Lessons Learned From Awake ECMO Approach in Covid-19-Related Acute Respiratory Distress Syndrome - a Scoping Review.

IF 2.8 3区 医学 Q1 Pharmacology, Toxicology and Pharmaceutics
Therapeutics and Clinical Risk Management Pub Date : 2025-05-13 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S507120
Peter Sklienka, Filip Burša, Michal Frelich, Jan Máca, Tereza Romanová, Vojtěch Vodička, Hana Straková, Markéta Bílená, Ondřej Jor, Jan Neiser, Hana Tomášková
{"title":"Lessons Learned From Awake ECMO Approach in Covid-19-Related Acute Respiratory Distress Syndrome - a Scoping Review.","authors":"Peter Sklienka, Filip Burša, Michal Frelich, Jan Máca, Tereza Romanová, Vojtěch Vodička, Hana Straková, Markéta Bílená, Ondřej Jor, Jan Neiser, Hana Tomášková","doi":"10.2147/TCRM.S507120","DOIUrl":null,"url":null,"abstract":"<p><p>During the COVID-19 pandemic, specific COVID-19-related conditions renewed interest in the full-awake venovenous extracorporeal membrane oxygenation ( <i><sup>fa</sup></i> V-V ECMO) approach, in which ECMO is applied to awake, cooperative, and non-intubated patients. This scoping review aims to provide a descriptive overview of <i><sup>fa</sup></i> V-V ECMO in patients with COVID-19-related acute respiratory distress syndrome (CARDS). We searched the PubMed, Web of Science, and Scopus databases using the keywords \"awake ECMO\" or \"spontaneous breathing AND ECMO\", combined with \"COVID-19\", \"SARS-CoV-2\" or \"coronavirus\", utilizing the Boolean operator \"AND\". The search included papers published from November 1, 2019, to December 31, 2024. Sixty-four papers were assessed for eligibility at the abstract level, and fourteen articles (seven small-sample cohort studies and seven case reports) comprising 95 patients were included in the final analysis. The most frequent reasons for preferring <i><sup>fa</sup></i> V-V ECMO over mechanical ventilation were barotrauma and patient refusal of intubation and mechanical ventilation. The <i><sup>fa</sup></i> V-V ECMO strategy was successful (ie, patients not intubated, disconnected from ECMO, and discharged from the hospital) in 36.4% of cases (cohort studies only). The incidence of defined severe adverse events (bleeding, thrombosis, cannula malposition, delirium, and progression of barotrauma) was considered low. The mortality rate for CARDS patients treated with <i><sup>fa</sup></i> V-V ECMO (including only patients from cohort studies) reached 33.0%, notably lower than the 48% reported for CARDS patients treated with V-V ECMO in the ELSO registry. Patients who were intubated due to worsening respiratory failure during <i><sup>fa</sup></i> V-V ECMO had significantly higher mortality. Infectious complications, sepsis, and multiorgan failure were the most frequent causes of death. However, significant heterogeneity in the definitions and reporting of management, ECMO-related complications, and outcomes was observed across the papers. Despite the heterogeneity of the data, <i><sup>fa</sup></i> V-V ECMO in CARDS patients can be considered a safe approach associated with a lower mortality rate than that reported in the overall V-V ECMO CARDS population.</p>","PeriodicalId":22977,"journal":{"name":"Therapeutics and Clinical Risk Management","volume":"21 ","pages":"655-668"},"PeriodicalIF":2.8000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085139/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutics and Clinical Risk Management","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2147/TCRM.S507120","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"Pharmacology, Toxicology and Pharmaceutics","Score":null,"Total":0}
引用次数: 0

