Question

Role of ECMO in management of Covid-19 pneumonia.

Hint:

ECMO is a critical intervention for patients with severe respiratory and cardiac failure in Covid-19 pneumonia, but it requires careful patient selection and management to prevent complications.

Answer 1

Step 1: Introduction to ECMO:
Extracorporeal membrane oxygenation (ECMO) is a life-saving procedure used to provide prolonged cardiac and respiratory support to patients whose heart and lungs are severely compromised. In the case of Covid-19 pneumonia, ECMO is utilized when conventional mechanical ventilation and other supportive therapies fail to improve oxygenation and gas exchange.
Step 2: Indications for ECMO in Covid-19 Pneumonia:
ECMO is considered in the following situations:
1. Severe ARDS: Patients with ARDS due to Covid-19 pneumonia who fail to respond to mechanical ventilation or proning.
2. Refractory Hypoxemia: When blood oxygen levels remain dangerously low despite maximal ventilator support.
3. Cardiac Arrest or Shock: In patients with severe cardiac dysfunction or shock, ECMO can help support both cardiac and respiratory functions.
4. Failure to Wean from Mechanical Ventilation: If the patient cannot be weaned off mechanical ventilation after a prolonged period, ECMO can help facilitate recovery.
Step 3: ECMO Technique:
During ECMO, blood is drawn from the patient’s body, oxygenated through a membrane oxygenator, and then returned to the body. ECMO can be delivered in two main configurations:
1. Venovenous (VV) ECMO: Provides respiratory support by circulating blood through a circuit that involves the venous system only. It is used when the primary issue is respiratory failure.
2. Venoarterial (VA) ECMO: Provides both cardiac and respiratory support by drawing blood from the venous system and returning it to the arterial system. It is used when there is significant cardiac failure alongside respiratory failure.
Step 4: Complications of ECMO:
While ECMO can be life-saving, it comes with risks such as:
- Bleeding complications: Due to the use of anticoagulation during ECMO.
- Infection: Due to the prolonged use of catheters and cannulas.
- Organ failure: Due to prolonged support and complications arising from ECMO itself.
Step 5: Outcome and Prognosis:
ECMO offers survival benefits in Covid-19 pneumonia patients with severe ARDS and refractory hypoxemia. However, its use is associated with significant morbidity, and patients may require long-term rehabilitation.