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[Artigo] Preparing for the Most Critically Ill PatientsWith COVID-19 The Potential Role of Extracorporeal Membrane Oxygenation

The novel coronavirus has now infected tens of thousands of people in China and has spread rapidly around the globe. The World Health Organization (WHO) has declared the disease, coronavirus disease 2019 (COVID-19), a Public Health Emergency of International Concern and released interim guidelines on patient management.2Early reports that emerged fromWuhan, the epicenter of the outbreak, demonstrated that the clinical manifestations of infection were fever, cough,
and dyspnea, with radiological evidence of viral pneumonia.3,4Approximately 15% to 30% of these patients developed acute respiratory distress syndrome (ARDS). The WHO interim guidelines made general recommendations for treatment of ARDS in this setting, including that consideration be given to referring patients with refractory hypoxemia to expert centers capable of providing extracorporealmembrane oxygenation (ECMO).

ECMO is a form of modified cardiopulmonary bypass in which venous blood is removed from the body and pumped through an artificial membrane lung in patients who have refractory respiratory or cardiac failure. Oxygen is added, carbon dioxide is removed, and blood is returned to the patient, either via another vein to provide respiratory support or a major artery to provide circulatory support. ECMO is a resource-intensive, highly specialized, and expensive form of life support with the potential for significant complications, in particular hemorrhage and nosocomial infection. Recent evidence suggests that use of ECMO in themost severe cases of ARDS
is associated with reducedmortality.6 There is some evidence that outcomes from ECMO are better in highervolume centers.

 

The role of ECMO in the management of COVID-19 is unclear at this point. It has been used in some patients with COVID-19 in China but detailed information is unavailable.3 ECMO may have a role in the management of some patients with COVID-19 who have refractory hypoxemic respiratory failure.6 However, much about the virus is unknown, including the natural history, incidence of late complications, viral persistence, or the prognoses in different subsets of patients. This uncertainty might be compared to the emergence of influenza A(H1N1) in 2009, when it was initially unclear what the role of ECMO should be.

 

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