Extracorporeal cardiopulmonary resuscitation for hypoxemic cardiac arrest secondary to COVID-19

Introduction: Due to the anticipated poor outcome, risk of health care worker exposure, and potential limited resource capacity during a pandemic, extracorporeal cardiopulmonary resuscitation (ECPR) in the COVID-19 population has been discouraged Exception to this recommendation is when an arrest occurs in a patient already being evaluated or treated with extracorporeal membrane oxygenation (ECMO) To date, experience in this subset of patients has been limited Methods: A retrospective review was performed for all patients supported with ECMO during the COVID-19 pandemic from March 2020 to August 2020 at a single institution including patient demographics, cannulation strategies, outcomes, and complications Results: During the study period, 32 patients were supported with ECMO Twenty-nine patients were supported with venovenous (VV) ECMO alone;3 patients suffered cardiac arrest secondary to an acute episode of hypoxemia requiring ECPR: 1 upon presentation and 2 while already supported on VV ECMO All 3 patients were subsequently transitioned from venoarterial (VA) to veno-arterio-venous (VAV) ECMO to VV ECMO;1 has been weaned off ECMO and discharged alive, 1 has been weaned off ECMO and remains in the ICU on mechanical ventilation, and 1 remains on VV ECMO None of the patients suffered any complications related to the cannulation procedure None of the patients suffered any neurological complications and have a Cerebral Performance Category scale (CPC) of 1 Conclusions: ECPR is safe and feasible in COVID-19 patients being evaluated or treated with ECMO Centers with significant ECPR experience should consider this option in COVID-19 patients