Abstract

During the COVID-19 pandemic, specific COVID-19-related conditions renewed interest in the full-awake venovenous extracorporeal membrane oxygenation ( fa V-V ECMO) approach, in which ECMO is applied to awake, cooperative, and non-intubated patients. This scoping review aims to provide a descriptive overview of fa V-V ECMO in patients with COVID-19-related acute respiratory distress syndrome (CARDS). We searched the PubMed, Web of Science, and Scopus databases using the keywords "awake ECMO" or "spontaneous breathing AND ECMO", combined with "COVID-19", "SARS-CoV-2" or "coronavirus", utilizing the Boolean operator "AND". The search included papers published from November 1, 2019, to December 31, 2024. Sixty-four papers were assessed for eligibility at the abstract level, and fourteen articles (seven small-sample cohort studies and seven case reports) comprising 95 patients were included in the final analysis. The most frequent reasons for preferring fa V-V ECMO over mechanical ventilation were barotrauma and patient refusal of intubation and mechanical ventilation. The fa V-V ECMO strategy was successful (ie, patients not intubated, disconnected from ECMO, and discharged from the hospital) in 36.4% of cases (cohort studies only). The incidence of defined severe adverse events (bleeding, thrombosis, cannula malposition, delirium, and progression of barotrauma) was considered low. The mortality rate for CARDS patients treated with fa V-V ECMO (including only patients from cohort studies) reached 33.0%, notably lower than the 48% reported for CARDS patients treated with V-V ECMO in the ELSO registry. Patients who were intubated due to worsening respiratory failure during fa V-V ECMO had significantly higher mortality. Infectious complications, sepsis, and multiorgan failure were the most frequent causes of death. However, significant heterogeneity in the definitions and reporting of management, ECMO-related complications, and outcomes was observed across the papers. Despite the heterogeneity of the data, fa V-V ECMO in CARDS patients can be considered a safe approach associated with a lower mortality rate than that reported in the overall V-V ECMO CARDS population.

Abstract Image

清醒ECMO方法治疗covid -19相关急性呼吸窘迫综合征的经验教训——一项范围综述
在COVID-19大流行期间,与COVID-19相关的特定疾病重新引起了人们对全清醒静脉-静脉体外膜氧合(fa V-V ECMO)方法的兴趣,该方法将ECMO应用于清醒、合作和非插管的患者。本综述旨在对covid -19相关急性呼吸窘迫综合征(CARDS)患者的fa V-V ECMO进行描述性概述。我们使用“清醒ECMO”或“自发呼吸和ECMO”等关键词,结合“COVID-19”、“SARS-CoV-2”或“冠状病毒”,使用布尔运算符“and”进行检索PubMed、Web of Science和Scopus数据库。搜索包括2019年11月1日至2024年12月31日发表的论文。64篇论文被评估为符合摘要水平,14篇文章(7篇小样本队列研究和7篇病例报告)包括95名患者被纳入最终分析。选择fa V-V ECMO而非机械通气的最常见原因是气压创伤和患者拒绝插管和机械通气。在36.4%的病例中,fa V-V ECMO策略是成功的(即患者没有插管,断开ECMO,出院)(仅限队列研究)。严重不良事件(出血、血栓形成、套管错位、谵妄和气压创伤进展)的发生率被认为很低。接受fa V-V ECMO治疗的CARDS患者的死亡率(仅包括来自队列研究的患者)达到33.0%,明显低于ELSO登记中报道的接受V-V ECMO治疗的CARDS患者的48%。在fa - V-V ECMO期间因呼吸衰竭加重而插管的患者死亡率明显较高。感染并发症、败血症和多器官衰竭是最常见的死亡原因。然而,在定义和报告管理、ecmo相关并发症和结果方面,所有论文都观察到显著的异质性。尽管数据存在异质性,但与总体V-V ECMO卡人群报告的死亡率相比,在卡患者中进行fa V-V ECMO可被认为是一种安全的方法,其死亡率较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Therapeutics and Clinical Risk Management
Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-
CiteScore
5.30
自引率
3.60%
发文量
139
审稿时长
16 weeks
期刊介绍: Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信