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Peer A, Perschinka F, Lehner G, Mayerhöfer T, Mair P, Kilo J, Breitkopf R, Fries D, Joannidis M. Outcome of COVID-19 patients treated with VV-ECMO in Tyrol during the pandemic. Wien Klin Wochenschr 2024; 136:465-471. [PMID: 37947878 PMCID: PMC11327186 DOI: 10.1007/s00508-023-02301-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION A small percentage of patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) showed severe respiratory deterioration requiring treatment with extracorporeal membrane oxygenation (ECMO). During the pandemic surges availability of ECMO devices was limited and resources had to be used wisely. The aim of this analysis was to determine the incidence and outcome of venovenous (VV) ECMO patients in Tyrol, when criteria based on the Extracorporeal Life Support Organization (ELSO) guidelines for VV-ECMO initiation were established. METHODS This is a secondary analysis of the Tyrol-CoV-ICU-Reg, which includes all patients admitted to an intensive care unit (ICU) during the coronavirus disease 2019 (COVID-19) pandemic in Tyrol. Of the 13 participating departments, VV-ECMO was performed at 4 units at the University Hospital Innsbruck. RESULTS Overall, 37 (3.4%) of 1101 patients were treated with VV-ECMO during their ICU stay. The hospital mortality rate was approximately 40% (n = 15). Multiorgan failure due to sepsis was the most common cause of death. No significant difference in survival rates between newly initiated and experienced centers was observed. The median survival time of nonsurvivors was 27 days (interquartile range, IQR: 22-36 days) after initiation of VV-ECMO. Acute kidney injury meeting the Kidney Disease: Improving Global Outcomes (KDIGO) criteria occurred in 48.6%. Renal replacement therapy (RRT) was initiated in 12 (32.4%) patients after a median of 18 days (IQR: 1-26 days) after VV-ECMO start. The median length of ICU and hospital stays were 38 days (IQR: 30-55 days) and 50 days (IQR: 37-83 days), respectively. DISCUSSION Despite a rapidly increased demand and the resulting requirement to initiate an additional ECMO center, we could demonstrate that a structured approach with interdisciplinary collaboration resulted in favorable survival rates similar to multinational reports.
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Affiliation(s)
- Andreas Peer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Fabian Perschinka
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Georg Lehner
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Timo Mayerhöfer
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Mair
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Juliane Kilo
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Breitkopf
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of Anaesthesiology and Intensive Care Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Kim WY, Jung SY, Kim JY, Chae G, Kim J, Joh JS, Park TY, Baek AR, Jegal Y, Chung CR, Lee J, Cho YJ, Park JH, Hwang JH, Song JW. ECMO is associated with decreased hospital mortality in COVID-19 ARDS. Sci Rep 2024; 14:14835. [PMID: 38937516 PMCID: PMC11211457 DOI: 10.1038/s41598-024-64949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
This study determined whether compared to conventional mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) is associated with decreased hospital mortality or fibrotic changes in patients with COVID-19 acute respiratory distress syndrome. A cohort of 72 patients treated with ECMO and 390 with conventional MV were analyzed (February 2020-December 2021). A target trial was emulated comparing the treatment strategies of initiating ECMO vs no ECMO within 7 days of MV in patients with a PaO2/FiO2 < 80 or a PaCO2 ≥ 60 mmHg. A total of 222 patients met the eligibility criteria for the emulated trial, among whom 42 initiated ECMO. ECMO was associated with a lower risk of hospital mortality (hazard ratio [HR], 0.56; 95% confidence interval [CI] 0.36-0.96). The risk was lower in patients who were younger (age < 70 years), had less comorbidities (Charlson comorbidity index < 2), underwent prone positioning before ECMO, and had driving pressures ≥ 15 cmH2O at inclusion. Furthermore, ECMO was associated with a lower risk of fibrotic changes (HR, 0.30; 95% CI 0.11-0.70). However, the finding was limited due to relatively small number of patients and differences in observability between the ECMO and conventional MV groups.
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Affiliation(s)
- Won-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong-Yeon Kim
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Ganghee Chae
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Junghyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Borame Medical Center, Seoul, Republic of Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yangjin Jegal
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Immohr MB, Hettlich VH, Kindgen-Milles D, Brandenburger T, Feldt T, Aubin H, Tudorache I, Akhyari P, Lichtenberg A, Dalyanoglu H, Boeken U. Changes in Therapy and Outcome of Patients Requiring Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19. Thorac Cardiovasc Surg 2024; 72:311-319. [PMID: 37146634 DOI: 10.1055/s-0043-57032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation (vv-ECMO) is related with poor outcome, especially in Germany. We aimed to analyze whether changes in vv-ECMO therapy during the pandemic were observed and lead to changes in the outcome of vv-ECMO patients. METHODS All patients undergoing vv-ECMO support for COVID-19 between 2020 and 2021 in a single center (n = 75) were retrospectively analyzed. Weaning from vv-ECMO and in-hospital mortality were defined as primary and peri-interventional adverse events as secondary endpoints of the study. RESULTS During the study period, four infective waves were observed in Germany. Patients were assigned correspondingly to four study groups: ECMO implantation between March 2020 and September 2020: first wave (n = 11); October 2020 to February 2021: second wave (n = 23); March 2021 to July 2021: third wave (n = 25); and August 2021 to December 2021: fourth wave (n = 20). Preferred cannulation technique changed within the second wave from femoro-femoral to femoro-jugular access (p < 0.01) and awake ECMO was implemented. Mean ECMO run time increased by more than 300% from 10.9 ± 9.6 (first wave) to 44.9 ± 47.0 days (fourth wave). Weaning of patients was achieved in less than 20% in the first wave but increased to approximately 40% since the second one. Furthermore, we observed a continuous numerically decrease of in-hospital mortality from 81.8 to 57.9% (p = 0.61). CONCLUSION Preference for femoro-jugular cannulation and awake ECMO combined with preexisting expertise and patient selection are considered to be associated with increased duration of ECMO support and numerically improved ECMO weaning and in-hospital mortality.
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Affiliation(s)
- Moritz Benjamin Immohr
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | | | - Detlef Kindgen-Milles
- Department of Anesthesiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Timo Brandenburger
- Department of Anesthesiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Torsten Feldt
- Department of Hepatology and Infectiology, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Hannan Dalyanoglu
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Germany
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Javidfar J, Zaaqoq AM, Labib A, Barnett AG, Hayanga JWA, Eschun G, Yamashita MH, Jacobs JP, Heinsar S, Suen JY, Fraser JF, Bassi GL, Arora RC, Peek GJ. Morbid obesity's impact on COVID-19 patients requiring venovenous extracorporeal membrane oxygenation: The covid-19 critical care consortium database review. Perfusion 2024; 39:702-712. [PMID: 36753684 PMCID: PMC9912044 DOI: 10.1177/02676591231156487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Introduction: Obesity is associated with a worse prognosis in COVID-19 patients with acute respiratory distress syndrome (ARDS). Veno-venous (V-V) Extracorporeal Membrane Oxygenation (ECMO) can be a rescue option, however, the direct impact of morbid obesity in this select group of patients remains unclear.Methods: This is an observational study of critically ill adults with COVID-19 and ARDS supported by V-V ECMO. Data are from 82 institutions participating in the COVID-19 Critical Care Consortium international registry. Patients were admitted between 12 January 2020 to 27 April 2021. They were stratified based on Body Mass Index (BMI) at 40 kg/m2. The endpoint was survival to hospital discharge.Results: Complete data available on 354 of 401 patients supported on V-V ECMO. The characteristics of the high BMI (>40 kg/m2) and lower BMI (≤40 kg/m2) groups were statistically similar. However, the 'high BMI' group were comparatively younger and had a lower APACHE II score. Using survival analysis, older age (Hazard Ratio, HR 1.49 per-10-years, CI 1.25-1.79) and higher BMI (HR 1.15 per-5 kg/m2 increase, CI 1.03-1.28) were associated with a decreased patient survival. A safe BMI threshold above which V-V ECMO would be prohibitive was not apparent and instead, the risk of an adverse outcome increased linearly with BMI.Conclusion: In COVID-19 patients with severe ARDS who require V-V ECMO, there is an increased risk of death associated with age and BMI. The risk is linear and there is no BMI threshold beyond which the risk for death greatly increases.
