Critical care & ECMO in the era of COVID-19: why data matters! ELSO webinar, moderated by Dr. Robert Bartlett & Matt Paden, highlighting the current research underway focused on better understanding the impact of COVID-19, and the role of extracorporeal support and ICU care in patients with SARS-CoV-2 Coronavirus infection. Topics & speakers: ELSO Registry and the live dashboard for COVID-19 Cases: Matt Paden & Ryan Barbaro EuroELSO Survey on ECLS in COVID-19, Roberto Lorusso & Jan Bělohlávek COVID-Critical Care Consortium, John Fraser & Heidi Dalton
Here full replay!
… and some slides:
Barbaro R.: We always know data matters! since H1N1 pandemic: now, more than 10 years later, COVID- 19 presented uncertainty & dynamic understanding, but thanks to community data soon start arriving, through: ELSO Registry COVID-19 addendum and live dashboard COVID critical care consortium EuroELSO survey on ECMO in COVID-19
Lorusso R.: with @jan_belohlavek sharing (preliminary) data but really interesting insights from EuroECMO COVID, the scientific “adventure” of EuroELSO survey, amazing collection of data in really short ime, thanks to EuroELSO & collaborative centers.
Fraser J.: presenting COVID critical care consortium, global collaboration of more than 330 hospital across 50 countries, 1021 patients enrolled to date, aimed to characterize COVID-19 ICU pts, & its subgroups: we need data to get whole picture!
And please take the ongoing related surveys, ie neonatal and pediatric ICU & ECMO survey http://bit.ly/3d7MSmR aimed to acquire basic informations on neonates & pediatric SARS-CoV-2 Coronavirus patients requiring ICU admission/ECMO, or the ethics ECMO & pandemis survey.
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
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
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 nursing… 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 team preparation PPE donning/doffing clinical checklist airway instrumentation tube position control and protective ventilation transport. 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. Twitter Facebook Linkedin 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.
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!
ECMO in COVID-19 related severe cardiopulmonary failure: visual summary of the recently published ELSO – Extracorporeal Life Support Organization Consensus guideline: unique considerations on when & how to provide ECLS in SARS-CoV-2 Coronavirus pandemic, with potential indications/contraindications. Download full document at https://bit.ly/ELSOCOVID19
Surviving Sepsis Campaign COVID-19 guidelines to support management of critically ill ICU patients with SARS-CoV-2 Coronavirus infection: here a graphic summary! infection control, diagnosis & testing hemodynamics support monitoring, fluids & vasoactives non-invasive ventilatory support: SpO2 targets, conventional oxygen therapy, High Flow Nasal Cannula & Non-Invasive Positive Pressure Ventilation invasive mechanical ventilation: MV settings, recruitment maneuver, prone posi tioning, fluids, NMBAs & inhaled vasodilators therapy: steroids antipyretics, antivirals, IVIg, convalescent plasma, rIFNs, chloroquine, tocilizumab & more! full open access at https://bit.ly/SSCCOVID19
Basic advices & informal decisional algorithm by a study Group on management of critically ills COVID-19 patients based at Niguarda Ca’ Granda Hospital (Director Prof. R. Fumagalli) & Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico (Director Prof. A. Pesenti) in Milan, Italy: hot to set mechanical ventilation (initial acute phase, stabilization, weaning), hot to do recruitment maneuver & notes on porne positioning… to do or (maybe) not? therapy: antivirals/adjuvants (be careful with lopinavir/ritonavir!) antibiotics, fluids/NE, analgesia & sedation, NMBA temperature management monitoring Aim to stardardize treatments, optimizing outcome & resources consumption, and support physicians, nurses, HCPs dealing with severe respiratory failure related to COVID19, waiting for the response of the immune system, the most effective strategy! By Thomas Langer & Nicola Bottino Graphics by @foamecmo available both in English & Italian
Request full document with management advices to the authors Thomas Langer email@example.com & Nicola Bottino firstname.lastname@example.org
PS Advices are based on preliminary informations collected during the first experience in China, and during the first week of the emergency in Lombardy, Northern of Italy; additional data ad evidence eventually arising will impose updating the recommendations.
COVID-19 network in Lombardy to early identify, triage & manage SARS-CoV-2 Coronavirus patients: JAMA livestream with Professor Maurizio Cecconi, Here a summary… Do not underestimate! high percentage of patients will require hospitalization, high percentage will require intensive care: get ready, prepare now, work on protocols and have plans: outbreak could comes near to you!also check related paper by Prof Cecconi, Giacomo Grasselli and Antonio Pesenti just released on JAMA.
COVID19 dedicated GiViTI video conference with intensivists from North of Italy sharing their initial experience with Coronavirus SARSCoV19 epidemics: lung ultrasound LUS, prone positioning, MV, ECMO… it’s like a tsunami, you can’t understand if you are not in. Recordings of the conference (for the ones speaking in Italian!) available link thanks to Istituto Mario Negri
How to manage critically ills with COVID19? be prepared! be familiar with case definition, ensure strict compliance with IPC, beware of diagnostic testing… ESICM webinar with Prof Yaseen Arabi moderated by Lennie Derde. Here a graphics, slideset & summary available.
Missed the ESICM COVID-19 webinar with Professor Bin Du from China? here some dedicated notes: data about #Coronavirus pandemic, disease evolution, clinical features, organ failure & need for mechanical ventilation; check ESICM blog at for more data! full open access webinar here. A summary in the graphics.