with 3700 passengers
Takayuki Ogura, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan:
ECMO case in Utsunomiya Hospital
Here some suggested readings related to the webinar topic, all full texts are open access:
First article report a case of successful implementation of veno-venous ECMO on a cruise passenger tested positive for SARS-CoV-2 Coronavirus https://bit.ly/2UOHFIR
A report describing findings from the initial phase of a cruise ship investigation into COVID-19 cases among crew members during quarantine. Full text
Data about chronology of COVID-19 cases on the cruise ship, with ethical considerations related to infection control, including the reasonable justification for isolation, the psychological fragility and quality of life of the isolated passengers and crew members, the procedural justice inherent in a forced quarantine, and the optimization of control measures. Full text.
First Extracorporeal Life Support Organization webinar dedicated to the role of extracorporeal support in patients with SARS-CoV-2 infection, speakers:
Michael A. Matthay, MD Departments of Medicine & Anesthesia Cardiovascular Research Institute University of California, San Francisco
Acute Respiratory Distress Syndrome – with Special Reference to COVID-19
A/Prof Kiran Shekar, Adult Intensive Care Services and Critical Care Research Group – The Prince Charles Hospital, Brisbane, Australia
Provision of ECMO During COVID-19 and Other Pandemics
K.R. Ramanathan, Department of Cardiothoracic Intensive Care Unit, Dept of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore.
Infection Control Measures during ECMO for CoVID-19
Here full video, and all the slides, available for download.
Open access book: COVID-19 prevention & treatment by First Affiliated Hospital, Zhejiang University School of Medicine: three sections,
infection prevention and control management
diagnosis & management
including an ECMO support for SARS-CoV-2 section: timing for implementing ECLS, configuration & settings, management, monitoring & complications: waiting for more data from ECMOCARD study!
Thanks to the authors & editors for writing and sharing as open access this important resource!
Managing airways in confirmed/suspected COVID-19 patients
Patients infected by SARS-CoV-2 Coronavirus may develop severe pneumonia induced by COVID-19, eventually requiring invasive mechanical ventilation to support gas exchange; in these subjects, endotracheal intubation needs to be performed. Given the potential for aereosol/droplets generation, this procedure is one of the highest-risk moments for spreading the disease, and any effort should be made to minimize this risk, maximizing safety of any of the healthcare providers performing intubation, or involved in, and patients’ safety too. Here a collections of free open access checklists, algorithms & infographics focused on this current & complex topic. All of these are reproduced with permission (random order!). Note: given continuously evolving evidence about this topic, as more data are continuously collected/published, these advices may potentially need to be updated in the near future.
This the algorithm for airways management in COVID-19 patients proposed by SIAARTI, Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (Italian Society of Anesthesia, Analgesia and Intensive Care) available for download, along with other interesting documents on the SIAARTI website. This document include:
double check for indications for endotracheal intubation
tube position control and protective ventilation
Authors: M. Sorbello, I. Di Giacinto, F. Bressan, R. Cataldo, G. Cortese, C. Esposito, S. Falcetta, G. Merli , F. Petrini SIAARTI airways management study group.
Department of Anaesthesia and Intensive Care – The Chinese University of Hong Kong
Here an amazing graphics with principles of airway management in suspected or confirmed COVID-19 patients which may apply to Operative Room, Intensive Care Unit, Emergency Department and, eventually, ward; similar principles may be applied at extubation, by Albert Chan (@gaseousXchange on twitter) realized for the Department of Anaesthesia and Intensive Care – The Chinese University of Hong Kong, and proposed in lot of different languages (English, French, Spanish, Italian, German, Japanese, Portuguese, and simplified Chinese), with the purpose to try helping clinicians around the world; all versions are available for download here (high resolution) .
Criticalcarenorthampton & Propofology
The following represent a proposal of checklists when considering or performing airway intervention in suspected (& confirmed) COVID-19 patients, with pre-intubation, intubation and post-intubation approach , made by a collaborative group including (random order): Dr Jonny Wilkinson, Dr David Lyness, The ICS – Intensive Care Society, and the Midlands Coronavirus ITU Group. Proposed in different styles…
First one by Jonny Wilkinson (follow him on twitter @Wilkinsonjonny) available for download at Criticalcarenorthampton.com, with lot of COVID-19 resources including an intubation COVID trolley set up checklist.
The other two amazing ones by David Lyness: check COVID-19 dedicated page on his blog, Propofology blog (full resolution infographics & tons of other educational stuff related to SARS-CoV-2 infection), and follow him on twitter @Gas_Craic.
An update of the Alfred ICU guidelines for intubation of critically ills to include an appendix with specific considerations for SARS-CoV-2, outlining modifications for suspected COVID19 has been published by Julia Coull & Chris Nickson (follow them on twitter, @julia_coull & @precordialthump) check & download full document on Intensive Blog.
In the last infographics, emerging best practices for performing tracheal intubation in this population, based on current evidence from China and prior understanding of SARS. Focus on what to do/avoid in this setting!
By Patrick Boreskie and published on CanadiEM website!
The Extracorporeal Life Support Organization, ELSO, is the global nonprofit organization for ExtraCorporeal Membrane Oxygenation (ECMO) and Extracorporeal Life Support (ECLS). We are working with our partners across the globe on the response to COVID-19 as it relates to the use of ECMO for supporting patients infected with the virus.
We are relying on the same sources as others for accurate information related to the rapidly evolving COVID-19 virus epidemiology. Specifically, we will continue to rely on the World Health Organization, the Centers for Disease Control, as well as, local health officials and governments as the situation evolves. We remain a real-time authoritative resource because of ELSO’s global member centers which provide up-to-date information and data to allow our physicians and scientists to continually edit our recommendations.
COVID-19 can cause respiratory distress in some patients. ECMO has proven to be an effective option to support selective patients with severe respiratory distress, some of which are COVID-19 patients. We are tracking this information globally, including as part of our registry.
In addition, we are launching new studies and data sharing agreements with our partners across the globe. As an example, our Asia Pacific ELSO Chapter is coordinating efforts across the Asia Pacific region and globally to study ECMO in the treatment of patients with COVID-19. The group’s trial, ExtraCorporeal Membrane Oxygenation for Coronavirus 19 Acute Respiratory Distress (ECMOCARD) will study the clinical data of COVID-19 patients where ECMO treatment was provided in more than 50 hospitals across 4 continents and 19 countries. This study has been endorsed by the World Health Organization and the international ECMO research group, ECMONet.
As new studies and results emerge, we will share relevant information on our website. We will be updating this information with the urgency that this situation requires. We will have a link from our homepage: http://www.elso.org, social media sites on Twitter, Facebook, LinkedIn, and our ELSO ECMOed blog on COVID 19.
ELSO ECMOed blog
We are committed to coordinating with our ECLS centers across the globe and sharing updated information as this situation warrants.
Thank you, and stay healthy.
Dr. Mark Ogino, ELSO President
ECMO in COVID-19
To date, there is limited worldwide experience with using ECMO in COVID-19 patients. The ELSO – Extracorporeal Life Support Organization continues to collect data through our member centers, and will provide recommendations as additional information becomes available. Moreover, to support the ECMO providers community, we are going to host a series of webinars to answer main questions related to Coronavirus outbreak and induced disease COVID-19 & the use of ECMO, involving leaders in the field of intensive care medicine and extracorporeal support ECLS. Any question, doubt or concern? Any particular topic you would like our expert to address?
Send all questions to firstname.lastname@example.org or through DM & stay tuned, info on date/timing coming soon!