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Affiliation(s)
- Jeffrey Javidfar
- Division of Cardiothoracic
Surgery, Department of Surgery, Emory School of
Medicine, USA
| | - Akram M Zaaqoq
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, USA
| | - Ahmed Labib
- Medical Intensive Care
Unit, Department of Medicine, Hamad General Hospital, Qatar
| | - Adrian G Barnett
- School of Public Health & Social
Work, Queensland University of
Technology, Australia
| | - JW Awori Hayanga
- Department of Cardiovascular &
Thoracic Surgery, West Virginia
University, USA
| | - Greg Eschun
- Department of Medicine, Section of Critical Care
Medicine, Max Rady College of
Medicine, University of Manitoba, Canada
| | - Michael H Yamashita
- Department of Surgery, Section of Cardiac
Surgery, Max Rady College of
Medicine, University of Manitoba, Canada
| | - Jeffrey P Jacobs
- Congenital Heart Center, Department of Surgery, University of Florida, USA
| | - Silver Heinsar
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - Jacky Y Suen
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - John F Fraser
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - Gianluigi Li Bassi
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
| | - Rakesh C Arora
- Heart &Vascular
Institute, Division of Cardiac
Surgery, University Hospitals, USA
| | - Giles J Peek
- Congenital Heart Center, Department of Surgery, University of Florida, USA
| | - on behalf of the Covid-19 Critical Care Consortium (COVID
Critical)
- Division of Cardiothoracic
Surgery, Department of Surgery, Emory School of
Medicine, USA
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, USA
- Medical Intensive Care
Unit, Department of Medicine, Hamad General Hospital, Qatar
- School of Public Health & Social
Work, Queensland University of
Technology, Australia
- Department of Cardiovascular &
Thoracic Surgery, West Virginia
University, USA
- Department of Medicine, Section of Critical Care
Medicine, Max Rady College of
Medicine, University of Manitoba, Canada
- Department of Surgery, Section of Cardiac
Surgery, Max Rady College of
Medicine, University of Manitoba, Canada
- Congenital Heart Center, Department of Surgery, University of Florida, USA
- Critical Care Research
Group, The Prince Charles
Hospital, and University of
Queensland, Australia
- Heart &Vascular
Institute, Division of Cardiac
Surgery, University Hospitals, USA
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5
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Sylvestre A, Forel JM, Textoris L, Gragueb-Chatti I, Daviet F, Salmi S, Adda M, Roch A, Papazian L, Hraiech S, Guervilly C. Outcomes of Severe ARDS COVID-19 Patients Denied for Venovenous ECMO Support: A Prospective Observational Comparative Study. J Clin Med 2024; 13:1493. [PMID: 38592410 PMCID: PMC10932228 DOI: 10.3390/jcm13051493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Few data are available concerning the outcome of patients denied venovenous extracorporeal membrane oxygenation (VV-ECMO) relative to severe acute respiratory distress syndrome (ARDS) due to COVID-19. Methods: We compared the 90-day survival rate of consecutive adult patients for whom our center was contacted to discuss VV-ECMO indication. Three groups of patients were created: patients for whom VV-ECMO was immediately indicated (ECMO-indicated group), patients for whom VV-ECMO was not indicated at the time of the call (ECMO-not-indicated group), and patients for whom ECMO was definitely contraindicated (ECMO-contraindicated group). Results: In total, 104 patients were referred for VV-ECMO support due to severe COVID-19 ARDS. Among them, 32 patients had immediate VV-ECMO implantation, 28 patients had no VV-ECMO indication, but 1 was assisted thereafter, and 44 patients were denied VV-ECMO for contraindication. Among the 44 patients denied, 30 were denied for advanced age, 24 for excessive prior duration of mechanical ventilation, and 16 for SOFA score >8. The 90-day survival rate was similar for the ECMO-indicated group and the ECMO-not-indicated group at 62.1 and 61.9%, respectively, whereas it was significantly lower (20.5%) for the ECMO-contraindicated group. Conclusions: Despite a low survival rate, 50% of patients were at home 3 months after being denied for VV-ECMO for severe ARDS due to COVID-19.
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Affiliation(s)
- Aude Sylvestre
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Jean-Marie Forel
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Laura Textoris
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Ines Gragueb-Chatti
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Florence Daviet
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Saida Salmi
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Mélanie Adda
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Antoine Roch
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Laurent Papazian
- Centre Hospitalier de Bastia, Service de Réanimation, 604 Chemin de Falconaja, 20600 Bastia, France;
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, Università di Corsica, IRD 190, Inserm 1207, IRBA), 13284 Marseille, France
| | - Sami Hraiech
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Christophe Guervilly
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
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6
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Jacobson JC, Ryan ML, Vogel AM, Mehl SC, Acker SN, Prendergast C, Padilla BE, Lee J, Chao SD, Martin NR, Russell KW, Larsen K, Harting MT, Linden AF, Ignacio RC, Slater BJ, Juang D, Jensen AR, Melhado CG, Pelayo JC, Zhong A, Spencer BL, Gadepalli SK, Maamari M, Jimenez Valencia M, Qureshi FG, Pandya SR. Outcomes of Extracorporeal Life Support Utilization for Pediatric Patients With COVID-19 Infections. ASAIO J 2024; 70:146-153. [PMID: 37816012 DOI: 10.1097/mat.0000000000002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
Outcomes of pediatric patients who received extracorporeal life support (ECLS) for COVID-19 remain poorly described. The aim of this multi-institutional retrospective observational study was to evaluate these outcomes and assess for prognostic factors associated with in-hospital mortality. Seventy-nine patients at 14 pediatric centers across the United States who received ECLS support for COVID-19 infections between January 2020 and July 2022 were included for analysis. Data were extracted from the electronic medical record. The median age was 14.5 years (interquartile range [IQR]: 2-17 years). Most patients were female (54.4%) and had at least one pre-existing comorbidity (84.8%), such as obesity (44.3%, median body mass index percentile: 97% [IQR: 67.5-99.0%]). Venovenous (VV) ECLS was initiated in 50.6% of patients. Median duration of ECLS was 12 days (IQR: 6.0-22.5 days) with a mean duration from admission to ECLS initiation of 5.2 ± 6.3 days. Survival to hospital discharge was 54.4%. Neurological deficits were reported in 16.3% of survivors. Nonsurvivors were of older age (13.3 ± 6.2 years vs. 9.3 ± 7.7 years, p = 0.012), more likely to receive renal replacement therapy (63.9% vs. 30.2%, p = 0.003), demonstrated longer durations from admission to ECLS initiation (7.0 ± 8.1 days vs. 3.7 ± 3.8 days, p = 0.030), and had higher rates of ECLS-related complications (91.7% vs. 69.8%, p = 0.016) than survivors. Pediatric patients with COVID-19 who received ECLS demonstrated substantial morbidity and further investigation is warranted to optimize management strategies.
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Affiliation(s)
- Jillian C Jacobson
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mark L Ryan
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adam M Vogel
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Steven C Mehl
- Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Shannon N Acker
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Connor Prendergast
- Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Benjamin E Padilla
- Department of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - Justin Lee
- Department of Pediatric Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - Stephanie D Chao
- Division of Pediatric Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Nolan R Martin
- Division of Pediatric Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Katie W Russell
- Department of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Kezlyn Larsen
- Department of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Matthew T Harting
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas
| | - Allison F Linden
- Section of Pediatric Surgery, Department of Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Romeo C Ignacio
- Division of Pediatric Surgery/Department of Surgery, University of California School of Medicine, La Jolla, California
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - David Juang
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Aaron R Jensen
- Department of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California
| | - Caroline G Melhado
- Department of Pediatric Surgery, UCSF Benioff Children's Hospitals, Oakland, California
| | - Juan Carlos Pelayo
- Division of Pediatric Surgery and Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Allen Zhong
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Department of Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Brianna L Spencer
- Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan
| | - Samir K Gadepalli
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Mott Children's Hospital, Ann Arbor, Michigan
- Department of Pediatric Surgery, Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, Ann Arbor, Michigan
| | - Mia Maamari
- Division of Critical Care Medicine, UT Southwestern Medical Center, Children's Medical Center, Dallas, Texas
| | - Maria Jimenez Valencia
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Faisal G Qureshi
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samir R Pandya
- From the Division of Pediatric Surgery, Children's Medical Center & Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Tonna JE, Boonstra PS, MacLaren G, Paden M, Brodie D, Anders M, Hoskote A, Ramanathan K, Hyslop R, Fanning JJ, Rycus P, Stead C, Barrett NA, Mueller T, Gómez RD, Kapoor PM, Fraser JF, Bartlett RH, Alexander PM, Barbaro RP. Extracorporeal Life Support Organization Registry International Report 2022: 100,000 Survivors. ASAIO J 2024; 70:131-143. [PMID: 38181413 PMCID: PMC10962646 DOI: 10.1097/mat.0000000000002128] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
The Extracorporeal Life Support Organization (ELSO) maintains the world's largest extracorporeal membrane oxygenation (ECMO) registry by volume, center participation, and international scope. This 2022 ELSO Registry Report describes the program characteristics of ECMO centers, processes of ECMO care, and reported outcomes. Neonates (0-28 days), children (29 days-17 years), and adults (≥18 years) supported with ECMO from 2009 through 2022 and reported to the ELSO Registry were included. This report describes adjunctive therapies, support modes, treatments, complications, and survival outcomes. Data are presented descriptively as counts and percent or median and interquartile range (IQR) by year, group, or level. Missing values were excluded before calculating descriptive statistics. Complications are reported per 1,000 ECMO hours. From 2009 to 2022, 154,568 ECMO runs were entered into the ELSO Registry. Seven hundred and eighty centers submitted data during this time (557 in 2022). Since 2009, the median annual number of adult ECMO runs per center per year increased from 4 to 15, whereas for pediatric and neonatal runs, the rate decreased from 12 to 7. Over 50% of patients were transferred to the reporting ECMO center; 20% of these patients were transported with ECMO. The use of prone positioning before respiratory ECMO increased from 15% (2019) to 44% (2021) for adults during the coronavirus disease-2019 (COVID-19) pandemic. Survival to hospital discharge was greatest at 68.5% for neonatal respiratory support and lowest at 29.5% for ECPR delivered to adults. By 2022, the Registry had enrolled its 200,000th ECMO patient and 100,000th patient discharged alive. Since its inception, the ELSO Registry has helped centers measure and compare outcomes across its member centers and strategies of care. Continued growth and development of the Registry will aim to bolster its utility to patients and centers.
