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Rieder M, Zahn T, Benk C, Lother A, Bode C, Staudacher D, Duerschmied D, Supady A. Cytokine adsorption in a patient with severe coronavirus disease 2019 related acute respiratory distress syndrome requiring extracorporeal membrane oxygenation therapy: A case report. Artif Organs 2020; 45:191-194. [PMID: 32929761 DOI: 10.1111/aor.13805] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/26/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Marina Rieder
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Timm Zahn
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Christoph Benk
- Department of Cardiovascular Surgery, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Achim Lother
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany.,Institute of Experimental and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Dawid Staudacher
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Daniel Duerschmied
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Department of Medicine III (Interdisciplinary Medical Intensive Care), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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102
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Swol J, Lorusso R. Additive treatment considerations in COVID-19-The clinician's perspective on extracorporeal adjunctive purification techniques. Artif Organs 2020; 44:918-925. [PMID: 32516506 PMCID: PMC7300593 DOI: 10.1111/aor.13748] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/17/2022]
Abstract
The aim of this document was to inform the scientific community of sparse preliminary results regarding advanced supportive therapies and technology-driven systems in addition to highlighting the benefits and possibilities of performing concise research during challenging times. Advanced organ support for lung and heart offers the possibility to buy the time needed for recovery. However, remaining a bridging strategy, extracorporeal life support cannot act as the ultimate treatment for the underlying COVID-19 disease. Appropriate patient selection criteria addressed by experts and scientific organizations, such as Extracorporeal Life Support Organization and World Health Organization, may provide significant help in the difficult decision-making and to reduce mortality in patients with profound respiratory and/or cardiac failure due to COVID-19. Severe, systemic cytokine-mediated inflammation associated with the SARS-CoV-2 has also been described. Effects of crosstalk between coagulation and inflammatory pathways appear to significantly affect disease progression and lead to poor outcomes. Multiple therapeutic strategies, including antibody therapies (such as Tocilizumab, Sarilumab, Siltuximab), therapeutic plasma exchange (TPE), and blood purification techniques for direct removal of cytokines, including filtration, dialysis (diffusion), and adsorption are available. Further, we believe, that research should be facilitated and promoted, particularly under the guidance of recognized scientific societies or expert-based multicenter investigation, with rapid communication of critical and relevant information to enhance better appraisal of patient profiles, complications, and treatment modalities.
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Affiliation(s)
- Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep MedicineParacelsus Medical University NurembergNurembergGermany
| | - Roberto Lorusso
- Cardio‐Thoracic Surgery Department, Heart & Vascular CentreMaastricht University Medical HospitalMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)MaastrichtThe Netherlands
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103
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Abstract
COVID-19 is a coronavirus responsible for a global pandemic that started in China in December 2019 and has quickly spread to almost all countries. Approximately 2% of cases are diagnosed in children. There is increasing evidence for transmission by asymptomatic or presymptomatic adults and children. The clinical features do not differ from those of other respiratory viral infections, although rare cases manifest an unusual rash involving the digits. Disease is generally mild in children but deaths have been reported. Risk groups for severe disease in children are yet to be delineated. All treatments remain experimental.
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Affiliation(s)
- Joan Robinson
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Dolores Freire
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
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104
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Hou L, Li M, Guo K, Wang W, Li B, Li J, Yuan Y. First successful treatment of a COVID-19 pregnant woman with severe ARDS by combining early mechanical ventilation and ECMO. Heart Lung 2020; 50:33-36. [PMID: 32948334 PMCID: PMC7441876 DOI: 10.1016/j.hrtlng.2020.08.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023]
Abstract
The novel coronavirus (COVID-19) has become a global pandemic outbreak. Patients with COVID-19 are prone to progress to acute respiratory distress syndrome (ARDS), and even severe ARDS with ineffective mechanical ventilation, and an extremely high mortality. Extracorporeal membrane oxygenation (ECMO) provides effective respiratory support and saves time for the treatment of severe COVID-19. The present study reports that a 31-year-old pregnant female infected by COVID-19, who suffered from fever, dyspnea, and rapid ARDS. The patient's pulmonary function gradually recovered by combining early mechanical ventilation and ECMO, and finally, this patient was successfully weaned from ECMO and the ventilator. No fibrosis lesions were found in the chest CT, and the patient recovered very well after leaving from the hospital for one month.
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Affiliation(s)
- Liusheng Hou
- Department of Cardiovascular Center, Zhongshan People's Hospital, Zhongshan 528403, PR China
| | - Mingxing Li
- Department of Cardiovascular Center, Zhongshan People's Hospital, Zhongshan 528403, PR China
| | - Kai Guo
- Department of Cardiovascular Center, Zhongshan People's Hospital, Zhongshan 528403, PR China
| | - Weijia Wang
- Department of Laboratory Diagnosis Center, Zhongshan People's Hospital, Zhongshan 528403, PR China
| | - Binfei Li
- DepartmenLit of Intensive care Medicine, Zhongshan People's Hospital, Zhongshan 528403, PR China
| | - Jianwei Li
- DepartmenLit of Intensive care Medicine, Zhongshan People's Hospital, Zhongshan 528403, PR China
| | - Yong Yuan
- Department of Cardiovascular Center, Zhongshan People's Hospital, Zhongshan 528403, PR China.
