63: Covid and ECMO – Who do we cannulate? with Jenelle Badulak

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“Normal life is changing.  It is now a covid 19 life” – Bin Cao

I write this with some trepidation as well as pride in the role we all get to play in Covid 19.  The sure in the US and many other places worldwide is just beginning.  It is on us to seek guidance from those who have gone through this already.  Today we will address the use of ECMO in Covid with an expert in ECMO who is in the throws of the worst outbreak of the United States – Seattle, Washington.  Jenelle Badulak and I give you a short yet powerful discussion about what Covid patients should receive ECMO.

Take homes for decision to initiate- comorbidities (HTN, DM especially), single organ dysfunction, young age, trajectory of course

Hosts – Jenelle Badulak, Zack Shinar

ECMO guidance for Coronavirus

• MERS ECMO Data
  • Alshahrani MS, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B, Zein A, Khatani N, Al-Hameed F, Alamri S, Abdelzaher M, Alghamdi A, Alfousan F, Tash A, Tashkandi W, Alraddadi R, Lewis K, Badawee M, Arabi YM, Fan E, Alhazzani W. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018 Jan 10;8(1):3. doi: 10.1186/s13613-017-0350-x. PubMed PMID: 29330690; PubMed Central PMCID: PMC5768582
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• Chinese Society of Extracorporeal Life Support. [Recommendations on extracorporeal life support for critically ill patients with novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb 9;43(0):E009. doi: 10.3760/cma.j.issn.1001-0939.2020.0009. [Epub ahead of print] Chinese. PubMed PMID: 32035430.
  • http://rs.yiigle.com/yufabiao/1180132.htm
  • Inclusion criteria under this paper are–>
  • Under optimal ventilation conditions (FiO ₂ ≥ 0.8, tidal volume 6 ml / kg, PEEP ≥ 10 cmH ₂ O), ECMO can be started if there are no contraindications and one of the following conditions is met ^{[ 7 , 8 , 14 , 16 , 17 , 18 ]} : (1) PaO ₂ / FiO ₂ <50 mmHg for more than 3 h; (2) PaO ₂ / FiO ₂ <80 mmHg for more than 6 h; (3) FiO ₂ = 1.0, PaO ₂ / FiO ₂ <100 mmHg; (4) Arterial blood pH <7.25 and PaCO ₂ > 60 mmHg for more than 6 hours, and respiratory rate> 35 times / min; (5) When respiratory rate> 35 times / min, blood pH <7.2 The plateau pressure was> 30 cmH ₂ O; (6) severe air leak syndrome; (7) combined with cardiogenic shock or cardiac arrest.

• Good overall webinar – ECMO considerations start – http://iv.docbook.com.cn/record/app-name/46020/2020-03-19-20-45-14_2020-03-19-21-40-14.mp4
  • Slides here – Ning Zhou-The application of ECMO in severe Covid-19 patients
• ELSO Guidance Document