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Affiliation(s)
- Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, Utah
| | - Philip S. Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore, Singapore
| | - Matthew Paden
- Department of Surgery, Division of Pediatric Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel Brodie
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc Anders
- Department of Surgery, Division of Critical Care, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Aparna Hoskote
- Department of Surgery, Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Department of Surgery, Institute of Cardiovascular Science, University College London, Zayed Centre for Research into Rare Diseases in Children, London, UK
| | - Kollengode Ramanathan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Rob Hyslop
- Department of Surgery, Heart Institute, Children’s Hospital Colorado, Aurora, Colorado
| | - Jeffrey J. Fanning
- Department of Pediatrics, Extracorporeal Life Support Program, Medical City Children’s Hospital, Dallas, Texas
| | - Peter Rycus
- Department of Surgery, Extracorporeal Life Support Organization (ELSO), Ann Arbor, Michigan
| | - Christine Stead
- Department of Surgery, Extracorporeal Life Support Organization (ELSO), University of Michigan, Ann Arbor, Michigan
| | - Nicholas A. Barrett
- Department of Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Surgery, Centre for Human & Applied Physiological Sciences, King’s College London, London, UK
| | - Thomas Mueller
- Intensive Care Medicine, Department of Internal Medicine II, University Hospital Regensburg, Germany
| | - Rene D. Gómez
- Department of Surgery, Terapias Avanzadas de Soporte Cardiopulmonar, Hospitales Tec Salud, Escuela de Medicina ITESM, Monterrey, Mexico
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesiology and Critical Care, Cardio Thoracic Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - John F. Fraser
- Department of Surgery, University of Queensland, The Prince Charles Hospital, Brisbane, Australia
| | | | - Peta M.A. Alexander
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ryan P. Barbaro
- Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
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Rypulak E, Szczukocka M, Czarnik T. Utilisation and outcomes of a mobile (ambulance and air transport) venovenous extracorporeal membrane oxygenation (VV-ECMO) program in Poland during the COVID-19 pandemic - a retrospective, two-centres, case-series study. Anaesthesiol Intensive Ther 2024; 56:141-145. [PMID: 39166505 PMCID: PMC11284578 DOI: 10.5114/ait.2024.139526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/04/2024] [Indexed: 08/23/2024] Open
Abstract
INTRODUCTION Many patients required mechanical ventilation support due to severe COVID-19 pneumonia. A significant proportion of mechanically ventilated patients also required venovenous extracorporeal membrane oxygenation (VV-ECMO) due to refractory hypoxemia. A high demand for VV-ECMO support during the pandemic was challenging due to many factors, including limited resources and lack of established transfer protocols. This study aims to present the organisation and outcomes of a mobile VV-ECMO program in two high-volume centres in Poland during the COVID-19 pandemic. MATERIAL AND METHODS This retrospective, two-centre case series study, which lasted 36 months, was conducted between March 10, 2020, and January 31, 2023. The data of all patients transferred using venovenous extracorporeal membrane oxygenation (VV-ECMO) were analysed, including five women in the perinatal period with severe respiratory failure attri-buted to the COVID-19 virus. The analysis encompassed baseline patient demographics, Sequential Organ Failure Assessment (SOFA) scores, admission laboratory parameters, ECMO therapy, duration of mechanical ventilation, and patient survival to ICU discharge. RESULTS We assessed 86 patients who met the ELSO inclusion criteria and were transported during VV-ECMO support. Mortality in the analysed group was high (80.3%). Despite high mortality, VV-ECMO appeared to be a safe procedure in COVID-19 patients with severe ARDS. No complications were noted in more than half of the analysed procedures. Despite the above, many severe complications were observed, including stroke or cerebral haemorrhage (9.8%) and limb or gut ischemia (1.6%). The most common problems co-existing with VV-ECMO treatment were bleeding complications (34.4%). CONCLUSIONS The ICU mortality rate among patients requiring VV-ECMO for COVID-19 in high-volume ECMO centres was high but not associated with the type of transportation.
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Affiliation(s)
- Elżbieta Rypulak
- Second Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Marta Szczukocka
- Second Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Tomasz Czarnik
- Department of Anaesthesiology, Intensive Care, and Regional ECMO Centre, Institute of Medical Sciences, University of Opole, Poland
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Qaddoura A, Bartoszko J, Mitchell R, Frenette C, Johnston L, Mertz D, Pelude L, Thampi N, Smith SW. Extracorporeal membrane oxygenation for COVID-19-associated severe acute respiratory distress syndrome in Canada: Analysis of data from the Canadian Nosocomial Infection Surveillance Program. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2024; 8:272-282. [PMID: 38250620 PMCID: PMC10797765 DOI: 10.3138/jammi-2023-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 01/23/2024]
Abstract
Background Extracorporeal membrane oxygenation (ECMO) for COVID-19 across Canada has not been well-described. We studied trends for patients with COVID-19-related acute respiratory distress syndrome who received ECMO. Methods Multicentre retrospective cohort study using data from the Canadian Nosocomial Infection Surveillance Program across four different waves. Surveillance data was collected between March 2020 and June 2022. We reported data stratified by ECMO status and wave. Results ECMO recipients comprised 299 (6.8%) of the 4,408 critically ill patients included. ECMO recipients were younger (median age 49 versus 62 years, p < 0.001), less likely to be vaccinated against COVID-19 (Wave 4 data: 5.3% versus 19%; p = 0.002), and had fewer comorbidities compared to patients who did not receive ECMO. Thirty-day all-cause mortality was similar between the ECMO and non-ECMO groups (23% versus 26%; p = 0.25). Among ECMO recipients, mortality tended to decrease across Waves 1 to 4: 48%, 31%, 18%, and 16%, respectively (p = 0.04 for trend). However, this was no longer statistically significant when removing the high mortality during Wave 1 (p = 0.15). Conclusions Our findings suggest that critically ill patients in Canadian hospitals who received ECMO had different characteristics from those who did not receive ECMO. We also observed a trend of decreased mortality over the waves for the ECMO group. Possible explanatory factors may include potential delay in ECMO initiation during Wave 1, evolution of the virus, better understanding of COVID-19 disease and ECMO use, and new medical treatments and vaccines available in later waves. These findings may provide insight for future potential pandemics.
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Affiliation(s)
- Amro Qaddoura
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Bartoszko
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Robyn Mitchell
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Charles Frenette
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lynn Johnston
- Division of Infectious Diseases, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Dominik Mertz
- Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Linda Pelude
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Nisha Thampi
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Stephanie W Smith
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
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Setiadi H, El-Banayosy AM, Long JW, Maybauer MO, Mihu MR, El Banayosy A. Oncostatin M for characterizing the inflammatory burden and outcome of V-V ECMO in ARDS patients. Artif Organs 2023; 47:1885-1892. [PMID: 37476931 DOI: 10.1111/aor.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Assessing the outcome of Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) support remains challenging as plasma lactate (pLA), the widely used tool for this purpose, has been shown unreliable. We hypothesized that plasma oncostatin M (pOSM), a sensitive marker of leukocyte activation in infection and inflammation, could address this deficiency. METHODS Plasma OSM levels were measured by ELISA in 30 Acute Respiratory Distress Syndrome (ARDS) patients, prior to cannulation (baseline) and decannulation. RESULTS Based on the absolute pOSM levels at presentation, patients were separated into two groups, A and B. Patients in group A had low pOSM levels (Mean ± SD; Median, 1.1 ± 3.8; 0 pg/mL), whereas group B had high pOSM levels (1548 ± 1999; 767 pg/mL) [t-test: p < 0.01]. The percentage of pOSM levels at decannulation relative to baseline OSM levels was significantly higher in those who died (116.8 ± 68.0; 85.3%) than those who survived (47.6 ± 25.5; 48.9%) [t-test: p = 0.02; Mann-Whitney U Test: p = 0.01]. Conversely, no significant difference was observed in the percentage of pLA levels between those who died (142.9 ± 179.9; 89.8%) and those who survived (79.3 ± 34.3; 81.8%) [t-test: p = 0.31; Mann-Whitney U Test: p = 0.63]. CONCLUSION These early findings suggested critical value of absolute and relative pOSM to characterize the inflammatory burden of ARDS patients and the outcome of their V-V ECMO support.
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Affiliation(s)
- Hendra Setiadi
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Ahmed M El-Banayosy
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - James W Long
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Marc O Maybauer
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mircea R Mihu
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Aly El Banayosy
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
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11
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O'Gara BP, Tung MG, Kennedy KF, Espinosa-Leon JP, Shaefi S, Gluck J, Raz Y, Seethala R, Reich JA, Faugno AJ, Brodie D, Garan AR, Grandin EW. Outcomes With Single-Site Dual-Lumen Versus Multisite Cannulation for Adults With COVID-19 Respiratory Failure Receiving Venovenous Extracorporeal Membrane Oxygenation. Crit Care Med 2023; 51:1716-1726. [PMID: 37548506 DOI: 10.1097/ccm.0000000000006014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To determine whether multisite versus single-site dual-lumen (SSDL) cannulation is associated with outcomes for COVID-19 patients requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). DESIGN Retrospective analysis of the Extracorporeal Life Support Organization Registry. Propensity score matching (2:1 multisite vs SSDL) was used to control for confounders. PATIENTS The matched cohort included 2,628 patients (1,752 multisite, 876 SSDL) from 170 centers. The mean ( sd ) age in the entire cohort was 48 (11) years, and 3,909 (71%) were male. Patients were supported with mechanical ventilation for a median (interquartile range) of 79 (113) hours before VV-ECMO support. INTERVENTIONS None. MEASUREMENTS The primary outcome was 90-day survival. Secondary outcomes included survival to hospital discharge, duration of ECMO support, days free of ECMO support at 90 days, and complication rates. MAIN RESULTS There was no difference in 90-day survival (49.4 vs 48.9%, p = 0.66), survival to hospital discharge (49.8 vs 48.2%, p = 0.44), duration of ECMO support (17.9 vs 17.1 d, p = 0.82), or hospital length of stay after cannulation (28 vs 27.4 d, p = 0.37) between multisite and SSDL groups. More SSDL patients were extubated within 24 hours (4% vs 1.9%, p = 0.001). Multisite patients had higher ECMO flows at 24 hours (4.5 vs 4.1 L/min, p < 0.001) and more ECMO-free days at 90 days (3.1 vs 2.0 d, p = 0.02). SSDL patients had higher rates of pneumothorax (13.9% vs 11%, p = 0.03). Cannula site bleeding (6.4% vs 4.7%, p = 0.03), oxygenator failure (16.7 vs 13.4%, p = 0.03), and circuit clots (5.5% vs 3.4%, p = 0.02) were more frequent in multisite patients. CONCLUSIONS In this retrospective study of COVID-19 patients requiring VV-ECMO, 90-day survival did not differ between patients treated with a multisite versus SSDL cannulation strategy and there were only modest differences in major complication rates. These findings do not support the superiority of either cannulation strategy in this setting.
