TABLE 1.
Patient characteristics
| Case number | #1 | #2 | #3 | #4 | #5 |
|---|---|---|---|---|---|
| Age, years | 54 | 53 | 66 | 57 | 30 |
| Sex | Male | Male | Male | Male | Female |
| BSA (m2) | 1.94 | 1.89 | 1.83 | 1.85 | 1.65 |
| BMI (kg/m2) | 26.4 | 24.7 | 24.3 | 23.9 | 21.6 |
| Onset to MV (days) | 8 | 11 | 9 | 6 | 8 |
| MV to ECMO (days) | 6 | 9 | 7 | 19 | 6 |
| Comorbidities | DLP, heavy smoker | DM | HTN, ex‐Smoker | Asthma, HTN, DLP, COPD | Postpartum |
| CRRT before ECMO | Yes | Yes | |||
| Medication for COVID‐19 | Favipiravir, HCQ, Ciclesonide, Tocilizumab | Favipiravir, HCQ, Tocilizumab | Favipiravir, HCQ, Tocilizumab, steroid pulse, and IVIG | Favipiravir, HCQ | Favipiravir, HCQ, Ciclesonide, Tocilizumab, steroid pulse, and IVIG |
| Indications (before ECMO) | |||||
| PEEP | 10 | 12 | 16 | 10 | 15 |
| P/F | 141 | 127.5 | 42.6 | 137 | 99.6 |
| PaCO2 | 80.6 | 125 | 38.6 | 62.1 | 47.2 |
| pH | 7.213 | 7.049 | 7.359 | 7.269 | 7.404 |
| LDH | 339 | 379 | 1205 | 389 | 574 |
| Other | Hemodynamic instability with acidosis | Acidosis | Hypoxia | Pneumothorax | Progressive worsening |
| ECMO settings | |||||
| Outflow site | Rt IJ | Rt IJ | Rt FV | Rt IJ | Rt IJ |
| Cannula size, depth | 19 Fr, 12 cm | 19 Fr, 12 cm | 19 Fr, 46 cm | 19 Fr, 13 cm | 17 Fr, 13 cm |
| Drainage site | Rt FV | Rt FV | Lt FV | Lt FV | Rt FV |
| Cannula size, depth | 24 Fr, 45 cm | 24 Fr, 43 cm | 24 Fr, 39 cm | 24 Fr, 47 cm | 24 Fr, 43 cm |
| Plateau ECMO Flow (mL/kg) | 66.7 | 68.5 | 65.6 | 70.8 | 76.6 |
| Pump exchange | 1 | – | 3 | – | – |
| Cannula exchange | – | – | Yes a | – | – |
| Anticoagulation | |||||
| Heparin b (unit/kg/hr) | 15.7 | 16.2 | 11.7 | 22.1 | 21.2 |
| Nafamostat b (mg/kg/hr) | 0.021 | 0.016 | 0.029 | 0.017 | 0.014 |
| Outcomes | |||||
| ECMO duration | 21 | 9 | 81 | 9 | 8 |
| P/F after ECMO | 229 | 356 | 333 | 210 | |
| PaCO2 after ECMO | 54.5 | 44.6 | 50.7 | 50.8 | |
| Outcome | Discharged | Discharged | Died on ECMO | Discharged | Discharged |
| Complications during ECMO | |||||
| Hemorrhagic event | Hematuria | – | Intramuscular hemorrhage | – | Intramuscular hemorrhage |
| Hemopneumothorax | |||||
| Thrombotic event | – | – | – | – | – |
Abbreviations: BMI, body mass index; BSA, body surface area; COPD, chronic obstructive pulmonary disease; CRRT, continuous renal replacement therapy; DLP, dyslipidemia; DM, diabetes mellitus; FV, femoral vein; HCQ, hydroxychloroquine; HTN, hypertension; IJ: internal jugular vein; IVIG: intravenous immunoglobulin therapy; LDH, lactate dehydrogenase; Lt, left; P/F, PaO2/FiO2; MV, invasive mechanical ventilation; Rt, right.
a
The initial cannulas were suspected to be infected with Staphylococcus aureus and exchanged to a new dual lumen single catheter via right internal jugular vein after 30 days of support.
b
Maximum dose.