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105
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Prediction of respiratory decompensation in Covid-19 patients using machine learning: The READY trial. Comput Biol Med 2020; 124:103949. [PMID: 32798922 PMCID: PMC7410013 DOI: 10.1016/j.compbiomed.2020.103949] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/22/2022]
Abstract
Background Currently, physicians are limited in their ability to provide an accurate prognosis for COVID-19 positive patients. Existing scoring systems have been ineffective for identifying patient decompensation. Machine learning (ML) may offer an alternative strategy. A prospectively validated method to predict the need for ventilation in COVID-19 patients is essential to help triage patients, allocate resources, and prevent emergency intubations and their associated risks. Methods In a multicenter clinical trial, we evaluated the performance of a machine learning algorithm for prediction of invasive mechanical ventilation of COVID-19 patients within 24 h of an initial encounter. We enrolled patients with a COVID-19 diagnosis who were admitted to five United States health systems between March 24 and May 4, 2020. Results 197 patients were enrolled in the REspirAtory Decompensation and model for the triage of covid-19 patients: a prospective studY (READY) clinical trial. The algorithm had a higher diagnostic odds ratio (DOR, 12.58) for predicting ventilation than a comparator early warning system, the Modified Early Warning Score (MEWS). The algorithm also achieved significantly higher sensitivity (0.90) than MEWS, which achieved a sensitivity of 0.78, while maintaining a higher specificity (p < 0.05). Conclusions In the first clinical trial of a machine learning algorithm for ventilation needs among COVID-19 patients, the algorithm demonstrated accurate prediction of the need for mechanical ventilation within 24 h. This algorithm may help care teams effectively triage patients and allocate resources. Further, the algorithm is capable of accurately identifying 16% more patients than a widely used scoring system while minimizing false positive results. Validation of prediction algorithm for ventilation requirements in COVID-19 patients. Algorithm achieved significantly higher sensitivity than the common scoring system MEWS. Algorithm detected 16% more patients who will require invasive ventilation than MEWS. Advance warning of ventilation needs can help improve COVID-19 patient outcomes.
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106
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Fu EL, Janse RJ, de Jong Y, van der Endt VHW, Milders J, van der Willik EM, de Rooij ENM, Dekkers OM, Rotmans JI, van Diepen M. Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis. Clin Kidney J 2020; 13:550-563. [PMID: 32897278 PMCID: PMC7467593 DOI: 10.1093/ckj/sfaa160] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) can affect hospitalized patients with coronavirus disease 2019 (COVID-19), with estimates ranging between 0.5% and 40%. We performed a systematic review and meta-analysis of studies reporting incidence, mortality and risk factors for AKI in hospitalized COVID-19 patients. METHODS We systematically searched 11 electronic databases until 29 May 2020 for studies in English reporting original data on AKI and kidney replacement therapy (KRT) in hospitalized COVID-19 patients. Incidences of AKI and KRT and risk ratios for mortality associated with AKI were pooled using generalized linear mixed and random-effects models. Potential risk factors for AKI were assessed using meta-regression. Incidences were stratified by geographic location and disease severity. RESULTS A total of 3042 articles were identified, of which 142 studies were included, with 49 048 hospitalized COVID-19 patients including 5152 AKI events. The risk of bias of included studies was generally low. The pooled incidence of AKI was 28.6% [95% confidence interval (CI) 19.8-39.5] among hospitalized COVID-19 patients from the USA and Europe (20 studies) and 5.5% (95% CI 4.1-7.4) among patients from China (62 studies), whereas the pooled incidence of KRT was 7.7% (95% CI 5.1-11.4; 18 studies) and 2.2% (95% CI 1.5-3.3; 52 studies), respectively. Among patients admitted to the intensive care unit, the incidence of KRT was 20.6% (95% CI 15.7-26.7; 38 studies). Meta-regression analyses showed that age, male sex, cardiovascular disease, diabetes mellitus, hypertension and chronic kidney disease were associated with the occurrence of AKI; in itself, AKI was associated with an increased risk of mortality, with a pooled risk ratio of 4.6 (95% CI 3.3-6.5). CONCLUSIONS AKI and KRT are common events in hospitalized COVID-19 patients, with estimates varying across geographic locations. Additional studies are needed to better understand the underlying mechanisms and optimal treatment of AKI in these patients.