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Affiliation(s)
- Brian P O'Gara
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Matthew G Tung
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Kevin F Kennedy
- Department of Medicine, Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Juan P Espinosa-Leon
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jason Gluck
- Division of Cardiovascular Medicine, Department of Medicine, Hartford Hospital, Hartford, CT
| | - Yuval Raz
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Raghu Seethala
- Division of Thoracic and Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA
| | - John A Reich
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Anthony J Faugno
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Daniel Brodie
- Division of Critical Care Medicine and Pulmonary, Department of Medicine, Columbia University Medical Center, New York, NY
| | - A Reshad Garan
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - E Wilson Grandin
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Arachchillage DJ, Weatherill A, Rajakaruna I, Gaspar M, Odho Z, Isgro G, Cagova L, Fleming L, Ledot S, Laffan M, Szydlo R, Jooste R, Scott I, Vuylsteke A, Yusuff H. Thombosis, major bleeding, and survival in COVID-19 supported by veno-venous extracorporeal membrane oxygenation in the first vs second wave: a multicenter observational study in the United Kingdom. J Thromb Haemost 2023; 21:2735-2746. [PMID: 37423386 DOI: 10.1016/j.jtha.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Bleeding and thrombosis are major complications of veno-venous (VV) extracorporeal membrane oxygenation (ECMO). OBJECTIVES To assess thrombosis, major bleeding (MB), and 180-day survival in patients supported by VV-ECMO between the first (March 1 to May 31, 2020) and second (June 1, 2020, to June 30, 2021) waves of the COVID-19 pandemic. METHODS An observational study of 309 consecutive patients (aged ≥18years) with severe COVID-19 supported by VV-ECMO was performed in 4 nationally commissioned ECMO centers in the United Kingdom. RESULTS Median age was 48 (19-75) years, and 70.6% were male. Probabilities of survival, thrombosis, and MB at 180 days in the overall cohort were 62.5% (193/309), 39.8% (123/309), and 30% (93/309), respectively. In multivariate analysis, an age of >55 years (hazard ratio [HR], 2.29; 95% CI, 1.33-3.93; P = .003) and an elevated creatinine level (HR, 1.91; 95% CI, 1.19-3.08; P = .008) were associated with increased mortality. Correction for duration of VV-ECMO support, arterial thrombosis alone (HR, 3.0; 95% CI, 1.5-5.9; P = .002) or circuit thrombosis alone (HR, 3.9; 95% CI, 2.4-6.3; P < .001) but not venous thrombosis increased mortality. MB during ECMO had a 3-fold risk (95% CI, 2.6-5.8, P < .001) of mortality. The first wave cohort had more males (76.7% vs 64%; P = .014), higher 180-day survival (71.1% vs 53.3%; P = .003), more venous thrombosis alone (46.4% vs 29.2%; P = .02), and lower circuit thrombosis (9.2% vs 28.1%; P < .001). The second wave cohort received more steroids (121/150 [80.6%] vs 86/159 [54.1%]; P < .0001) and tocilizumab (20/150 [13.3%] vs 4/159 [2.5%]; P = .005). CONCLUSION MB and thrombosis are frequent complications in patients on VV-ECMO and significantly increase mortality. Arterial thrombosis alone or circuit thrombosis alone increased mortality, while venous thrombosis alone had no effect. MB during ECMO support increased mortality by 3.9-fold.
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Affiliation(s)
- Deepa J Arachchillage
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK; Department of Haematology, Imperial College Healthcare NHS Trust, London, UK.
| | - Anna Weatherill
- Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Indika Rajakaruna
- Department of Computer Science, University of East London, London, UK
| | - Mihaela Gaspar
- Department of Haematology, Royal Brompton Hospital, London, UK
| | - Zain Odho
- Department of Biochemistry, Royal Brompton Hospital, London, UK
| | - Graziella Isgro
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Lenka Cagova
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Lucy Fleming
- Department of Critical Care, NHS Grampian, Aberdeen, UK
| | - Stephane Ledot
- Department of Anaesthesia and Critical Care, Royal Brompton Hospital, London, UK
| | - Mike Laffan
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK; Department of Haematology, Imperial College Healthcare NHS Trust, London, UK
| | - Richard Szydlo
- Centre for Haematology, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Rachel Jooste
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Ian Scott
- Department of Critical Care, NHS Grampian, Aberdeen, UK
| | - Alain Vuylsteke
- Department of Anaesthesia and Critical Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Hakeem Yusuff
- Department of Anaesthesia and Critical Care, University Hospitals of Leicester NHS Trust, Leicester, UK
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13
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Tomioka Y, Miyoshi K, Tanaka S, Sugimoto S, Kanai R, Nikai T, Toyooka S, Yamane M. Successful management of temporary veno-venous extracorporeal membrane oxygenation for a pediatric lung transplant recipient with bronchiolitis obliterans syndrome awaiting lung re-transplantation: a case report. Surg Case Rep 2023; 9:163. [PMID: 37713011 PMCID: PMC10504144 DOI: 10.1186/s40792-023-01742-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation is an uncommon strategy in Japan owing to the severe donor shortage and absence of urgent allocation policy. Moreover, the use of veno-venous (VV) ECMO for immunosuppressed patients is controversial; thus, applying ECMO to patients who await lung re-transplantation is challenging. CASE PRESENTATION A 16-year-old lung transplant recipient with grade 3 bronchiolitis obliterans syndrome was waitlisted for lung re-transplantation. Eleven months later, he fell into severe respiratory acidosis with hypercapnia, which were not resolved with mechanical ventilation. VV ECMO was introduced to minimize lung stress and strain. Tracheostomy was additionally performed on day 5 after the start of ECMO, and respiratory condition swiftly improved; hence, the weaning process from VV ECMO began on day 9. Rehabilitation became implementable, and bilateral re-lung transplantation was successfully performed 6 months after the ECMO treatment. No critical complication related to the precedent use of ECMO was noted. CONCLUSIONS VV ECMO can be a feasible treatment option even for lung transplant candidates awaiting re-transplantation for a prolonged period. Introduction of ECMO and tracheostomy in the early deterioration stage may be crucial to successful subsequent patient management.
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Affiliation(s)
- Yasuaki Tomioka
- Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-Cho, Izumo, Shimane 693-8501 Japan
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shin Tanaka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan
| | - Rie Kanai
- Department of Pediatrics, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Tetsuro Nikai
- Department of Anesthesiology, Faculty of Medicine, Shimane University, Izumo, Shimane Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masaomi Yamane
- Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, Shimane University, 89-1 Enya-Cho, Izumo, Shimane 693-8501 Japan
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Dave SB, Rabinowitz R, Shah A, Tabatabai A, Galvagno SM, Mazzeffi MA, Rector R, Kaczorowski DJ, Scalea TM, Menaker J. COVID-19 outcomes of venovenous extracorporeal membrane oxygenation for acute respiratory failure vs historical cohort of non-COVID-19 viral infections. Perfusion 2023; 38:1165-1173. [PMID: 35653427 PMCID: PMC9168413 DOI: 10.1177/02676591221105603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become a support modality for patients with acute respiratory failure refractory to standard therapies. VV ECMO has been increasingly used during the current COVID-19 pandemic for patients with refractory respiratory failure. The object of this study was to evaluate the outcomes of VV ECMO in patients with COVID-19 compared to patients with non-COVID-19 viral infections. METHODS We retrospectively reviewed all patients supported with VV ECMO between 8/2014 and 8/2020 whose etiology of illness was a viral pulmonary infection. The primary outcome of this study was to evaluate in-hospital mortality. The secondary outcomes included length of ECMO course, ventilator duration, hospital length of stay, incidence of adverse events through ECMO course. RESULTS Eighty-nine patients were included (35 COVID-19 vs 54 non-COVID-19). Forty (74%) of the non-COVID-19 patients had influenza virus. Prior to cannulation, COVID-19 patients had longer ventilator duration (3 vs 1 day, p = .003), higher PaCO2 (64 vs 53 mmHg, p = .012), and white blood cell count (14 vs 9 ×103/μL, p = .004). Overall in-hospital mortality was 33.7% (n = 30). COVID-19 patients had a higher mortality (49% vs. 24%, p = .017) when compared to non-COVID-19 patients. COVID-19 survivors had longer median time on ECMO than non-COVID-19 survivors (24.4 vs 16.5 days p = .03) but had a similar hospital length of stay (HLOS) (41 vs 48 Extracorporeal Membrane Oxygenationdays p = .33). CONCLUSION COVID-19 patients supported with VV ECMO have a higher mortality than non-COVID-19 patients. While COVID-19 survivors had significantly longer VV ECMO runs than non-COVID-19 survivors, HLOS was similar. This data add to a growing body of literature supporting the use of ECMO for potentially reversible causes of respiratory failure.
