{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T01:56:59Z","timestamp":1760234219924,"version":"build-2065373602"},"reference-count":96,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T00:00:00Z","timestamp":1618963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Membranes"],"abstract":"<jats:p>(1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status\/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients.<\/jats:p>","DOI":"10.3390\/membranes11050306","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T12:47:07Z","timestamp":1619009227000},"page":"306","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2302-733X","authenticated-orcid":false,"given":"Aakash","family":"Shah","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sagar","family":"Dave","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Galvagno","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristen","family":"George","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley R.","family":"Menne","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Haase","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Emergency Medicine, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"McCormick","sequence":"additional","affiliation":[{"name":"Perfusion Services, University of Maryland Medical Center, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raymond","family":"Rector","sequence":"additional","affiliation":[{"name":"Perfusion Services, University of Maryland Medical Center, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siamak","family":"Dahi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronson J.","family":"Madathil","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristopher B.","family":"Deatrick","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehrdad","family":"Ghoreishi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James S.","family":"Gammie","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Kaczorowski","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M.","family":"Scalea","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Menaker","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California San Francisco Medical Center, San Francisco, CA 94143, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Herr","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5325-4907","authenticated-orcid":false,"given":"Ali","family":"Tabatabai","sequence":"additional","affiliation":[{"name":"Program in Trauma, Department of Medicine, Division of Pulmonary and Critical Care, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Krause","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Thoracic Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4187\/respcare.04716","article-title":"Past and present ARDS mortality rates: A systematic review","volume":"62","author":"Jor","year":"2017","journal-title":"Respir. Care"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Peek, G.J., Clemens, F., Elbourne, D., Firmin, R., Hardy, P., Hibbert, C., Killer, H., Mugford, M., Thalanany, M., and Tiruvoipati, R. (2006). CESAR: Conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure. BMC Health Serv. Res., 6.","DOI":"10.1186\/1472-6963-6-163"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1056\/NEJMoa1800385","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome","volume":"378","author":"Combes","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1016\/j.jss.2020.05.089","article-title":"Association of trauma center level and patient volume with outcomes for penetrating thoracic trauma","volume":"255","author":"Checchi","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1378\/chest.120.4.1347","article-title":"Treatment of ARDS","volume":"120","author":"Brower","year":"2001","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s00134-017-4996-5","article-title":"A prospective international observational prevalence study on prone positioning of ARDS patients: The APRONET (ARDS Prone Position Network) study","volume":"44","author":"Beuret","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1056\/NEJMoa1005372","article-title":"ACURASYS study investigators. neuromuscular blockers in early acute respiratory distress syndrome","volume":"363","author":"Papazian","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/TA.0000000000001524","article-title":"The lung rescue unit-Does a dedicated intensive care unit for venovenous extracorporeal membrane oxygenation improve survival to discharge?","volume":"83","author":"Menaker","year":"2017","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1001\/jama.2020.6825","article-title":"Management of COVID-19 respiratory distress","volume":"323","author":"Marini","year":"2020","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1111\/his.14134","article-title":"Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction","volume":"77","author":"Menter","year":"2020","journal-title":"Histopathology"},{"key":"ref_11","first-page":"95","article-title":"Microvascular COVID-19 lung vessels obstructive thromboinflammatory syndrome (MicroCLOTS): An atypical acute respiratory distress syndrome working hypothesis","volume":"22","author":"Ciceri","year":"2020","journal-title":"Crit. Care