Establishment of a Disaster Management-like System for COVID-19 Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation in Japan

Takayuki Ogura; Shinichiro Ohshimo; Keibun Liu; Yoshiaki Iwashita; Satoru Hashimoto; Shinhiro Takeda

doi:10.3390/membranes11080625

Establishment of a Disaster Management-like System for COVID-19 Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation in Japan

Membranes (Basel). 2021 Aug 14;11(8):625. doi: 10.3390/membranes11080625.

Authors

Takayuki Ogura¹, Shinichiro Ohshimo², Keibun Liu³, Yoshiaki Iwashita⁴, Satoru Hashimoto⁵, Shinhiro Takeda⁶

Affiliations

¹ Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation SAISEIKAI, Utsunomiya Hospital, Tochigi 321-0974, Japan.
² Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
³ Critical Care Research Group, The Prince Charles Hospital, Brisbane 4032, Australia.
⁴ Department of Emergency and Critical Care Medicine, Shimane University, Shimane 693-8501, Japan.
⁵ Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan.
⁶ Kawaguchi Cardiovascular and Respiratory Hospital, Saitama 333-0842, Japan.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has increased the number of patients who require extracorporeal membrane oxygenation (ECMO). To manage the demand for ECMO, Japan ECMOnet for COVID-19 was developed as a "disaster management-like system", utilizing the Cross ICU Searchable Information System (CRISIS) database. This study investigated the effect of the establishment of this disaster management-like system in Japan. This was a nationwide retrospective observational study conducted from 1 February to 31 July in 2020. A total of 187 patients with COVID-19 who received ECMO were included. The median age was 60 years (interquartile range, 53-68), the median length of ventilatory support before ECMO was 3 days (1-5), and the median PaO₂ to FiO₂ ratio at ECMO initiation was 86 (71.3-101.5). During the study period, 165 telephone consultations were conducted, including general questions about ECMO. Among them, 44 concerned patients who were already on ECMO or who ultimately received ECMO. Further coordination, including transport and ECMO physician dispatch, was provided for 23 cases. Overall, 125/187 (66.8%) patients were successfully weaned from ECMO. This study demonstrated that Japan has achieved favorable survival outcomes for patients with COVID-19 who received ECMO with a disaster management-like system. Further research on the causes of these outcomes is needed.

Keywords: acute respiratory distress syndrome; coronavirus disease 2019; disaster management; extracorporeal membrane oxygenation; influenza; intensive care unit.