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Affiliation(s)
- Sagar B Dave
- Department of Emergency Medicine,
Department of Anesthesiology, Division of Critical Care,
Emory
University School of Medicine, Atlanta,
GA, USA
| | - Ronald Rabinowitz
- Department of Medicine, Program in
Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Aakash Shah
- Department of Surgery, Division of
Cardiac Surgery, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Ali Tabatabai
- Department of Medicine, Division of
Pulmonary and Critical Care, Program in Trauma, R Adams Cowley Shock Trauma
Center, University
of Maryland School of Medicine,
Baltimore, MD, USA
| | - Samuel M Galvagno
- Department of Anesthesiology,
Program in Trauma, R Adams Cowley Shock Trauma Center,
University
of Maryland School of Medicine,
Baltimore, MD, USA
| | - Michael A Mazzeffi
- Department of Anesthesiology and
Critical Care Medicine, George Washington School of Medicine and
Health Sciences, Washington, DC,
USA
| | - Raymond Rector
- Perfusion Services,
University
of Maryland Medical Center, Baltimore,
MD, USA
| | - David J Kaczorowski
- Department of Cardiothoracic
Surgery, University
of Pittsburgh Medical Center,
Pittsburgh, PA, USA
| | - Thomas M Scalea
- Department of Surgery, Program in
Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of
Medicine, Baltimore, MD, USA
| | - Jay Menaker
- Department of Surgery, Johns
Hopkins Medicine, Howard County General
Hospital, Columbia, MD, USA
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15
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He J, Lin Y, Cai W, Lin Y, Qin W, Shao Y, Liu Q. EFFICACY OF SUPPLEMENTAL HEMOADSORPTION THERAPY ON SEVERE AND CRITICAL PATIENTS WITH COVID-19: AN EVIDENCE-BASED ANALYSIS. Shock 2023; 60:333-344. [PMID: 37548606 PMCID: PMC10510838 DOI: 10.1097/shk.0000000000002189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/06/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
ABSTRACT Background: The COVID-19 pandemic has posed a disproportionately high threat to the global health system and social stability. COVID-19 damage can lead to hyperinflammation and tissue damage due to a "cytokine storm," which in turn contributes to an increase in the mortality rate. Extracorporeal hemoadsorption therapy (HAT) in patients with severe COVID-19 may improve organ function and stabilize hemodynamic status; however, the effects of supplemental HAT remain controversial. Methods: The Cochrane Library, Embase, and PubMed databases were comprehensively searched from inception to August 20, 2022, for potential studies. Results: A total of 648 patients with severe COVID-19 in three randomized controlled trials and 11 observational studies met the inclusion criteria. A meta-analysis indicated that supplemental HAT significantly improved the mortality rate of patients with severe COVID-19 compared with conventional therapy (relative risk [RR] = 0.74, 95% confidence interval [CI] = 0.56 to 0.96, P = 0.026). In subgroup analyses, supplemental HAT significantly decreased mortality rates in patients without extracorporeal membrane oxygenation (ECMO) support (RR = 0.59, 95% CI = 0.44-0.79, P < 0.0001), while a significant difference was not observed in patients requiring ECMO support (RR = 1.61, 95% CI = 0.63-4.09, P = 0.316). Standardized mean difference (SMD) meta-analysis showed that IL-6 removal was more significant in HAT group than conventional therapy group (SMD = 0.46, 95% CI = 0.01 to 0.91, P = 0.043), followed by C-reactive protein (SMD = 0.70, 95% CI = -0.04 to 1.44, P = 0.065) and IL-8 (SMD = 0.36, 95% CI = -0.34 to 1.07, P = 0.311). No evidence of substantial publication bias concerning mortality was observed. Conclusion: Given the better mortality outcomes, HAT confers clinical benefits to patients with severe COVID-19, which correlated with cytokine removal by HAT. Cytokine adsorption may not provide clinical benefits for patients with severe COVID-19 requiring ECMO and should be used with caution. However, because of the very low quality of evidence, multicenter randomized trials with large sample sizes are required to verify these findings.
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Affiliation(s)
- Junbing He
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Yao Lin
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Weiming Cai
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Yingying Lin
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Wanbing Qin
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
| | - Yiming Shao
- The Intensive Care Unit, The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, China
| | - Qinghua Liu
- Jieyang Medical Research Center, Jieyang People's Hospital, Jieyang, China
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- NHC Key Laboratory of Clinical Nephrology (Sun Yat-Sen University) and Guangdong Provincial Key Laboratory of Nephrology, Guangzhou, China
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16
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Powell EK, Haase DJ, Lankford A, Boswell K, Esposito E, Hamera J, Dahi S, Krause E, Bittle G, Deatrick KB, Young BAC, Galvagno SM, Tabatabai A. Body mass index does not impact survival in COVID-19 patients requiring veno-venous extracorporeal membrane oxygenation. Perfusion 2023; 38:1174-1181. [PMID: 35467981 PMCID: PMC9039588 DOI: 10.1177/02676591221097642] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION With the increased demand for veno-venous extracorporeal membrane oxygenation (VV ECMO) during the COVID-19 pandemic, guidelines for patient candidacy have often limited this modality for patients with a body mass index (BMI) less than 40 kg/m2. We hypothesize that COVID-19 VV ECMO patients with at least class III obesity (BMI ≥ 40) have decreased in-hospital mortality when compared to non-COVID-19 and non-class III obese COVID-19 VV ECMO populations. METHODS This is a single-center retrospective study of COVID-19 VV ECMO patients from January 1, 2014, to November 30, 2021. Our institution used BMI ≥ 40 as part of a multi-disciplinary VV ECMO candidate screening process in COVID-19 patients. BMI criteria were not considered for exclusion criteria in non-COVID-19 patients. Univariate and multivariable analyses were performed to assess in-hospital mortality differences. RESULTS A total of 380 patients were included in our analysis: The COVID-19 group had a lower survival rate that was not statistically significant (65.7% vs.74.9%, p = .07). The median BMI between BMI ≥ 40 COVID-19 and non-COVID-19 patients was not different (44.5 vs 45.5, p = .2). There was no difference in survival between the groups (73.3% vs. 78.5%, p = .58), nor was there a difference in survival between the COVID-19 BMI ≥ 40 and BMI < 40 patients (73.3, 62.7, p= .29). Multivariable logistic regression with the outcome of in-hospital mortality was performed and BMI was not found to be significant (OR 0.99, 95% CI 0.89, 1.01; p = .92). CONCLUSION BMI ≥ 40 was not an independent risk factor for decreased in-hospital survival in this cohort of VV ECMO patients at a high-volume center. BMI should not be the sole factor when deciding VV ECMO candidacy in patients with COVID-19.
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Affiliation(s)
- Elizabeth K Powell
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Haase
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Allison Lankford
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly Boswell
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Emily Esposito
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Joseph Hamera
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Siamak Dahi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric Krause
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gregory Bittle
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristopher B Deatrick
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Bree Ann C Young
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Samuel M Galvagno
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ali Tabatabai
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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17
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Kosovali BD, Mutlu NM. Global scientific outputs of extracorporeal membrane oxygenation in COVID-19: A bibliometric overview. Perfusion 2023; 38:1153-1164. [PMID: 35635047 PMCID: PMC9152629 DOI: 10.1177/02676591221105405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIM Although the number of global studies on ECMO, which is an important support system in the treatment of COVID-19 related respiratory failure, has increased in recent months, there is still no bibliometric study on the use of ECMO in COVID-19 in the literature. The aim of this study is to analyze the scientific articles on the use of ECMO in COVID-19 by statistical and bibliometric methods. METHOD Articles published between 2019-2022 about the use of ECMO in COVID-19 were obtained from the Web of Science (WoS) database and analyzed using statistical and bibliometric methods. Spearman correlation coefficient was used for correlation studies. Network visualization maps were used to identify effe analysis and trending topics. RESULTS A total of 1197 publications were found. 758 (63.3%) of these publications were articles. The top 3 contributing countries to the literature were USA (257, 33.9%), Germany (102, 13.4%) and Japan (87, 11.5%). The top 3 most active institutions were League of European Research Universities (90), Harvard University (50), and Udice French Research Universities (39). The top 3 journals with the highest count of publications were ASAIO Journal (n = 36), Frontiers in Medicine (22), and Perfusion-UK (n = 20). According to the average count of citations per article, the most influential journals were JAMA (1319), Intensive Care Medicine (327), and Lancet (95.7), respectively. We have shared a summary of 758 articles in this comprehensive bibliometric study on the use of ECMO in COVID-19. CONCLUSION It can be said that the use of ECMO in COVID-19 has been the trending topic recently and most of the studies are from countries in the ELSO Awards of Excellence list which indicates that the follow-up of ECMO in certain centers and teams can also be influencing the publications. This article can be a useful resource for clinicians, scientists, and students concerning global output for ECMO use in COVID-19.
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Affiliation(s)
| | - Nevzat M Mutlu
- Department of Critical Care,
Ankara
City Hospital, Ankara, Turkey
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18
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Ruhi-Williams P, Wu B, Nahmias J, Sagebin F, Fazl Alizadeh R, Gadde KM, Amin A, Nguyen NT. Analysis of Veno-Venous Extracorporeal Membrane Oxygenation for COVID-19 Compared to Non-COVID Etiologies. Ann Surg 2023; 278:464-470. [PMID: 37325899 DOI: 10.1097/sla.0000000000005959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE This study analyzed the characteristics and outcomes of veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS) due to COVID-19 versus non-COVID causes at US academic centers. BACKGROUND DATA V-V ECMO support has been utilized for COVID-19 patients with ARDS since the beginning of the pandemic. Mortality for ECMO in COVID-19 has been reported to be high but similar to reported mortality for ECMO support for non-COVID causes of respiratory failure. METHODS Using ICD-10 codes, data of patients who underwent V-V ECMO for COVID-19 ARDS were compared with patients who underwent V-V ECMO for non-COVID causes between April 2020 and December 2022. The primary outcome was in-hospital mortality. Secondary outcome measures included length of stay and direct cost. Multivariate logistic regression modeling was performed to analyze differences in mortality between COVID and non-COVID groups, adjusting for other important risk factors (age, sex, and race/ethnicity). RESULTS We identified and compared 6382 patients who underwent V-V ECMO for non-COVID causes to 6040 patients who underwent V-V ECMO for COVID-19. There was a significantly higher proportion of patients aged ≥ 65 years who underwent V-V ECMO in the non-COVID group compared with the COVID group (19.8% vs. 3.7%, respectively, P <0.001). Compared with patients who underwent V-V ECMO for non-COVID causes, patients who underwent V-V ECMO for COVID had increased in-hospital mortality (47.6% vs. 34.5%, P <0.001), length of stay (46.5±41.1 days vs. 40.6±46.1, P <0.001), and direct hospitalization cost ($207,022±$208,842 vs. $198,508±205,510, P =0.02). Compared with the non-COVID group, the adjusted odds ratio (OR) for in-hospital mortality in the COVID group was 2.03 (95% CI: 1.87-2.20, P <0.001). In-hospital mortality for V-V ECMO in COVID-19 improved during the study time period (50.3% in 2020, 48.6% in 2021, and 37.3% in 2022). However, there was a precipitous drop in the ECMO case volume for COVID starting in quarter 2 of 2022. CONCLUSIONS In this nationwide analysis, COVID-19 patients with ARDS requiring V-V ECMO support had increased mortality compared with patients who underwent V-V ECMO for non-COVID etiologies.