Resusc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1001\/jama.2020.5394","article-title":"Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy","volume":"323","author":"Grasselli","year":"2020","journal-title":"JAMA"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S2213-2600(20)30079-5","article-title":"Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study [published correction appears in Lancet Respir Med. 2020 Apr;8, e26]","volume":"8","author":"Yang","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1056\/NEJMoa2004500","article-title":"Covid-19 in critically ill patients in the Seattle region\u2014Case series","volume":"382","author":"Bhatraju","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1097\/MAT.0000000000001173","article-title":"Initial ELSO Guidance Document: ECMO for COVID-19 Patients with Severe Cardiopulmonary Failure [published correction appears in ASAIO J. 2020 Aug;66, e113]","volume":"66","author":"Bartlett","year":"2020","journal-title":"ASAIO J."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"MacLaren, G., Fisher, D., and Brodie, D. (2020). Preparing for the most critically Ill Patients with COVID-19: The Membrane potential role of extracorporeal oxygenation [published online ahead of print, 2020 Feb 19]. JAMA.","DOI":"10.1001\/jama.2020.2342"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Dave, S., Shah, A., Galvagno, S., George, K., Menne, A.R., Haase, D.J., McCormick, B., Rector, R., Dahi, S., and Madathil, R.J. (2021). A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part I: System Planning and Care Teams. Membranes, 11.","DOI":"10.3390\/membranes11040258"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1016\/j.jamcollsurg.2015.12.060","article-title":"Critical Care Resuscitation Unit: An Innovative Solution to Expedite Transfer of Patients with Time-Sensitive Critical Illness","volume":"222","author":"Scalea","year":"2016","journal-title":"J. Am Coll. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"CDC COVID-19 Response Team (2020). Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19)\u2014United States, February 12-March 16, 2020. MMWR Morb. Mortal. Wkly. Rep., 69, 343\u2013346.","DOI":"10.15585\/mmwr.mm6912e2"},{"key":"ref_20","first-page":"1775","article-title":"Case-Fatality rate and characteristics of patients dying in relation to COVID-19 in Italy","volume":"323","author":"Onder","year":"2020","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1016\/j.athoracsur.2015.05.072","article-title":"Class III obesity is not a contraindication to venovenous extracorporeal membrane oxygenation support","volume":"100","author":"Kon","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1213\/ANE.0000000000004454","article-title":"Does weight matter? Outcomes in adult patients on venovenous extracorporeal membrane oxygenation when stratified by obesity class","volume":"131","author":"Galvagno","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1002\/oby.22842","article-title":"Obesity is associated with severe forms of COVID-19","volume":"28","author":"Caussy","year":"2020","journal-title":"Obesity"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.orcp.2020.07.002","article-title":"Obesity and mortality of COVID-19. Meta-analysis","volume":"14","author":"Hussain","year":"2020","journal-title":"Obes. Res. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e79","DOI":"10.1097\/MAT.0000000000001135","article-title":"Cardiac arrest prior to initiation of veno-venous extracorporeal membrane oxygenation is not associated with increased in-hospital mortality","volume":"66","author":"Jones","year":"2020","journal-title":"ASAIO J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s13054-017-1744-8","article-title":"Influence of low-flow time on survival after extracorporeal cardiopulmonary resuscitation (eCPR)","volume":"21","author":"Wengenmayer","year":"2017","journal-title":"Crit Care."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1053\/j.jvca.2016.06.005","article-title":"Mobile extracorporeal membrane oxygenation teams: The north american versus the European experience","volume":"30","author":"Nwozuzu","year":"2016","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3762","DOI":"10.21037\/jtd.2016.12.88","article-title":"Veno-venous extracorporeal membrane oxygenation: Cannulation techniques","volume":"8","author":"Banfi","year":"2016","journal-title":"J. Thorac. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1001\/jamacardio.2020.1096","article-title":"Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19)","volume":"5","author":"Inciardi","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"m1091","DOI":"10.1136\/bmj.m1091","article-title":"Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study [published correction appears in BMJ. 2020 Mar 31;368:m1295]","volume":"368","author":"Chen","year":"2020","journal-title":"BMJ"},{"key":"ref_31","first-page":"1","article-title":"An update on current therapeutic drugs treating COVID-19 [published online ahead of print, 2020 May 11]","volume":"11","author":"Wu","year":"2020","journal-title":"Curr. Pharm. Rep"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/s13613-020-00681-9","article-title":"Nitric oxide inhalation as an interventional rescue therapy for COVID-19-induced acute respiratory distress syndrome","volume":"10","author":"Kobayashi","year":"2020","journal-title":"Ann. Intensive Care."