Risk for Perfusionist Infection When Caring for Patients on ECMO for COVID-19

Background: Nosocomial COVID-19 infections of healthcare providers remain a substantial concern with considerable theoretical risks due to exposures to infected patients Extra-corporeal membrane oxygenation (ECMO), as a modality to support critically ill COVID-19 patients, exposes the ECMO Specialist (ECMO-S)-charged with managing the circuit-to considerable risks for infection, but the risks are unclear The goal of this study is to examine the risks for infection for ECMO-S at our Perfusion-run program Methods: We explored the temporal risks for ECMO-S nosocomial infections in patients supported with ECMO for COVID-19 Results: Between 03/2020 and 06/2020, 14 perfusionists (ECMO-S) provided 1668 total hours (average: 119±84 hours/ECMO-S;range: 8-266 hours) of care to 8 ECMO patients Each patient was in strict airborne isolation precautions and in-room exposure was limited to cannulation, decannulation, and periodic circuit or patient management issues All ECMO-S were required to done and doff protective equipment using established national guidelines Three patients required renal replacement as part of the circuit, 4 oxygenator change outs were performed, and 7 patients were decannulated and discharged alive Total support ranged from 125-840 hours (405±286) using a combination of Maquet CardioHelp and Medtronic pumps- A ll with Maquet Quadrox-D oxygenators No ECMO-S developed symptoms, fevers, required treatment or isolation, or tested positive for COVID-19 within 3 weeks of the last exposure Conclusions: By using appropriate patient and ECMO-S precautions, even with considerable exposure risk to critically-ill patients, nosocomial COVID infection of ECMO-S was zero-but, in theory, the risks are potentially substantial