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Affiliation(s)
- Edouard L Fu
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roemer J Janse
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ype de Jong
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera H W van der Endt
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jet Milders
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esmee M van der Willik
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther N M de Rooij
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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107
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Falcoz PE, Monnier A, Puyraveau M, Perrier S, Ludes PO, Olland A, Mertes PM, Schneider F, Helms J, Meziani F. Extracorporeal Membrane Oxygenation for Critically Ill Patients with COVID-19-related Acute Respiratory Distress Syndrome: Worth the Effort? Am J Respir Crit Care Med 2020; 202:460-463. [PMID: 32543208 PMCID: PMC7397791 DOI: 10.1164/rccm.202004-1370le] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | | | - Marc Puyraveau
- uMETh-INSERM CIC 431Besançon, France
- Besançon University HospitalBesançon, Franceand
| | | | | | - Anne Olland
- Strasbourg University HospitalStrasbourg, France
| | | | | | - Julie Helms
- Strasbourg University HospitalStrasbourg, France
| | - Ferhat Meziani
- Strasbourg University HospitalStrasbourg, France
- University of StrasbourgStrasbourg, France
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108
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Alom S, Haiduc AA, Melamed N, Axiaq A, Harky A. Use of ECMO in Patients With Coronavirus Disease 2019: Does the Evidence Suffice? J Cardiothorac Vasc Anesth 2020; 35:1256-1262. [PMID: 32891520 PMCID: PMC7391219 DOI: 10.1053/j.jvca.2020.07.070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Samiha Alom
- St. George's, University of London, Cranmer Terrace, UK; School of Public Health, Imperial College London, South Kensington, UK
| | | | - Naomi Melamed
- St. George's, University of London, Cranmer Terrace, UK
| | - Ariana Axiaq
- School of Medicine, Queen's University Belfast, Belfast, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK; Department of Integrative Biology, Faculty of Life Sciences, University of Liverpool, Liverpool, UK; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
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109
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Preparedness and Reorganization of Care for Coronavirus Disease 2019 Patients in a Swiss ICU: Characteristics and Outcomes of 129 Patients. Crit Care Explor 2020; 2:e0173. [PMID: 32766566 PMCID: PMC7392615 DOI: 10.1097/cce.0000000000000173] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: In many countries, large numbers of critically ill patients with coronavirus disease 2019 are admitted to the ICUs within a short period of time, overwhelming usual care capacities. Preparedness and reorganization ahead of the wave to increase ICU surge capacity may be associated with favorable outcome. The purpose of this study was to report our experience in terms of ICU organization and anticipation, as well as reporting patient characteristics, treatment, and outcomes. Design: A prospective observational study. Setting: The division of intensive care at the Geneva University Hospitals (Geneva, Switzerland). Patients: All consecutive adult patients with acute respiratory failure due to coronavirus disease 2019 admitted in the ICU between March 9, 2020, and May 19, 2020, were enrolled. Patients’ demographic data, comorbidities, laboratory values, treatments, and clinical outcomes were collected. Interventions: None. Measurements and Main Results: The ICU was reorganized into cells of six to eight patients under the care of three physicians and five nurses. Its capacity increased from 30 to 110 beds, fully equipped and staffed, transforming the surgical intermediate care unit, the postoperative care facility, and operating theaters into ICUs. Surge capacity has always exceeded the number of patients hospitalized. Among 129 critically ill patients with severe acute hypoxemic respiratory failure, 96% required invasive mechanical ventilation. A total of 105 patients (81%) were discharged alive and 24 died, corresponding to a mortality of 19%. Patients who died were significantly older, with higher severity scores at admission, had higher levels of d-dimers, plasma creatinine, high-sensitive troponin T, C-reactive protein, and procalcitonin, and required more frequent prone sessions. Conclusions: A rapid increase in ICU bed capacity, including adequate equipment and staffing, allowed for a large number of critically ill coronavirus disease 2019 patients to be taken care of within a short period of time. Anticipation and preparedness ahead of the wave may account for the low mortality observed in our center. These results highlight the importance of resources management strategy in the context of the ongoing coronavirus disease 2019 pandemic.
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110
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Kingston EV. High rates of stillbirth and preterm delivery in women with covid-19 and the efficacy of ECMO in pregnancy. BMJ 2020; 370:m2921. [PMID: 32718936 DOI: 10.1136/bmj.m2921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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111
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Haiduc AA, Alom S, Melamed N, Harky A. Role of extracorporeal membrane oxygenation in COVID-19: A systematic review. J Card Surg 2020; 35:2679-2687. [PMID: 32717771 DOI: 10.1111/jocs.14879] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aimed to examine the literature evidence behind using extracorporeal membrane oxygenation in COVID-19 patients in a systematic review manner. METHODS We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search was conducted on Global Health Medline, EMBASE, and Cochrane databases using keywords and MeSH terms to identify articles pertaining to extracorporeal membrane oxygenation (ECMO) and Coronavirus disease 2019 (COVID-19). A narrative synthesis was then undertaken to identify the key themes. RESULTS A total of 25 articles met the inclusion criteria of this systematic review. Three main themes were identified following the data extraction: (a) evidence against/inconclusive regarding ECMO for COVID-19, (b) evidence supporting ECMO for COVID-19, and finally (c) VV-ECMO and VA-ECMO. After combining the data, there were 3428 patients diagnosed with COVID-19 and 95 ECMO-associated deaths (19.83%). CONCLUSION Our study highlights the paucity of evidence and the need for further data to consolidate the efficacy of ECMO in improving patient outcomes. Although ECMO has been shown to be beneficial in a selected group of patients, the recuperative effects of ECMO remain inconclusive. We must ensure that risk-benefit analysis for each candidate is conducted thoroughly so that patients that have increased probability of survival can benefit from this scarce resource.
