RCT 242: ECMO, COVID-19, ARDS & Respiratory failure

What is ECMO? (4)

1. Replaces the function of the heart and lungs

2. Used for severe and life-threatening illness

3. Provides temporary cardiorespiratory support → provides oxygen, removes carbon dioxide, supports perfusion

4. Provides time for recovery in severe, reversible respiratory or cardiac failure when conventional therapies fail

What is the placement of the cannulas is called?

Cannulation

What is venoarterial?

Provides complete or partial cardiac and/or cardiopulmonary

support (heart and lungs)

When to use venoarterial examples

1. Cardiogenic shock

2. Cardiac arrest

3. Combined cardiac-respiratory failure

What is venovenous? 

Provides complete or partial support to the lungs

When to use venovenous example

Severe hypoxemic or hypercapnic RF (ARDS, Covid-19)

Complications of ECMO

1. Bleeding

2. Infection

3. Lower extremity ischemia

4. Lower extremity amputation

5. Compartment syndrome

6. Stroke

7. Air embolism

8. Acquired von Willebrand syndrome

9. Disseminated intravascular coagulopathy

10. Hemolysis

11. Tamponade

Contraindications of ECMO

1. Advanced age

2. Comorbid conditions → malignancy, nonpulmonary

organ dysfunction (emphysema, cirrhosis, renal failure), immunodeficiency or pharmacologic immune suppression

3. Severe aortic incompetence and aortic dissection

4. Prolonged CPR without adequate tissue perfusion

5. Anticoagulation issues

6. Obesity

What are the 3 main variables of ECMO?

1. Blood flow

2. Fraction of O2 in the sweep gas

3. Sweep gas flow rate

Management of ECMO

1. Minimize lung injury from mechanical ventilation (“lung rest” strategies: low VT, low driving pressures, moderate PEEP)

2. Careful monitoring of anticoagulation

3. Continuous heparin infusion is utilized to prevent clotting in the circuit

4. Instituting adequate physical therapy – ambulate when possible

How was COVID-19 caused?

Disease caused by a virus SARS-CoV-2

What are some pulmonary effects of COVID-19?

1. Fluid and cellular exudation, hyaline membrane formation

2. Organizing pneumonia

3. Airway inflammation

4. Increased capillary permeability

What are some cardiac effects of COVID-19?

Ischemic injury with plaque rupture and thrombosis

What are some renal effects of COVID-19?

Systemic abnormalities such as diabetes, hypertension, hypoxemia may lead to acute kidney injury

What are some neurological effects of COVID-19?

ACE2 receptors in cerebral cortex and brain stem are affected

What are some skin effects of COVID-19?

1. Similar to chronic inflammatory diseases such as acne, eczema, psoriasis, and rosacea

2. May have fluid filled blisters, rashes

What are some psychological effects of COVID-19?

May show inattention, disorientation, poorly organized movements, anxiety, depression, and post-traumatic stress disorder

How does COVID-19 spread?

Spreads when an infected person breathes out droplets and small particles → others may breathe in these droplets or touch contaminated surfaces

What are some symptoms of COVID-19?

1. Fever, chills

2. Cough

3. Shortness of breath

4. Fatigue

5. Muscle or body aches

6. Headache

7. New loss of taste or smell

8. Sore throat

9. Congestion or runny nose

10. Nausea or vomiting

11. diarrhea

What do typical CXR look like for COVID-19 patients?

1. Bilateral patchy and confluent

2. Bandlike ground-glass

3. Consolidative opacity in a peripheral

4. Mid to lower lung zone distribution

Which COVID-19 testing is more reliable?

NAATs

What are some risk factors for COVID-19?

Immunocompromised patients:

 Tumor or hematologic malignancies

 Organ transplant or on

immunosuppressive therapy

 Advanced or untreated HIV

 Active high dose corticosteroids

Medical conditions:

 Advanced age

 Chronic lung diseases

 Chronic kidney and liver disease

 Diabetes

 Neurological conditions

 Cardiac issues

 Obesity

 Pregnancy

True or False: There are treatments for COVID-19?

True

What is “Awake Prone” position?

It is a position used to help critically ill COVID-19 patients

What is some post covid or long covid conditions?

1. Fatigue

2. Symptoms that worsen after physical or mental effort

3. Fever

4. SOB

5. Cough

6. Chest pain

7. Heart palpitations

Post-Covid Conditions

• Symptoms continued:

8. Difficulty thinking or concentrating

9. Headache

10. Sleep issues

11. Depression/anxiety

12. Diarrhea

13. Changes in menstrual cycles

14. Joint or muscle pain

15. Rash

True or False: Long covid may last weeks to months and year?

True