COVID-19 and management of ECMO/blood purification devices

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  • Suzuki Kenichi
    Department of Medical Engineering, Nippon Medical School Hospital
  • Nakayama Takuya
    Department of Medical Engineering, Nippon Medical School Hospital
  • Ichiba Shingo
    Department of Clinical Engineering and Intensive Care Medicine, Tokyo Women’s Medical University

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  • COVID-19とECMO/血液浄化装置の管理
  • COVID-19 ト ECMO/ケツエキ ジョウカ ソウチ ノ カンリ

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Abstract

<p>COVID-19 patients with BMI 30 or higher are more likely to become severely ill and are at increased risk of requiring ECMO. In addition, although the incidence of severe AKI in non-ECMO cases is not high, patients with ECMO are often complicated with severe AKI, requiring combination therapy with CRRT. It has been pointed out that cytokine storms are involved as a factor in the severity of the disease, and when performing CRRT, a hemofilter that has adsorptive properties for inflammatory cytokines could be selected. However, fibrinogen/fibrin degradation products and D-dimer tend to increase, and the CRRT treatment membrane tends to generate clot formation, which cause a shortening of life-time. It is necessary to monitor APTT etc. to adjust the dose of anticoagulant. If CRRT or HD is not possible due to equipment problem, it is necessary to consider treatment with high-flow RRT. In addition, in order to prevent infection of medical staffs, it is necessary to pay close attention and ingenuity to the management of drainage from CRRT and the equipment used. </p>

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