key: cord-0762802-17z08ogj
authors: Ogawa, Haruhiko; Kakuchi, Yasushi; Asakura, Hidesaku
title: Adjunctive therapies for early withdrawal from extracorporeal membrane oxygenation
date: 2020-09-29
journal: J Card Surg
DOI: 10.1111/jocs.15024
sha: 2f8f16c8ba9b488e2355338a2ecdd986768aa310
doc_id: 762802
cord_uid: 17z08ogj

nan

ECMO systems are clearly a finite resource, and there would be limitations in providing ECMO in the case of an outbreak of COVID-19. 2 Indeed, there have been several media reports of patients with refractory hypoxemia being unable to receive ECMO because of a shortage of equipment. Such problems tend to be emphasized as social issues, but it should be noted that ECMO is not an active treatment but supportive therapy against ARDS.

To reduce the immunological disadvantages involved in initiation of an extracorporeal circuit 3 and increase the survival rate of these patients, early withdrawal from ECMO must be achieved with preparation of additional therapy while sustaining increased systemic oxygen delivery with ECMO.

Therefore, the use of selective cytokine blockers, such as the IL-6 receptor blocker, tocilizumab, 4 and direct hemoperfusion therapy with polymyxin B-immobilized fiber cartridges (PMX-DHP), which is an extracorporeal circulation therapy similar to ECMO, would be beneficial. 5 Although the efficacy of PMX-DHP against ARDS due to endotoxic shock induced by gram-negative bacterial infection remains controversial, it has been reported to be efficacious against ARDS due to cytokine storm It is remarkable that amyopathic dermatomyositis patients with rapidly progressive interstitial pneumonia showed a decline in IL-6 level accompanied with improvement of respiratory condition after treatment with PMX-DHP. 6 We reported the rapid improvement of oxygenation, i.e., an in- 

The authors declare that there are no conflict of interests.

Haruhiko Ogawa and Hidesaku Asakura wrote the manuscript.

Haruhiko Ogawa and Yasushi Kakuchi were involved in treating patients. 

Role of extracorporeal membrane oxygenation in COVID-19: a systematic review

Planning and infectious diseases

COVID-19, ECMO, and lymphopenia: a word of caution

A prospective, randomised, double blind placebo-controlled trial to evaluate the efficacy and safety of tocilizumab in patients with severe COVID-19 pneumonia (TOC-COVID): a structured summary of a study protocol for a randomised controlled trial. Version 2

Polymyxin B hemoperfusion: a mechanistic perspective

Clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia: the relation between the disease activity and the serum interleukin-6 level

Endotoxin adsorption therapy for a patient with severe pneumonia resulting from novel influenza A (H1N1) virus infection