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Affiliation(s)
| | - Samiha Alom
- Medical School, St George's, University of London, London, UK.,School of Public Health, Imperial College London, London, UK
| | - Naomi Melamed
- Medical School, St George's, University of London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Faculty of Life Sciences, University of Liverpool, Liverpool, UK
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112
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Chemonges S. Cardiorespiratory physiological perturbations after acute smoke-induced lung injury and during extracorporeal membrane oxygenation support in sheep. F1000Res 2020; 9:769. [PMID: 32953091 PMCID: PMC7481850 DOI: 10.12688/f1000research.24927.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background: Numerous successful therapies developed for human medicine involve animal experimentation. Animal studies that are focused solely on translational potential, may not sufficiently document unexpected outcomes. Considerable amounts of data from such studies could be used to advance veterinary science. For example, sheep are increasingly being used as models of intensive care and therefore, data arising from such models must be published. In this study, the hypothesis is that there is little information describing cardiorespiratory physiological data from sheep models of intensive care and the author aimed to analyse such data to provide biological information that is currently not available for sheep that received extracorporeal life support (ECLS) following acute smoke-induced lung injury. Methods: Nineteen mechanically ventilated adult ewes undergoing intensive care during evaluation of a form of ECLS (treatment) for acute lung injury were used to collate clinical observations. Eight sheep were injured by acute smoke inhalation prior to treatment (injured/treated), while another eight were not injured but treated (uninjured/treated). Two sheep were injured but not treated (injured/untreated), while one received room air instead of smoke as the injury and was not treated (placebo/untreated). The data were then analysed for 11 physiological categories and compared between the two treated groups. Results: Compared with the baseline, treatment contributed to and exacerbated the deterioration of pulmonary pathology by reducing lung compliance and the arterial oxygen partial pressure to fractional inspired oxygen (PaO 2/FiO 2) ratio. The oxygen extraction index changes mirrored those of the PaO 2/FiO 2 ratio. Decreasing coronary perfusion pressure predicted the severity of cardiopulmonary injury. Conclusions: These novel observations could help in understanding similar pathology such as that which occurs in animal victims of smoke inhalation from house or bush fires, aspiration pneumonia secondary to tick paralysis and in the management of the severe coronavirus disease 2019 (COVID-19) in humans.
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Affiliation(s)
- Saul Chemonges
- School of Veterinary Science, The University of Queensland, Gatton, Queensland 4343, Australia
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113
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Kon ZN, Smith DE, Chang SH, Goldenberg RM, Angel LF, Carillo JA, Geraci TC, Cerfolio RJ, Montgomery RA, Moazami N, Galloway AC. Extracorporeal Membrane Oxygenation Support in Severe COVID-19. Ann Thorac Surg 2020; 111:537-543. [PMID: 32687823 PMCID: PMC7366119 DOI: 10.1016/j.athoracsur.2020.07.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 01/05/2023]
Abstract
Background Coronavirus disease 2019 (COVID-19) remains a worldwide pandemic with a high mortality rate among patients requiring mechanical ventilation. The limited data that exist regarding the utility of extracorporeal membrane oxygenation (ECMO) in these critically ill patients show poor overall outcomes. This report describes our institutional practice regarding the application and management of ECMO support for patients with COVID-19 and reports promising early outcomes. Methods All critically ill patients with confirmed COVID-19 evaluated for ECMO support from March 10, 2020, to April 24, 2020, were retrospectively reviewed. Patients were evaluated for ECMO support based on a partial pressure of arterial oxygen/fraction of inspired oxygen ratio of less than 150 mm Hg or pH of less than 7.25 with a partial pressure of arterial carbon dioxide exceeding 60 mm Hg with no life-limiting comorbidities. Patients were cannulated at bedside and were managed with protective lung ventilation, early tracheostomy, bronchoscopies, and proning, as clinically indicated. Results Among 321 patients intubated for COVID-19, 77 patients (24%) were evaluated for ECMO support, and 27 patients (8.4%) were placed on ECMO. All patients were supported with venovenous ECMO. Current survival is 96.3%, with only 1 death to date in more than 350 days of total ECMO support. Thirteen patients (48.1%) remain on ECMO support, and 13 patients (48.1%) have been successfully decannulated. Seven patients (25.9%) have been discharged from the hospital. Six patients (22.2%) remain in the hospital, of which 4 are on room air. No health care workers who participated in ECMO cannulation developed symptoms of or tested positive for COVID-19. Conclusions The early outcomes presented here suggest that the judicious use of ECMO support in severe COVID-19 may be clinically beneficial.
