Extracorporeal Membrane Oxygenation in Severe ARDS Secondary to Middle East Respiratory Syndrome Coronavirus

Abstract

Background:

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a novel betacoronavirus that was first reported in Saudi Arabia 2012. The majority of infected cases were reported in Saudi Arabia too. Extracorporeal membrane oxygenation (ECMO) is an option as a rescue therapy for patients with refractory hypoxemia and has been successfully used in young patients with severe ARDS secondary H1N1 influenza with refractory hypoxemia. Aim: We conducted a retrospective study to determine the mortality rate of severe ARDS secondary to MERS-CoV infection in response to ECMO therapy in our adult ICU.

Methods:

A retrospective analysis of data from all patients admitted to our adult 23-bed mixed ICU with MERS-CoV infection who developed severe ARDS and been mechanically ventilated between March 1, 2013 and August 30, 2016.

Results:

During the period from March 1, 2013 and August 30, 2016, 32 patients were admitted with severe ARDS secondary to MERS-CoV infection (mean age 54 ± 21 years, 25 [78.1%] males). Bilateral pulmonary infiltrates were reported in all patients. Invasive mechanical ventilation and ECMO therapy was applied in all patients and vasopressor therapy in 26 (81.2%) patients during the ICU stay. Twenty-four (75%) patients died in the ICU. Non-survivors were older and/or had high APACHE II scores on admission.

Conclusions:

Severe ARDS secondary to MERS-CoV infection is associated with high mortality. ECMO therapy was associated with better survival rates and outcomes in younger patients and the patients who had lower APACHE II scores.