Saudi Outcomes of ECMO-treated MERS-CoV Patients

A highly pathogenic human coronavirus causing respiratory disease emerged in Saudi Arabia in 2012. This viral infection termed Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with high mortality rate in approximately 36% of reported patients. The World Health Organization (WHO) reported 1,374 laboratory-confirmed worldwide infections, including at least 490 related deaths, from September, 2012, to July 24, 2015.2 The higher incidence of MERS-CoV infections in Saudi Arabia may be related to multiple factors, including seasonality, increased proactive screening, poor infection control measures, low relative humidity, and high temperature. Infected patients with MERS-CoV usually have abnormal findings on chest radiography, ranging from subtle to extensive unilateral and bilateral abnormalities. MERS progresses rapidly to respiratory failure, in approximately 2/3 of infected patients, which has a high mortality rate, particularly in immunocompromised patients. Extracorporeal membrane oxygenation (ECMO) has emerged as a rescue therapy in patients with refractory hypoxemia during the H1N1 epidemic.The use of veno-venous (VV)-ECMO provides respiratory support for patients with respiratory failure, whereas the use of veno-arterial (VA)-ECMO could be helpful in those with cardiorespiratory failure.10 However, the survival rate of the infected patients with H1N1 who required the use of ECMO varies considerably among the Caucasian and Asian countries (90% survival in Sweden and 83% in the UK13 vs. 35% in Japan). This large discrepancy could be explained with lack of satisfactory equipment, therapeutic guidelines, training of staff, and effective systems allowing patient transfer to the dedicated ECMO centres. Guery and co-investigators described the use of ECMO in two French patients with cardiorespiratory failure secondary to MERS-CoV infection.This has been extended for treatment of refractory hypoxemic respiratory failure during the Saudi MERS-CoV outbreak.