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Affiliation(s)
| | | | | | | | - Luis F Angel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | | | | | | | - Robert A Montgomery
- Transplant Institute, New York University Langone Health, New York, New York
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114
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Iribarne A, Thourani VH, Cleveland JC, Malaisrie SC, Romano MA, Moon MR, Ramakrishna H, Mewhort HEM, Halkos M, Sultan I, Kindler C, Firstenberg MS, Dayan V, Kasirajan V, Salerno C, Phillips A. Cardiac surgery considerations and lessons learned during the COVID‐19 pandemic. J Card Surg 2020. [PMCID: PMC7404588 DOI: 10.1111/jocs.14798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The COVID‐19 pandemic has transformed cardiac surgical practices. Limitations in intensive care resources and personal protective equipment have required many practices throughout the globe to pause elective operations and now slowly resume operations. However, much of cardiac surgery is not elective and patients continue to require surgery on an urgent or emergent basis during the pandemic. This continued need for providing surgical services has introduced several unique considerations ranging from how to prioritize surgery, how to ensure safety for cardiac surgical teams, and how best to resume elective operations to ensure the safety of patients. Additionally, the COVID‐19 pandemic has required a careful analysis of how best to carry out heart transplantation, extra‐corporeal membrane oxygenation, and congenital heart surgery. In this review, we present the many areas of multidisciplinary consideration, and the lessons learned that have allowed us to carry out cardiac surgery with excellence during the COVID‐19 pandemic. As various states experience plateaus, declines, and rises in COVID‐19 cases, these considerations are particularly important for cardiac surgical programs throughout the globe.
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Affiliation(s)
- Alexander Iribarne
- Section of Cardiac Surgery, Heart & Vascular Center Dartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center Piedmont Heart Institute Atlanta Georgia
| | - Joseph C. Cleveland
- Division of Cardiothoracic Surgery University of Colorado Anschutz Medical Center Aurora Colorado
| | | | - Matthew A. Romano
- Department of Cardiac Surgery University of Michigan Ann Arbor Michigan
| | - Marc R. Moon
- Divison of Cardiothoracic Surgery Washington University Medical Center St. Louis Missouri
| | | | | | - Michael Halkos
- Department of Cardiothoracic Surgery Emory University Medical Center Atlanta Georgia
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery University of Pittsburgh Medical Center Pittsburgh Pennsylvania
| | - Christine Kindler
- Department of Cardiothoracic Surgery Einstein Healthcare Network Philadelphia Pennsylvania
| | | | - Victor Dayan
- Department of Cardiac Surgery University of the Republic of Uruguay Montevideo Uruguay
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Pauley Heart Center Virginia Commonwealth University Richmond Virginia
| | - Chris Salerno
- Department of Cardiothoracic Surgery Ascension Medical Group Indianapolis Indiana
| | - Alistair Phillips
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic Cleveland Ohio
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Luo M, Liu J, Jiang W, Yue S, Liu H, Wei S. IL-6 and CD8+ T cell counts combined are an early predictor of in-hospital mortality of patients with COVID-19. JCI Insight 2020; 5:139024. [PMID: 32544099 PMCID: PMC7406244 DOI: 10.1172/jci.insight.139024] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/03/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUNDFatal cases of COVID-19 are increasing globally. We retrospectively investigated the potential of immunologic parameters as early predictors of COVID-19.METHODSA total of 1018 patients with confirmed COVID-19 were enrolled in our 2-center retrospective study. Clinical feature, laboratory test, immunological test, radiological findings, and outcomes data were collected. Univariate and multivariable logistic regression analyses were performed to evaluate factors associated with in-hospital mortality. Receiver operator characteristic (ROC) curves and survival curves were plotted to evaluate their clinical utility.RESULTSThe counts of all T lymphocyte subsets were markedly lower in nonsurvivors than in survivors, especially CD8+ T cells. Among all tested cytokines, IL-6 was elevated most significantly, with an upward trend of more than 10-fold. Using multivariate logistic regression analysis, IL-6 levels of more than 20 pg/mL and CD8+ T cell counts of less than 165 cells/μL were found to be associated with in-hospital mortality after adjusting for confounding factors. Groups with IL-6 levels of more than 20 pg/mL and CD8+ T cell counts of less than 165 cells/μL had a higher percentage of older and male patients as well as a higher proportion of patients with comorbidities, ventilation, intensive care unit admission, shock, and death. Furthermore, the receiver operating curve of the model combining IL-6 (>20 pg/mL) and CD8+ T cell counts (<165 cells/μL) displayed a more favorable discrimination than that of the CURB-65 score. The Hosmer-Lemeshow test showed a good fit of the model, with no statistical significance.CONCLUSIONIL-6 (>20 pg/mL) and CD8+ T cell counts (<165 cells/μL) are 2 reliable prognostic indicators that accurately stratify patients into risk categories and predict COVID-19 mortality.FundingThis work was supported by funding from the National Natural Science Foundation of China (no. 81772477 and 81201848).