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1086\/425357","article-title":"Inhalation of nitric oxide in the treatment of severe acute respiratory syndrome: A rescue trial in Beijing","volume":"39","author":"Chen","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lei, C., Su, B., Dong, H., Bellavia, A., Di Fenza, R., Safaee Fakhr, B., Gianni, S., Grassi, L.G., Kacmarek, R., and Araujo Morais, C.C. (2020). Protocol of a randomized controlled trial testing inhaled Nitric Oxide in mechanically ventilated patients with severe acute respiratory syndrome in COVID-19 (SARS-CoV-2). Preprint. medRxiv.","DOI":"10.1101\/2020.03.09.20033530"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sahay, S., and Farber, H.W. (2020). Management of hospitalized patients with pulmonary arterial hypertension and COVID-19 infection. Pulm. Circ., 10.","DOI":"10.1177\/2045894020933480"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s00134-015-4200-8","article-title":"The \u201cbaby lung\u201d became an adult","volume":"42","author":"Gattinoni","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/rr15","article-title":"Mechanical ventilation: Lessons from the ARDSNet trial","volume":"1","author":"Slutsky","year":"2000","journal-title":"Respir. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1164\/rccm.200702-193OC","article-title":"ARDSnet ventilatory protocol and alveolar hyperinflation: Role of positive end-expiratory pressure","volume":"176","author":"Grasso","year":"2007","journal-title":"Am. J. Respir. Crit. Care. Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Acute Respiratory Distress Syndrome Network, Brower, R.G., Matthay, M.A., Morris, A., Schoenfeld, D., Thompson, B.T., and Wheeler, A. (2000). Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N. Engl. J. Med., 342, 1301\u20131308.","DOI":"10.1056\/NEJM200005043421801"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1164\/rccm.201605-1081CP","article-title":"Mechanical ventilation to minimize progression of lung injury in acute respiratory failure","volume":"195","author":"Brochard","year":"2017","journal-title":"Am. J. Respir. Crit. Care. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1186\/cc13778","article-title":"Protective mechanical ventilation in the non-injured lung: Review and meta-analysis","volume":"18","author":"Sutherasan","year":"2014","journal-title":"Crit. Care."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/cc13702","article-title":"Mechanical ventilation during extracorporeal membrane oxygenation","volume":"18","author":"Schmidt","year":"2014","journal-title":"Crit. Care."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/cc689","article-title":"Extracorporeal membrane oxygenation for severe acute respiratory failure","volume":"4","author":"Lewandowski","year":"2000","journal-title":"Crit Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e01236","DOI":"10.1213\/XAA.0000000000001236","article-title":"Factor VIII and functional protein c activity in critically ill patients with coronavirus disease 2019: A case series","volume":"14","author":"Tabatabai","year":"2020","journal-title":"A&A Pract."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"3495","DOI":"10.1053\/j.jvca.2020.05.020","article-title":"Thromboelastometry and D-Dimer Elevation in Coronavirus-2019","volume":"34","author":"Madathil","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395, 1038]","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00134-020-06033-2","article-title":"COVID-19 pneumonia: Different respiratory treatments for different phenotypes?","volume":"46","author":"Gattinoni","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1001\/jama.2020.4326","article-title":"Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State","volume":"323","author":"Arentz","year":"2020","journal-title":"JAMA"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s40635-016-0085-2","article-title":"The 30-year evolution of airway pressure release ventilation (APRV)","volume":"4","author":"Jain","year":"2016","journal-title":"Intensive Care Med. Exp."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"S228","DOI":"10.1097\/01.CCM.0000155920.11893.37","article-title":"Other approaches to open-lung ventilation: Airway pressure release ventilation","volume":"33","author":"Habashi","year":"2005","journal-title":"Crit. Care Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1056\/NEJMsa1410639","article-title":"Driving pressure and survival in the acute respiratory distress syndrome","volume":"372","author":"Amato","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1525","DOI":"10.1164\/rccm.202001-0023OC","article-title":"The Early Change in PaCO2 after Extracorporeal Membrane Oxygenation Initiation Is Associated with Neurological Complications","volume":"201","author":"Cavayas","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1097\/CCM.0000000000004347","article-title":"Association between arterial carbon dioxide tension and clinical outcomes in venoarterial extracorporeal membrane oxygenation","volume":"48","author":"Diehl","year":"2020","journal-title":"Crit. Care Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1164\/rccm.202004-1163LE","article-title":"Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study","volume":"201","author":"Ziehr","year":"2020","journal-title":"Am. J. Respir. Crit. Care. