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!
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.
Optimal site for providing extracorporeal cardio-pulmonary resuscitation ECPR in out-of-hospital cardiac arrest? maybe in the hospital, in the cath-lab better! here notes from the talk given by Jan Belohlavek, EuroELSO president, at EuroELSO2019 meeting: not ECLS alone, but a comprehensive approach including ECMO, with high quality bystander CPR/high quality ACLS, may have an impact on logistics for OHCA patients; we have technology but we still need to define proper patients & optimize logistics: randomized studies are absolutely necessary. Everything else is just an emotional bias. Visual abstract by @foamecmo See you at EuroELSO2020 Congress, next May 6-8 2020 in London! register here
Perfect prime for ECMO circuit?? We take care for neonates, pediatrics, growing number of adult patients… there is no gold standard that defines ideal prime, as no prime is going to fit all these populations, and sometimes is a race against time! here some notes freely based on the talk by Christine Franciscovich at 2019 ELSO Conference: clear & blood priming, and factors to be considered when choosing dilutional hematocrit calculation additives options: calcium, albumin, heparin, NaHcO3… lab/ABG on prime graphics by Velia Marta Antonini @foamecmo