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Affiliation(s)
- Miao Luo
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, and
| | - Jing Liu
- Department of Radiology, Wuhan Pulmonary Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weiling Jiang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, and
| | - Shuang Yue
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, and
| | - Huiguo Liu
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, and
| | - Shuang Wei
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, and
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116
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Buratto E, Konstantinov IE. Commentary: Evolving understanding of coronavirus disease 2019: Molecular biology, immunology, and surgery. J Thorac Cardiovasc Surg 2020; 161:e228-e230. [PMID: 32631659 PMCID: PMC7836525 DOI: 10.1016/j.jtcvs.2020.05.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 12/24/2022]
Affiliation(s)
- Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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117
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De Piero ME, Lo Coco V, Taccone FS, Belliato M, Broman LM, Malfertheiner MV, Lorusso R. Has Venoarterial ECMO Been Underutilized in COVID-19 Patients? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:317-321. [PMID: 32634058 DOI: 10.1177/1556984520939076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Maria Elena De Piero
- 199236 Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Hospital, The Netherlands.,Anestesia e Rianimazione 2, San Giovanni Bosco Hospital, Turin, Italy
| | - Valeria Lo Coco
- 199236 Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Hospital, The Netherlands
| | - Fabio Silvio Taccone
- 70496 Department of Intensive Care, Erasme Hospital, Universite' Libre de Bruxelles, Belgium
| | - Mirko Belliato
- 18631 U.O.C. Anestesia e Rianimazione 2 Cardiopolmonare, IRCCS, Policlinico San Matteo Foundation Hospital, Pavia, Italy
| | - Lars M Broman
- 59562 ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Maximilian V Malfertheiner
- 39070 Department of Internal Medicine II, Cardiology and Pneumology, University Medical Center Regensburg, Germany
| | - Roberto Lorusso
- 199236 Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Hospital, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), The Netherlands
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118
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Farooqi F, Dhawan N, Morgan R, Dinh J, Nedd K, Yatzkan G. Treatment of Severe COVID-19 with Tocilizumab Mitigates Cytokine Storm and Averts Mechanical Ventilation During Acute Respiratory Distress: A Case Report and Literature Review. Trop Med Infect Dis 2020; 5:E112. [PMID: 32635353 PMCID: PMC7559384 DOI: 10.3390/tropicalmed5030112] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19, caused by the novel severe acute respiratory coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, in 2019 and has resulted in the current pandemic. The disease continues to pose a major therapeutic challenge. Patient mortality is ultimately caused by acute respiratory distress syndrome (ARDS). Cytokine release syndrome (or "cytokine storm") is likely to be a contributing factor to ARDS in many patients. Because interleukin 6 (IL-6) is known to play a key role in inflammation, IL-6 receptor inhibitors such as tocilizumab may potentially treat COVID-19 by attenuating cytokine release. We present the case of a 48-year-old male with severe COVID-19, on the verge of meeting intubation requirements, who needed progressive oxygen support for respiratory distress. The patient was treated with a non-weight-based dosage of tocilizumab to prevent the onset of a cytokine storm. We chose to administer an IL-6 inhibitor because of the gradually increasing levels of acute phase reactants identified on serial blood draws, as well as his declining respiratory status. The treatment was well-tolerated in conjunction with standard drug therapies for COVID-19 (hydroxychloroquine, azithromycin, and zinc). The patient subsequently experienced marked improvements in his respiratory symptoms and overall clinical status over the following days. We believe that tocilizumab played a substantial role in his ability to avert clinical decline, particularly the need for mechanical ventilation. Ultimately, the patient was downgraded from the ICU and discharged within days. We highlight the potential of IL-6 inhibitors to prevent the progression of respiratory disease to a point requiring ventilator support. This case underscores the potential importance of early serial measurements of IL-6 and cytokine storm-associated acute phase reactants, such as ferritin, D-dimer, and C-reactive protein, in guiding clinical decision-making in the management of patients with suspected COVID-19. Conclusion: The early, proactive identification of serum acute phase reactants should be implemented in the treatment of COVID-19 in order to screen for a primary contributor to mortality-the cytokine storm. This screening, when followed by aggressive early treatment for cytokine storm, may have optimal therapeutic benefits and obviate the need for mechanical ventilation, thereby decreasing mortality. Additionally, we review current evidence regarding cytokine release syndrome in COVID-19 and the use of IL-6 receptor inhibition as a therapeutic strategy, and examine other reported cases in the literature describing IL-6 antagonist treatment for patients with COVID-19.
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Affiliation(s)
- Faryal Farooqi
- Department of Internal Medicine, Larkin Community Hospital, South Miami, FL 33143, USA; (N.D.); (R.M.); (J.D.); (K.N.)
| | - Naveen Dhawan
- Department of Internal Medicine, Larkin Community Hospital, South Miami, FL 33143, USA; (N.D.); (R.M.); (J.D.); (K.N.)
| | - Richard Morgan
- Department of Internal Medicine, Larkin Community Hospital, South Miami, FL 33143, USA; (N.D.); (R.M.); (J.D.); (K.N.)
| | - John Dinh
- Department of Internal Medicine, Larkin Community Hospital, South Miami, FL 33143, USA; (N.D.); (R.M.); (J.D.); (K.N.)
| | - Kester Nedd
- Department of Internal Medicine, Larkin Community Hospital, South Miami, FL 33143, USA; (N.D.); (R.M.); (J.D.); (K.N.)
| | - George Yatzkan
- Department of Pulmonary Medicine, Larkin Community Hospital, South Miami, FL 33143, USA;
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119
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Abstract
A hyperinflammatory response to COVID-19 is being described in children. While this presents, and responds to management, similar to that of Kawasaki Disease it is being coined a new entity. But is it really? We explore how this phenomenon may be Kawasaki Disease with a new trigger.