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1053\/j.jvca.2011.05.013","article-title":"\u03b2-Blockers to optimize peripheral oxygenation during extracorporeal membrane oxygenation: A case series","volume":"26","author":"Guarracino","year":"2012","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1164\/rccm.201404-0736CI","article-title":"Extracorporeal life support in critically ill adults","volume":"190","author":"Ventetuolo","year":"2014","journal-title":"Am. J. Respir. Crit. Care. Med."},{"key":"ref_57","first-page":"307","article-title":"Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults","volume":"80","author":"Guervilly","year":"2014","journal-title":"Minerva Anestesiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/MAT.0000000000000207","article-title":"Management of refractory hypoxemia during venovenous extracorporeal membrane oxygenation for ARDS","volume":"61","author":"Montisci","year":"2015","journal-title":"ASAIO J."},{"key":"ref_59","first-page":"S435","article-title":"Acute respiratory distress syndrome and pneumothorax","volume":"6","author":"Terzi","year":"2014","journal-title":"J. Thorac. Dis."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1002\/jmv.25891","article-title":"Analysis of 92 deceased patients with COVID-19","volume":"92","author":"Yang","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"87","DOI":"10.2214\/AJR.20.23034","article-title":"Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients","volume":"215","author":"Salehi","year":"2020","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s10140-020-01806-0","article-title":"Pneumomediastinum and spontaneous pneumothorax as an extrapulmonary complication of COVID-19 disease","volume":"27","year":"2020","journal-title":"Emerg. Radiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.chest.2018.01.048","article-title":"A systematic review and meta-analysis comparing pigtail catheter and chest tube as the initial treatment for pneumothorax","volume":"153","author":"Chang","year":"2018","journal-title":"Chest"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/S1010-7940(02)00478-5","article-title":"Morbidity of percutaneous tube thoracostomy in trauma patients","volume":"22","author":"Deneuville","year":"2002","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"25","DOI":"10.5152\/TurkThoracJ.2018.18056","article-title":"An analysis of patients who underwent tube thoracostomy in the emergency department: A single center study","volume":"20","author":"Kantar","year":"2019","journal-title":"Turk. Thorac. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/S2213-2600(20)30230-7","article-title":"Tracheostomy in the COVID-19 era: Global and multidisciplinary guidance","volume":"8","author":"McGrath","year":"2020","journal-title":"Lancet. Respir. Med."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Shiba, T., Ghazizadeh, S., Chhetri, D., St John, M., and Long, J. (2020). Tracheostomy Considerations during the COVID-19 Pandemic. OTO Open., 4.","DOI":"10.1177\/2473974X20922528"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1177\/0267659119898327","article-title":"Early tracheostomy after initiation of venovenous extracorporeal membrane oxygenation is associated with decreased duration of extracorporeal membrane oxygenation support","volume":"35","author":"DiChiacchio","year":"2020","journal-title":"Perfusion"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1001\/jamasurg.2020.3950","article-title":"Extracorporeal membrane oxygenation for patients with COVID-19 in severe respiratory failure","volume":"155","author":"Mustafa","year":"2020","journal-title":"JAMA Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1182\/blood.2020006000","article-title":"COVID-19 and its implications for thrombosis and anticoagulation","volume":"135","author":"Connors","year":"2020","journal-title":"Blood"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1016\/j.bja.2020.04.079","article-title":"Extracorporeal membrane oxygenation for COVID-19-associated severe acute respiratory distress syndrome and risk of thrombosis","volume":"125","author":"Beyls","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_72","first-page":"45","article-title":"Acquired von Willebrand syndrome in respiratory extracorporeal life support: A systematic review of the literature","volume":"19","author":"Malfertheiner","year":"2017","journal-title":"Crit. Care. Resusc."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1053\/j.jvca.2018.11.031","article-title":"Von willebrand Factor-GP1b\u03b1 interactions in venoarterial extracorporeal membrane oxygenation patients","volume":"33","author":"Mazzeffi","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1186\/s13054-020-03077-0","article-title":"The unique characteristics of COVID-19 coagulopathy","volume":"24","author":"Iba","year":"2020","journal-title":"Crit. Care"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1182\/blood.2020006520","article-title":"COVID and coagulation: Bleeding and thrombotic manifestations of SARS-CoV2 infection","volume":"136","author":"Dzik","year":"2020","journal-title":"Blood"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.athoracsur.2020.02.011","article-title":"Feasibility of Venovenous Extracorporeal Membrane Oxygenation Without Systemic Anticoagulation","volume":"110","author":"Kurihara","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.jocn.2020.04.124","article-title":"COVID-19, SARS and MERS: A neurological perspective","volume":"77","author":"Mehta","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1021\/acschemneuro.0c00122","article-title":"Evidence of the COVID-19 virus targeting the CNS: Tissue distribution, host-virus Interaction, and proposed neurotropic mechanisms","volume":"11","author":"Baig","year":"2020","journal-title":"ACS Chem. Neurosci."