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Affiliation(s)
- Perisa Ruhi-Williams
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Baolin Wu
- Department of Epidemiology and Biostatistics, Program in Public Health, Susan & Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA
| | - Jeffry Nahmias
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Fabio Sagebin
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Kishore M Gadde
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
| | - Alpesh Amin
- Department of Medicine, University of California Irvine Medical Center, Orange, CA
| | - Ninh T Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, CA
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19
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Whitmore SP, Cyr KJ, Cohen ES, Schlauch DJ, Gidwani HV, Sterling RK, Castiglia RP, Stell OT, Jarzembowski JL, Kunavarapu CR, McRae AT, Dellavolpe JD. Extracorporeal Membrane Oxygenation for Acute Respiratory Failure Due to COVID-19: A Multicenter Matched Cohort Study. ASAIO J 2023; 69:734-741. [PMID: 37531086 PMCID: PMC10627401 DOI: 10.1097/mat.0000000000001963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Mechanical ventilation for respiratory failure due to COVID-19 is associated with significant morbidity and mortality. Veno-venous extracorporeal membrane oxygenation (ECMO) is an attractive management option. This study sought to determine the effect of ECMO on hospital mortality and discharge condition in this population. We conducted a retrospective multicenter study to emulate a pragmatic targeted trial comparing ECMO to mechanical ventilation without ECMO for severe COVID-19. Data were gathered from a large hospital network database in the US. Adults admitted with COVID-19 were included if they were managed with ECMO or mechanical ventilation for severe hypoxemia and excluded if they had significant comorbidities or lacked functional independence on admission. The groups underwent coarsened exact matching on multiple clinical variables. The primary outcome was adjusted in-hospital mortality; secondary outcomes included ventilator days, intensive care days, and discharge destination. A total of 278 ECMO patients were matched to 2,054 comparison patients. Adjusted in-hospital mortality was significantly less in the ECMO group (38.8% vs. 60.1%, p < 0.001). Extracorporeal membrane oxygenation was associated with higher rates of liberation from mechanical ventilation, intensive care discharge, and favorable discharge destination. These findings support the use of ECMO for well-selected patients with severe acute respiratory failure due to COVID-19.
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Affiliation(s)
- Sage P. Whitmore
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | | | - Elliott S. Cohen
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | | | - Hitesh V. Gidwani
- Department of Critical Care Medicine, Methodist Hospital, San Antonio, Texas
| | - Rachel K. Sterling
- Department of Critical Care Medicine, Methodist Hospital, San Antonio, Texas
| | - Robert P. Castiglia
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | - Owen T. Stell
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | | | | | - Andrew T. McRae
- Department of Cardiology, TriStar Centennial Medical Center, Nashville, Tennessee
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20
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Sanivarapu RR, Osman U, Latha Kumar A. A Systematic Review of Mortality Rates Among Adult Acute Respiratory Distress Syndrome Patients Undergoing Extracorporeal Membrane Oxygenation Therapy. Cureus 2023; 15:e43590. [PMID: 37719572 PMCID: PMC10503872 DOI: 10.7759/cureus.43590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a severe lung disease associated with a high mortality rate. Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for severe ARDS patients who do not respond to conventional treatments. Nevertheless, the optimal management of ARDS patients undergoing ECMO and their mortality rates remain subjects of controversy. Thus, this systematic review aims to assess mortality rates in ARDS patients on ECMO and identify associated factors. The review adhered to the Preferred Reporting Items for Systemic Review and Meta-Analysis (PRISMA) 2020 guidelines. A comprehensive literature search was conducted on PubMed, PubMed Central (PMC), Medline, and Embase. In accordance with our inclusion and exclusion criteria, filters, and key terms, we proceeded to screen the articles. After assessing the relevance of each article to our topic, further screening was carried out. Quality assessment of the articles was conducted, resulting in the inclusion of a total of 12 articles for the review. The primary outcome focused on mortality rates among ARDS patients undergoing ECMO. Secondary outcomes explored potential contributors to mortality, including patient age, underlying cause of ARDS, and Sequential Organ Failure Assessment (SOFA) scores at the initiation of ECMO. Mortality rates exhibited significant variation, ranging from 22% to 62.6%. Several factors emerged as potential predictors of mortality, encompassing patient age, comorbidities, complications during ECMO therapy, and treatment-related variables. This systematic review offers valuable insights into the intricate factors influencing mortality rates among ARDS patients on ECMO. A comprehension of these factors is essential to steer clinical practice and enhance patient outcomes. While ECMO serves as a restorative avenue for ARDS patients, future research is warranted to further elucidate these complex interactions and refine ECMO therapy protocols.
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Affiliation(s)
- Raghavendra R Sanivarapu
- Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Usama Osman
- Research, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Geriatrics, Michigan State University College of Human Medicine, East Lansing, USA
| | - Abishek Latha Kumar
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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21
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Breda JR, Parker BM, Guerra G, Dawson A, Loebe M. Should VV ECMO be considered as treatment option in COVID-19 infection after kidney transplant? A word of caution. Clin Transplant 2023; 37:e15020. [PMID: 37198961 DOI: 10.1111/ctr.15020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 05/19/2023]
Abstract
Several reports have shown that hospitalized kidney transplant recipients (KTR) had high mortality rates when infected with COVID-19. Extracorporeal Membrane Oxygenation (ECMO) has been shown to be an option for refractory respiratory failure in COVID-19 patients with variable rates of recovery. The outcome of ECMO in respiratory failure is highly related to cohort investigated and patient selection. Over a 10-month period in the height of COVID-19 pandemic 5 KTR patients were placed on ECMO with none of the patients surviving to discharge. All patients experienced multisystem organ failure (MSOF) and hematologic pathology while on ECMO. We concluded that COVID-19 in KTR patients presents with a refractory MSOF that is not well supported with ECMO in a traditional approach. Future work is needed to determine how to best support refractory respiratory failure in KTR patients with COVID-19.
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Affiliation(s)
- Joao Roberto Breda
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brandon Masi Parker
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Giselle Guerra
- Division of Kidney Transplant, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Akia Dawson
- Medical Student, Ross University School of Medicine, Miramar, Florida, USA
| | - Matthias Loebe
- Division of Thoracic Transplantation and Mechanical Support, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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22
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Bibler TM, Zainab A. Withdrawing extra corporeal membrane oxygenation (ECMO) against a family's wishes: Three permissible scenarios. J Heart Lung Transplant 2023; 42:849-852. [PMID: 36972748 DOI: 10.1016/j.healun.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
The ethical permissibility of unilaterally withdrawing life-sustaining technologies has been a perennial topic in transplant and critical care medicine, often focusing on CPR and mechanical ventilation. The permissibility of unilateral withdrawal of extracorporeal membrane oxygenation (ECMO) has been discussed sparingly. When addressed, authors have appealed to professional authority rather than substantive ethical analysis. In this Perspective, we argue that there are at least three (3) scenarios wherein healthcare teams would be justified in unilaterally withdrawing ECMO, despite the objections of the patient's legal representative. The ethical considerations that provide the groundwork for these scenarios are, primarily: equity, integrity, and the moral equivalence between withholding and withdrawing medical technologies. First, we place equity in the context of crisis standards of medicine. After this, we discuss professional integrity as it relates to the innovative usage of medical technologies. Finally, we discuss the ethical consensus known at the "equivalence thesis." Each of these considerations include a scenario and justification for unilateral withdrawal. We also provide three (3) recommendations that aim at preventing these challenges at their outset. Our conclusions and recommendations are not meant to be blunt arguments that ECMO teams wield whenever disagreement about the propriety of continued ECMO support arises. Instead, the onus will be on individual ECMO programs to evaluate these arguments and decide if they represent sensible, correct, and implementable starting points for clinical practice guidelines or policies.
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Affiliation(s)
- Trevor M Bibler
- Center for Ethics and Health Policy, Baylor College of Medicine, Houston, Texas.
| | - Asma Zainab
- Department of Cardiovascular Anesthesia, Weill Cornell Medical College, New York, New York; Intensivist Cardiovascular Surgical ICU, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
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23
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Song JY, Huang JY, Hsu YC, Lo MT, Lin C, Shen TC, Liao MT, Lu KC. Coronavirus disease 2019 and cardiovascular disease. Tzu Chi Med J 2023; 35:213-220. [PMID: 37545802 PMCID: PMC10399840 DOI: 10.4103/tcmj.tcmj_219_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/28/2022] [Accepted: 05/17/2023] [Indexed: 08/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus behind the coronavirus disease 2019 (COVID-19) pandemic, is a type of RNA virus that is nonsegmented. Cardiovascular diseases (CVDs) increase the mortality risk of patients. In this review article, we overview the existing evidence regarding the potential mechanisms of myocardial damage in coronavirus disease 2019 (COVID-19) patients. Having a comprehensive knowledge of the cardiovascular damage caused by SARS-CoV-2 and its underlying mechanisms is essential for providing prompt and efficient treatment, ultimately leading to a reduction in mortality rates. Severe COVID-19 causes acute respiratory distress syndrome and shock in patients. In addition, awareness regarding COVID-19 cardiovascular manifestations has increased, including the adverse impact on prognosis with cardiovascular involvement. Angiotensin-converting enzyme 2 receptor may play a role in acute myocardial injury caused by SARS-CoV-2 infection. COVID-19 patients experiencing heart failure may have their condition exacerbated by various contributing factors and mechanisms. Increased oxygen demand, myocarditis, stress cardiomyopathy, elevated pulmonary pressures, and venous thrombosis are potential health issues. The combination of these factors may lead to COVID-19-related cardiogenic shock, resulting in acute systolic heart failure. Extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs) are treatment options when inotropic support fails for effective circulatory support. To ensure effective COVID-19-related cardiovascular disease (CVD) surveillance, it is crucial to closely monitor the future host adaptation, viral evolution, and transmissibility of SARS-CoV-2, given the virus's pandemic potential.