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120
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Fremed MA, Lytrivi ID, Liberman L, Anderson BR, Barry OM, Choudhury TA, Chrisomalis-Dring S, Ferris A, Glickstein JS, Krishnan U, Levasseur S, Rosenzweig EB, Shah A, Silver ES, Suh S, Turner ME, Weller R, Woo J, Starc TJ. Cardiac workup and monitoring in hospitalised children with COVID- 19. Cardiol Young 2020; 30:907-910. [PMID: 32611457 PMCID: PMC8717675 DOI: 10.1017/s1047951120001778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
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Affiliation(s)
- Michael A Fremed
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Irene D Lytrivi
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Brett R Anderson
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Oliver M Barry
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarif A Choudhury
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Anne Ferris
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Julie S Glickstein
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Usha Krishnan
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Stéphanie Levasseur
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Erika B Rosenzweig
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Amee Shah
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Sanghee Suh
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Mariel E Turner
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Rachel Weller
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joyce Woo
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Thomas J Starc
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, NY, USA
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121
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Yang Y, Rali AS, Inchaustegui C, Alakbarli J, Chatterjee S, Herlihy JP, George J, Shafii A, Nair A, Simpson L. Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019-associated Acute Respiratory Distress Syndrome: An Initial US Experience at a High-volume Centre. Card Fail Rev 2020; 6:e17. [PMID: 32670617 PMCID: PMC7341259 DOI: 10.15420/cfr.2020.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Yang Yang
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Aniket S Rali
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | | | - Javid Alakbarli
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Subhasis Chatterjee
- Michael E DeBakey Department of Surgery, Baylor College Medicine Houston, TX, US.,Department of Cardiovascular Surgery, Texas Heart Institute Houston, TX, US
| | - James P Herlihy
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Joggy George
- Department of Cardiology, Texas Heart Institute Houston, TX, US
| | - Alexis Shafii
- Michael E DeBakey Department of Surgery, Baylor College Medicine Houston, TX, US.,Department of Cardiovascular Surgery, Texas Heart Institute Houston, TX, US
| | - Ajith Nair
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
| | - Leo Simpson
- Department of Internal Medicine, Baylor College of Medicine Houston, TX, US
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122
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Burgos LM, Seoane L, Diez M. Extracorporeal membrane oxygenation for acute respiratory distress syndrome in patients with coronavirus disease 2019: what do we know so far? Perfusion 2020; 35:558-561. [PMID: 32579068 DOI: 10.1177/0267659120934279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Lucrecia María Burgos
- Heart Failure, Pulmonary Hypertension and Transplant Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Leonardo Seoane
- Critical Care Cardiology Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
| | - Mirta Diez
- Heart Failure, Pulmonary Hypertension and Transplant Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
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123
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Cheruku S, Dave S, Goff K, Park C, Ebeling C, Cohen L, Styrvoky K, Choi C, Anand V, Kershaw C. Cardiopulmonary Resuscitation in Intensive Care Unit Patients With Coronavirus Disease 2019. J Cardiothorac Vasc Anesth 2020; 34:2595-2603. [PMID: 32620487 PMCID: PMC7286272 DOI: 10.1053/j.jvca.2020.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 01/25/2023]
Abstract
Cardiopulmonary resuscitation (CPR) in patients with severe acute respiratory syndrome coronavirus-2–associated disease (coronavirus disease 2019) poses a unique challenge to health- care providers due to the risk of viral aerosolization and disease transmission. This has caused some centers to modify existing CPR procedures, limit the duration of CPR, or consider avoiding CPR altogether. In this review, the authors propose a procedure for CPR in the intensive care unit that minimizes the number of personnel in the immediate vicinity of the patient and conserves the use of scarce personal protective equipment. Highlighting the low likelihood of successful resuscitation in high-risk patients may prompt patients to decline CPR. The authors recommend the preemptive placement of central venous lines in high-risk patients with intravenous tubing extensions that allow for medication delivery from outside the patients’ rooms. During CPR, this practice can be used to deliver critical medications without delay. The use of a mechanical compression system for CPR further reduces the risk of infectious exposure to health- care providers. Extracorporeal membrane oxygenation should be reserved for patients with few comorbidities and a single failing organ system. Reliable teleconferencing tools are essential to facilitate communication between providers inside and outside the patients' rooms. General principles regarding the ethics and peri-resuscitative management of coronavirus 2019 patients also are discussed.
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Affiliation(s)
- Sreekanth Cheruku
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX.
| | - Siddharth Dave
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Kristina Goff
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Caroline Park
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX
| | - Callie Ebeling
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Leah Cohen
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Kim Styrvoky
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Christopher Choi
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX
| | - Vikram Anand
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
| | - Corey Kershaw
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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124
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Savarimuthu S, BinSaeid J, Harky A. The role of ECMO in COVID-19: Can it provide rescue therapy in those who are critically ill? J Card Surg 2020; 35:1298-1301. [PMID: 32442347 PMCID: PMC7280692 DOI: 10.1111/jocs.14635] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/31/2022]
Abstract
Arising from the city of Wuhan, Hubei province in China, a novel coronavirus named severe acute respiratory syndrome coronavirus 2 has been rapidly spreading since its first presentation in late 2019. The World Health Organization declared a pandemic on the 11th March 2020, and as of 29th of April 2020 more than 3 million cases have been reported worldwide with over 225 000 confirmed deaths. Where mechanical ventilation may not be enough, extracorporeal membrane oxygenation (ECMO) could play a role as a form of rescue therapy and may provide beneficial results in the hands of skilled clinicians in centers with experience of using ECMO appropriately in selected patients. Our understanding of COVID‐19 is ever‐changing and the need for intensive care beds is rising, which means that ECMO will surely play a key role in the near future.
