Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

Abstract

Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa^® and MIRUS^TM, and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.

Keywords: Extracorporeal membrane oxygenation; COVID-19; Acute respiratory distress syndrome; Critical care; Volatile anesthetics; Inhaled sedation

Core Tip: This article summarizes the use of inhaled sedation for extracorporeal membrane oxygenation in patients suffering from coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome, including a description of respiratory management, the technical aspects, and requirements for delivery of volatile anesthetics. The article closes with important future considerations for inhaled sedation in critically ill COVID-19 patients undergoing extracorporeal membrane oxygenation therapy.