Description

Abstract:

Background:

      The SARS-CoV-2 has emerged since December 2019 in Wuhan city, and has quickly spread throughout China and other countries.We are learning and experiencing this viral tsunami with limited data regarding management guidelines and patient outcomes.

Main Text:

Till date, no specific treatment has been proven to be useful for SARS-CoV-2 infection.According to WHO, management of coronavirus disease- 19 has mainly focused on infection prevention, case detection and monitoring, and supportive care.Extracorporeal membrane oxygenation has been proven to be an effective therapy in the treatment of respiratory failure or ARDS resulting from severe COVID-19 infection.Extracorporeal membrane oxygenation (ECMO) is usually associated with bleeding and coagulopathy complications, which requires transfusion of blood and blood components.

Conclusion:

This article reviews with available literature for the role of ECMO and its Blood Transfusion strategies in COVID-19 patients.

Key Words: COVID-19,Extra Corporeal Membrane Oxygenation,Blood Transfusion

Background:

        Coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome (ARDS) accounting for more number of cases and deaths all over the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, extracorporeal membrane oxygenation (ECMO) may be used.

      In April 7, 2020 — Food and Drug Administration (FDA) issued guidance to  expand the availability of devices used in extracorporeal membrane oxygenation (ECMO) therapy for COVID-19 patients.

Main Text

Evolution of ECMO:

       Kolff and Berk(1) in 1944 noted that blood became oxygenated as it passed through the cellophane chambers of their artificial kidney. This concept was applied in 1953 by Gibbon who used artificial oxygenation and perfusion support for the first successful open heart operation(2) . In 1965, Rashkind and colleagues were the first to use a bubble oxygenator as support in a neonate dying of respiratory failure(3).

Long-term ECMO for severe respiratory failure was first used in 1972 for adult patient with post-traumatic respiratory failure(4) . Kolobow developed a new membrane lung specifically for CO2 removal in chronic obstructive pulmonary disease patients(5) . In 1975, Bartlett et al. reported the first successful use of ECMO in neonates with severe respiratory distress(6) .

The CESAR trial showed a decline in death rate of patients with severe respiartory failure on treatment with ECMO(7).