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Affiliation(s)
| | - Jalal BinSaeid
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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125
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Pardo J, Shukla AM, Chamarthi G, Gupte A. The journey of remdesivir: from Ebola to COVID-19. Drugs Context 2020; 9:dic-2020-4-14. [PMID: 32547625 PMCID: PMC7250494 DOI: 10.7573/dic.2020-4-14] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 12/24/2022] Open
Abstract
Countries around the world are currently fighting the coronavirus disease 2019 (COVID-19) pandemic, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is a betacoronavirus, belonging to the same genus as severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV. Currently, there are no proven antiviral therapies for COVID-19. Numerous clinical trials have been initiated to identify an effective treatment. One leading candidate is remdesivir (GS-5734), a broad-spectrum antiviral that was initially developed for the treatment of Ebola virus (EBOV). Although remdesivir performed well in preclinical studies, it did not meet efficacy endpoints in a randomized trial conducted during an Ebola outbreak. Remdesivir holds promise for treating COVID-19 based on in vitro activity against SARS-CoV-2, uncontrolled clinical reports, and limited data from randomized trials. Overall, current data are insufficient to judge the efficacy of remdesivir for COVID-19, and the results of additional randomized studies are eagerly anticipated. In this narrative review, we provide an overview of Ebola and coronavirus outbreaks. We then summarize preclinical and clinical studies of remdesivir for Ebola and COVID-19.
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Affiliation(s)
- Joe Pardo
- Pharmacy Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Ashutosh M Shukla
- Department of Medicine, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Asmita Gupte
- Department of Medicine, North Florida/South Georgia Veterans Health System, Gainesville, FL, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
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126
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Haye G, Fourdrain A, Abou-Arab O, Berna P, Mahjoub Y. COVID-19 Outbreak in France: Setup and Activities of a Mobile Extracorporeal Membrane Oxygenation Team During the First 3 Weeks. J Cardiothorac Vasc Anesth 2020; 34:3493-3495. [PMID: 32457006 PMCID: PMC7207137 DOI: 10.1053/j.jvca.2020.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Guillaume Haye
- Department of Anaesthesiology and Critical Care Medicine
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens Picardy University Hospital, Amiens, France
| | | | - Pascal Berna
- Department of Thoracic Surgery, Amiens Picardy University Hospital, Amiens, France
| | - Yazine Mahjoub
- Department of Anaesthesiology and Critical Care Medicine
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127
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Kowalik MM, Trzonkowski P, Łasińska-Kowara M, Mital A, Smiatacz T, Jaguszewski M. COVID-19 - Toward a comprehensive understanding of the disease. Cardiol J 2020; 27:99-114. [PMID: 32378729 PMCID: PMC8016030 DOI: 10.5603/cj.a2020.0065] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/07/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
The evidence on the pathophysiology of the novel coronavirus SARS-CoV-2 infection is rapidly growing. Understanding why some patients suffering from COVID-19 are getting so sick, while others are not, has become an informal imperative for researchers and clinicians around the globe. The answer to this question would allow rationalizing the fear surrounding this pandemic. Understanding of the pathophysiology of COVID-19 relies on an understanding of interplaying mechanisms, including SARS-CoV-2 virulence, human immune response, and complex inflammatory reactions with coagulation playing a major role. An interplay with bacterial co-infections, as well as the vascular system and microcirculation affected throughout the body should also be examined. More importantly, a compre-hensive understanding of pathological mechanisms of COVID-19 will increase the efficacy of therapy and decrease mortality. Herewith, presented is the current state of knowledge on COVID-19: beginning from the virus, its transmission, and mechanisms of entry into the human body, through the pathological effects on the cellular level, up to immunological reaction, systemic and organ presentation. Last but not least, currently available and possible future therapeutic and diagnostic options are briefly commented on.
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Affiliation(s)
- Maciej M Kowalik
- Department of Cardiac Anesthesiology, Medical University of Gdańsk, Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland.
| | - Piotr Trzonkowski
- Department of Medical Immunology, Medical University of Gdansk, Dębinki 1, 80-209 Gdańsk, Poland
| | - Magdalena Łasińska-Kowara
- Department of Cardiac Anesthesiology, Medical University of Gdańsk, Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Andrzej Mital
- Department of Hematology and Transplantology, Medical University of Gdansk, Poland
| | | | - Miłosz Jaguszewski
- 1st Department of Cardiology, University Catheterization Laboratories, Medical University of Gdansk, Poland
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128
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Toomasian J. The COVID-19 pand-ECMO-ic. Perfusion 2020; 35:278-279. [DOI: 10.1177/0267659120929657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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129
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