Pre-ECMO Management-
All patients excluding outside transfers were admitted and managed with
lung protective ventilation, NMB, and prone positioning. Twelve of the
fifteen patients were managed with lung protective ventilation prior to
initiation of ECMO. The three patients that were not treated with lung
protective ventilation were patients transferred to our institution from
outside hospitals. Of the three transfers, one patient expired
peri-cannulation, one patient was decannulated after 17 days and remains
on MV, and one patient was successfully decannulated on ECMO day 16 and
has been discharged to home. Patients supported on mechanical
ventilation without lung protective ventilation remained on ECMO longer
than those that only received lung protective ventilation. Neuromuscular
blockade was utilized in 14 of 15 patients. The NMB exception was a
patient transferred from an outside hospital who expired immediately
after cannulation. 14 of 15 patients were placed in the prone position.
The exception to prone positioning was due to body habitus limitations
(BMI 44). Two patients did not receive inhaled vasodilator therapy prior
to ECMO cannulation; seven received inhaled epoprostenol and six
received inhaled nitric oxide. From onset of Covid-19 symptoms to
initiation of ECMO, the average time was 14 days, with a range of 4 - 29
days. The average duration of mechanical ventilation (MV) prior to ECMO
was 4.5 days, with a range of 1-9 days. As expected, all patients had
elevated inflammatory markers (d-dimer, CRP, ferritin). The Pre-ECMO
characteristics of the patients are listed in Tables 1 & 2.