Efficacy of Multidisciplinary Team Approach with Extracorporeal Membrane Oxygenation for COVID-19 in Low Volume ECMO Center

Abstract

Veno-venous extracorporeal membrane oxygenation (VV ECMO) is an effective and proven adjunct support for various severe respiratory failure requiring invasive mechanical ventilation and cardiovascular support. In response to the rapidly increasing number of COVID-19 patients in Japan, we launched an ECMO support team comprised of multidisciplinary experts including physicians, nurses, perfusionists, and bioethicists in preparation for the threat of a pandemic. Since April 2nd to July 15th, 2020, Tokyo Medical and Dental University hospital have treated 104 of PCR confirmed COVID-19 patients. Among those, 34 patients were admitted to ICU and 5 patients required VV ECMO. All management related to ECMO were decided by ECMO support team in addition to participation of the ECMO support team in daily multidisciplinary rounds in the ICU. Median age was 54 years old. Duration from onset to mechanical ventilation (MV) and MV to ECMO were 8 and 7 days respectively. Four patients (80%) were successfully weaned off from ECMO. One patient died after 81 days of ECMO run. Four patients were discharged and recovered to their pre-hospital quality of life without major disability. We achieved a high survival rate using ECMO in our low volume ECMO institution during COVID-19 pandemic. Multidisciplinary decision makings and team approach for the unclear pathology with emerging infectious disease was effective and contributed to the survival rate.