ArticleTherapeutic advances in respiratory disease
Optimizing the safety and efficacy of the awake venovenous extracorporeal membrane oxygenation in patients with COVID-19-related ARDS.
Article in Therapeutic advances in respiratory disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Awake vs. Sedated Cannulation for Extra-Corporeal Membrane Oxygenation in Patients with COVID-19 Induced Acute Respiratory Distress Syndrome.Journal of clinical medicine · 2026Article
- Extracorporeal membrane oxygenation with single-site dual-lumen in a patient with SARS-CoV-2-associated acute respiratory distress syndrome: a case report.Frontiers in medicine · 2026Article
- Delirium in Extracorporeal Membrane Oxygenation (ECMO) Patients: A Systematic Review and Meta-Analysis of Prevalence, Risk Factors, and Outcomes.Journal of clinical medicine · 2025Review
- Lessons Learned From Awake ECMO Approach in Covid-19-Related Acute Respiratory Distress Syndrome - a Scoping Review.Therapeutics and clinical risk management · 2025Review
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Authors and funding
9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundMaintaining the patient awake and not intubated during the venovenous extracorporeal membrane oxygenation (VV ECMO) reduces the risk of ventilation-induced lung injury in patients with ARDS. Currently, there is a lack of data on outcomes and complications associated with the awake ECMO approach.
objectivesTo evaluate outcomes and the occurrence of complications of awake ECMO approach guided by local safety protocol comprising ultrasound-guided cannulation, argatroban-based anticoagulation, respiratory support, and routine sedation targeted to reduce respiratory effort and keeping nurse-to-patient ratio of 1:1.
designA single-center retrospective case series analysis.
methodsConsecutive patients with COVID-19-related acute respiratory distress syndrome (ARDS) (CARDS) treated by full awake VV ECMO approach from April 2019 to December 2023 were eligible.
resultsOur center treated 10 patients (mean age 54.7 ± 11.6 years) with CARDS with an awake ECMO approach. The reasons for awake ECMO included the presence of barotrauma in six patients, a team consensus to prefer awake ECMO instead of mechanical ventilation in three patients, and the patient's refusal to be intubated in one case. Before ECMO, patients were severely hypoxemic, with a mean value of Horowitz index of 48.9 ± 9.1 mmHg and a mean respiratory rate of 28.8 ± 7.3 breaths per minute on high-flow nasal cannula or noninvasive ventilation support. The mean duration of awake VV ECMO was 558.0 ± 173.6 h. Seven patients (70%) were successfully disconnected from ECMO and fully recovered. Intubation from respiratory causes was needed in three patients (30%), all of whom died eventually. In total, three episodes of delirium, two episodes of significant bleeding, one pneumothorax requiring chest tube insertion, and one oxygenator acute exchange occurred throughout the 5580 h of awake ECMO. No complications related to cannula displacement or malposition occurred.
conclusionThe awake ECMO strategy guided by safety protocol appears to be a safe approach in conscious, severely hypoxemic, non-intubated patients with COVID-19-related ARDS.
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