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Affiliation(s)
- Jenn-Yeu Song
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jian-You Huang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Yi-Chiung Hsu
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Men-Tzung Lo
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan
| | - Ta-Chung Shen
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Min-Tser Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital Hsinchu Branch, Hsinchu, Taiwan
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
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Childress A, Bibler T, Moore B, Nelson RH, Robertson-Preidler J, Schuman O, Malek J. From Bridge to Destination? Ethical Considerations Related to Withdrawal of ECMO Support over the Objections of Capacitated Patients. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:5-17. [PMID: 35616323 DOI: 10.1080/15265161.2022.2075959] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention-a bridge to recovery or transplant-not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of withdrawal, including distributive justice, quality of life, patients' rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned.
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Cui W, Wang T, Xu Z, Liu J, Simakov S, Liang F. A numerical study of the hemodynamic behavior and gas transport in cardiovascular systems with severe cardiac or cardiopulmonary failure supported by venoarterial extracorporeal membrane oxygenation. Front Bioeng Biotechnol 2023; 11:1177325. [PMID: 37229493 PMCID: PMC10203410 DOI: 10.3389/fbioe.2023.1177325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been extensively demonstrated as an effective means of bridge-to-destination in the treatment of patients with severe ventricular failure or cardiopulmonary failure. However, appropriate selection of candidates and management of patients during Extracorporeal membrane oxygenation (ECMO) support remain challenging in clinical practice, due partly to insufficient understanding of the complex influences of extracorporeal membrane oxygenation support on the native cardiovascular system. In addition, questions remain as to how central and peripheral venoarterial extracorporeal membrane oxygenation modalities differ with respect to their hemodynamic impact and effectiveness of compensatory oxygen supply to end-organs. In this work, we developed a computational model to quantitatively address the hemodynamic interaction between the extracorporeal membrane oxygenation and cardiovascular systems and associated gas transport. Model-based numerical simulations were performed for cardiovascular systems with severe cardiac or cardiopulmonary failure and supported by central or peripheral venoarterial extracorporeal membrane oxygenation. Obtained results revealed that: 1) central and peripheral venoarterial extracorporeal membrane oxygenation modalities had a comparable capacity for elevating arterial blood pressure and delivering oxygenated blood to important organs/tissues, but induced differential changes of blood flow waveforms in some arteries; 2) increasing the rotation speed of extracorporeal membrane oxygenation pump (ω) could effectively improve arterial blood oxygenation, with the efficiency being especially high when ω was low and cardiopulmonary failure was severe; 3) blood oxygen indices (i.e., oxygen saturation and partial pressure) monitored at the right radial artery could be taken as surrogates for diagnosing potential hypoxemia in other arteries irrespective of the modality of extracorporeal membrane oxygenation; and 4) Left ventricular (LV) overloading could occur when ω was high, but the threshold of ω for inducing clinically significant left ventricular overloading depended strongly on the residual cardiac function. In summary, the study demonstrated the differential hemodynamic influences while comparable oxygen delivery performance of the central and peripheral venoarterial extracorporeal membrane oxygenation modalities in the management of patients with severe cardiac or cardiopulmonary failure and elucidated how the status of arterial blood oxygenation and severity of left ventricular overloading change in response to variations in ω. These model-based findings may serve as theoretical references for guiding the application of venoarterial extracorporeal membrane oxygenation or interpreting in vivo measurements in clinical practice.
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Affiliation(s)
- Wenhao Cui
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Tianqi Wang
- School of Mechanical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Zhuoming Xu
- Cardiac Intensive Care Unit, Department of Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jinlong Liu
- Institute of Pediatric Translational Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sergey Simakov
- Department of Computational Physics, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
- Marchuk Institute of Numerical Mathematics of the Russian Academy of Sciences, Moscow, Russia
| | - Fuyou Liang
- Department of Engineering Mechanics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
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Rabie AA, Elhazmi A, Azzam MH, Abdelbary A, Labib A, Combes A, Zakhary B, MacLaren G, Barbaro RP, Peek GJ, Antonini MV, Shekar K, Al-Fares A, Oza P, Mehta Y, Alfoudri H, Ramanathan K, Ogino M, Raman L, Paden M, Brodie D, Bartlett R. Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study. Ann Intensive Care 2023; 13:36. [PMID: 37129771 PMCID: PMC10152433 DOI: 10.1186/s13613-023-01126-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The high-quality evidence on managing COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support is insufficient. Furthermore, there is little consensus on allocating ECMO resources when scarce. The paucity of evidence and the need for guidance on controversial topics required an international expert consensus statement to understand the role of ECMO in COVID-19 better. Twenty-two international ECMO experts worldwide work together to interpret the most recent findings of the evolving published research, statement formulation, and voting to achieve consensus. OBJECTIVES To guide the next generation of ECMO practitioners during future pandemics on tackling controversial topics pertaining to using ECMO for patients with COVID-19-related severe ARDS. METHODS The scientific committee was assembled of five chairpersons with more than 5 years of ECMO experience and a critical care background. Their roles were modifying and restructuring the panel's questions and, assisting with statement formulation in addition to expert composition and literature review. Experts are identified based on their clinical experience with ECMO (minimum of 5 years) and previous academic activity on a global scale, with a focus on diversity in gender, geography, area of expertise, and level of seniority. We used the modified Delphi technique rounds and the nominal group technique (NGT) through three face-to-face meetings and the voting on the statement was conducted anonymously. The entire process was planned to be carried out in five phases: identifying the gap of knowledge, validation, statement formulation, voting, and drafting, respectively. RESULTS In phase I, the scientific committee obtained 52 questions on controversial topics in ECMO for COVID-19, further reviewed for duplication and redundancy in phase II, resulting in nine domains with 32 questions with a validation rate exceeding 75% (Fig. 1). In phase III, 25 questions were used to formulate 14 statements, and six questions achieved no consensus on the statements. In phase IV, two voting rounds resulted in 14 statements that reached a consensus are included in four domains which are: patient selection, ECMO clinical management, operational and logistics management, and ethics. CONCLUSION Three years after the onset of COVID-19, our understanding of the role of ECMO has evolved. However, it is incomplete. Tota14 statements achieved consensus; included in four domains discussing patient selection, clinical ECMO management, operational and logistic ECMO management and ethics to guide next-generation ECMO providers during future pandemic situations.
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Affiliation(s)
- Ahmed A Rabie
- Critical Care Department-ECMO care Unit (ECU), Riyadh Region Cluster1, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Alyaa Elhazmi
- Internal Medicine Department, King Faisal University, Riyadh, Saudi Arabia
| | - Mohamed H Azzam
- Adult Critical Care Department, Dr. Sulaiman Alhabib Medical Group, Jeddah, Saudi Arabia
| | | | - Ahmed Labib
- Hamad Medical Corporation, Weill Cornell Medical College, Doha, Qatar
| | - Alain Combes
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 75013, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Graeme MacLaren
- Cardiothoracic ICU, National University Hospital, Singapore, Singapore
| | - Ryan P Barbaro
- Division of Pediatric Critical Care and Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Giles J Peek
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | | | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Abdulrahman Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Ministry of Health, Kuwait City, Kuwait
- Al-Amiri Hospital Center for Respiratory and Cardiac Failure, Kuwait Extracorporeal Life Support Program, Ministry of Health, Kuwait City, Kuwait
| | - Pranay Oza
- Riddhi Vinayak Multispecialty Hospital, Mumbai, India
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, 122001, Haryana, India
| | - Huda Alfoudri
- Department of Anaesthesia, Critical Care, and Pain Management, Al-Adan Hospital Ministry of Health, Hadiya, Kuwait
| | | | - Mark Ogino
- Chief Partnership Officer, Nemours Children's Health, Delaware Valley, USA
| | - Lakshmi Raman
- Division of Paediatric Critical Care, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Matthew Paden
- Division of Paediatric Critical Care, Emory University, Atlanta, GA, USA
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians & Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian/Columbia University Medical Center, New York, USA
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Park FS, Shah AC, Rao S, Rinehart J, Togashi K. Clinical Outcome Comparison of Patients Requiring Extracorporeal Membrane Oxygenation With or Without COVID-19 Infection. Cureus 2023; 15:e39078. [PMID: 37332447 PMCID: PMC10268902 DOI: 10.7759/cureus.39078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
In severe COVID-19-related respiratory failure, extracorporeal membrane oxygenation (ECMO) is a useful modality that is used to provide effective oxygenation and ventilation to the patient. This descriptive study aimed to investigate and compare the outcomes between COVID-19-infected patients and patients who were not infected and required ECMO support. A retrospective study was undertaken on a cohort of 82 adult patients ([Formula: see text]18-year-old) who required venoarterial (VA-ECMO) and venovenous (VV-ECMO) ECMO between January 2019 and December 2022 in a single academic center. Patients who were cannulated for COVID-19-related respiratory failure (C-group) were compared to patients who were cannulated for non-COVID etiologies (non-group). Patients were excluded if data were missing regarding cannulation, decannulation, presenting diagnosis, and survival status. Categorical data were reported as counts and percentages, and continuous data were reported as means with 95% confidence intervals. Out of the 82 included ECMO patients, 33 (40.2%) were cannulated for COVID-related reasons, and 49 (59.8%) were cannulated for reasons other than COVID-19 infection. Compared to the non-group, the C-group had a higher in-hospital (75.8% vs. 55.1%) and overall mortality rate (78.8% vs. 61.2%). The C-group also had an average hospital length of stay (LOS) of 46.6 ± 13.2 days and an average intensive care unit (ICU) LOS of 44.1 ± 13.3 days. The non-group had an average hospital LOS of 24.8 ± 6.6 days and an average ICU LOS of 20.8 ± 5.9 days. Subgroup analysis of patients only treated with VV-ECMO yielded a greater in-hospital mortality rate for the C-group compared to the non-group (75.0% vs. 42.1%). COVID-19-infected patients may experience different morbidity and mortality rates as well as clinical presentations compared to non-COVID-infected patients when requiring ECMO support.