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"e40","DOI":"10.1213\/ANE.0000000000004887","article-title":"Sedation of mechanically ventilated COVID-19 patients: Challenges and special considerations","volume":"131","author":"Hanidziar","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ajem.2020.05.059","article-title":"Critical medication shortages further dwindling hospital resources during COVID-19","volume":"40","author":"Farrell","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1016\/j.athoracsur.2015.07.046","article-title":"Bleeding, Transfusion, and Mortality on Extracorporeal Life Support: ECLS Working Group on Thrombosis and Hemostasis","volume":"101","author":"Mazzeffi","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1007\/s00134-016-4312-9","article-title":"Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: A cohort study","volume":"42","author":"Abrams","year":"2016","journal-title":"Intensive. Care Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1007\/s00134-011-2370-6","article-title":"Acquired von Willebrand syndrome in patients with extracorporeal life support (ECLS)","volume":"38","author":"Heilmann","year":"2012","journal-title":"Intensive. Care Med."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1002\/ajh.2830380324","article-title":"Changes in fibrinolytic factors in newborns during extracorporeal membrane oxygenation (ECMO)","volume":"38","author":"McVeen","year":"1991","journal-title":"Am. J. Hematol."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Gul, M.H., Htun, Z.M., Shaukat, N., Imran, M., and Khan, A. (2020). Potential specific therapies in COVID-19. Ther. Adv. Respir. Dis., 14.","DOI":"10.1177\/1753466620926853"},{"key":"ref_86","first-page":"198","article-title":"Update on treatment of COVID-19: Ongoing studies between promising and disappointing results","volume":"28","author":"Esposito","year":"2020","journal-title":"Infez. Med."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2411","DOI":"10.1056\/NEJMoa2012410","article-title":"Observational study of hydroxychloroquine in hospitalized patients with Covid-19","volume":"382","author":"Geleris","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"m1432","DOI":"10.1136\/bmj.m1432","article-title":"Chloroquine and hydroxychloroquine in covid-19","volume":"369","author":"Ferner","year":"2020","journal-title":"BMJ"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1001\/jama.288.7.862","article-title":"Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock [published correction appears in JAMA. 2008 Oct 8;300, 1652. Chaumet-Riffaut, Philippe [corrected to Chaumet-Riffaud, Philippe]]","volume":"288","author":"Annane","year":"2002","journal-title":"JAMA"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1056\/NEJMoa071366","article-title":"Hydrocortisone therapy for patients with septic shock","volume":"358","author":"Sprung","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1001\/jama.2016.14799","article-title":"Effect of hydrocortisone on development of shock among patients with severe sepsis: The hypress randomized clinical trial","volume":"316","author":"Keh","year":"2016","journal-title":"JAMA"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1056\/NEJMoa1705835","article-title":"Adjunctive glucocorticoid therapy in patients with septic shock","volume":"378","author":"Venkatesh","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1056\/NEJMoa1705716","article-title":"Hydrocortisone plus fludrocortisone for adults with septic shock","volume":"378","author":"Annane","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1186\/s13063-016-1456-4","article-title":"Evaluating the efficacy of dexamethasone in the treatment of patients with persistent acute respiratory distress syndrome: Study protocol for a randomized controlled trial","volume":"17","author":"Villar","year":"2016","journal-title":"Trials"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1378\/chest.06-2100","article-title":"Methylprednisolone infusion in early severe ARDS: Results of a randomized controlled trial","volume":"131","author":"Meduri","year":"2007","journal-title":"Chest"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1177\/0267659120906044","article-title":"Methylprednisolone may be associated with improved lung compliance in acute respiratory distress syndrome patients on veno-venous extracorporeal membrane oxygenation","volume":"35","author":"Tabatabai","year":"2020","journal-title":"Perfusion"}],"container-title":["Membranes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0375\/11\/5\/306\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:50:57Z","timestamp":1760161857000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0375\/11\/5\/306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,21]]},"references-count":96,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["membranes11050306"],"URL":"https:\/\/doi.org\/10.3390\/membranes11050306","relation":{},"ISSN":["2077-0375"],"issn-type":[{"type":"electronic","value":"2077-0375"}],"subject":[],"published":{"date-parts":[[2021,4,21]]}}}