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Affiliation(s)
- Flora S Park
- Anesthesiology and Perioperative Medicine, University of California Irvine Health, Orange, USA
| | - Aalap C Shah
- Anesthesiology and Perioperative Medicine, University of California Irvine Health, Orange, USA
| | - Sonali Rao
- Anesthesiology and Perioperative Medicine, University of California Irvine Health, Orange, USA
| | - Joseph Rinehart
- Anesthesiology and Perioperative Medicine, University of California Irvine Health, Orange, USA
| | - Kei Togashi
- Anesthesiology and Perioperative Medicine, University of California Irvine Health, Orange, USA
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28
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Gorder K, Young W, Kapur NK, Henry TD, Garcia S, Guddeti RR, Smith TD. Mechanical Circulatory Support in COVID-19. Heart Fail Clin 2023; 19:205-211. [PMID: 36863812 PMCID: PMC9973539 DOI: 10.1016/j.hfc.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Despite aggressive care, patients with cardiopulmonary failure and COVID-19 experience unacceptably high mortality rates. The use of mechanical circulatory support devices in this population offers potential benefits but confers significant morbidity and novel challenges for the clinician. Thoughtful application of this complex technology is of the utmost importance and should be done in a multidisciplinary fashion by teams familiar with mechanical support devices and aware of the particular challenges provided by this complex patient population.
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Affiliation(s)
- Kari Gorder
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA.
| | - Wesley Young
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA. https://twitter.com/wesyoungpa
| | - Navin K Kapur
- Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Timothy D Henry
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH 45219, USA. https://twitter.com/HenrytTimothy
| | - Santiago Garcia
- Minneapolis Heart Institute, 800 East, 28th Street, Minneapolis, MN 55407, USA
| | - Raviteja R Guddeti
- Minneapolis Heart Institute, 800 East, 28th Street, Minneapolis, MN 55407, USA. https://twitter.com/RavitejaGuddeti
| | - Timothy D Smith
- The Christ Hospital Heart and Vascular Institute, 2139 Auburn Avenue, Cincinnati OH 45219, USA. https://twitter.com/TimDSmithMD
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Lucchini A, Gariboldi R, Villa M, Cannizzo L, Pegoraro F, Fumagalli L, Rona R, Foti G, Giani M. One hundred ECMO retrivals before and during the Covid-19 pandemic: an observational study. Intensive Crit Care Nurs 2023; 75:103350. [PMID: 36464607 PMCID: PMC9647026 DOI: 10.1016/j.iccn.2022.103350] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Patients with severe acute respiratory distress syndrome may require veno-venous extracorporeal membrane oxygenation (V-V ECMO) support. For patients in peripheral hospitals, retrieval by mobile ECMO teams and transport to high-volume centers is associated with improved outcomes, including the recent COVID-19 pandemic. To enable a safe transport of patients, a specialised ECMO-retrieval program needs to be implemented. However, there is insufficient evidence on how to safely and efficiently perform ECMO retrievals. We report single-centre data from out-of-centre initiations of VV-ECMO before and during the COVID-19 pandemic. DESIGN & SETTING Single-centre retrospective study. We include all the retrievals performed by our ECMO centre between January 1st, 2014, and April 30th, 2021. RESULTS One hundred ECMO missions were performed in the study period, for a median retrieval volume of 13 (IQR: 9-16) missions per year. the cause of the acute respiratory distress syndrome was COVID-19 in 10 patients (10 %). 98 (98 %) patients were retrieved and transported to our ECMO centre. To allow safe transport, 91 of them were cannulated on-site and transported on V-V ECMO. The remaining seven patients were centralised without ECMO, but they were all connected to V-V ECMO in the first 24 hours. No complications occurred during patient transport. The median duration of the ECMO mission was 7 hours (IQR: 6-9, range: 2 - 17). Median duration of ECMO support was 14 days (IQR: 9-24), whereas the ICU stay was 24 days (IQR:18-44). Overall, 73 patients were alive at hospital discharge (74 %). Survival rate was similar in non-COVID-19 and COVID-19 group (73 % vs 80 %, p = 0.549). CONCLUSION In this single-centre experience, before and during COVID-19 era, retrieval and ground transportation of ECMO patients was feasible and was not associated with complications. Key factors of an ECMO retrieval program include a careful selection of the transport ambulance, training of a dedicated ECMO mobile team and preparation of specific checklists and standard operating procedures.
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Affiliation(s)
- Alberto Lucchini
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | - Roberto Gariboldi
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | | | - Luigi Cannizzo
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | | | | | - Roberto Rona
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | - Giuseppe Foti
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
| | - Marco Giani
- Department of Emergency and Intensive Care, San Gerardo University Hospital, Monza, University of Milano-Bicocca, Italy.
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Son J, Hyun S, Yu WS, Jung J, Haam S. Percutaneous Dilatational Tracheostomy in Patients with COVID-19 Supported by Extracorporeal Membrane Oxygenation. J Chest Surg 2023; 56:128-135. [PMID: 36792944 PMCID: PMC10008368 DOI: 10.5090/jcs.22.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/10/2022] [Accepted: 11/23/2022] [Indexed: 02/17/2023] Open
Abstract
Background Pneumonia caused by severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, often requiring prolonged mechanical ventilation and eventually tracheostomy. Both procedures occur in isolation units where personal protective equipment is needed. Additionally, the high bleeding risk in patients with extracorporeal membrane oxygenation (ECMO) places a great strain on surgeons. We investigated the clinical characteristics and outcomes of percutaneous dilatational tracheostomy (PDT) in patients with coronavirus disease 2019 (COVID-19) supported by ECMO, and compared the outcomes of patients with and without ECMO. Methods This retrospective, single-center, observational study included patients with severe COVID-19 who underwent elective PDT (n=29) from April 1, 2020, to October 31, 2021. The patients were divided into ECMO and non-ECMO groups. Data were collected from electronic medical records at Ajou University Hospital in Suwon, Korea. Results Twenty-nine COVID-19 patients underwent PDT (24 men [82.8%] and 5 women [17.2%]; median age, 61 years; range, 26-87 years; interquartile range, 54-71 years). The mean procedure time was 17±10.07 minutes. No clinically or statistically significant difference in procedure time was noted between the ECMO and non-ECMO groups (16.35±7.34 vs. 18.25±13.32, p=0.661). Overall, 12 patients (41.4%) had minor complications; 10 had mild subdermal bleeding from the skin incision, which was resolved with local gauze packing, and 2 (6.9%) had dislodgement. No healthcare provider infection was reported. Conclusion Our PDT approach is safe for patients and healthcare providers. With bronchoscopy assistance, PDT can be performed quickly and easily even in isolation units and with acceptable risk, regardless of the hypo-coagulable condition of patients on ECMO.
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Affiliation(s)
- JeongA Son
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seungji Hyun
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Woo Sik Yu
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Joonho Jung
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Seokjin Haam
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea
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Colombier S, Gross A, Schneider A, Tozzi P, Ltaief Z, Verdugo-Marchese M, Kirsch M, Niclauss L. Hemodynamic oxygenator exchange-related effects during veno-venous extracorporeal membrane oxygenation for the treatment of acute SARS-CoV-2 respiratory distress syndrome. Perfusion 2023; 38:425-427. [PMID: 35245992 PMCID: PMC9932605 DOI: 10.1177/02676591211056564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few patients with coronavirus disease 2019-associated severe acute respiratory distress syndrome (ARDS) require veno-venous extracorporeal membrane oxygenation (VV-ECMO). Prolonged VV-ECMO support necessitates repeated oxygenator replacement, increasing the risk for complications. Transient hypoxemia, induced by VV-ECMO stop needed for this procedure, may induce transient myocardial ischemia and acutely declining cardiac output in critically ill patients without residual pulmonary function. This is amplified by additional activation of the sympathetic nervous system (tachycardia, pulmonary vasoconstriction, and increased systemic vascular resistance). Immediate reinjection of the priming solution of the new circuit and induced acute iatrogenic anemia are other potentially reinforcing factors. The case of a critically ill patient presented here provides an instructive illustration of the hemodynamic relationships occurring during VV-ECMO support membrane oxygenator exchange.
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Affiliation(s)
- Sébastien Colombier
- Department of Cardiovascular
Surgery, Lausanne
University Hospital (CHUV),
Switzerland,Sébastien Colombier, Centre Hospitalier
Universitaire Vaudois, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
| | - Adrien Gross
- Department of Anaesthesiology,
Lausanne
University Hospital (CHUV),
Switzerland
| | - Antoine Schneider
- Department of Intensive Care Unit,
Lausanne
University Hospital (CHUV),
Switzerland
| | - Piergiorgio Tozzi
- Department of Cardiovascular
Surgery, Lausanne
University Hospital (CHUV),
Switzerland
| | - Zied Ltaief
- Department of Intensive Care Unit,
Lausanne
University Hospital (CHUV),
Switzerland
| | | | - Matthias Kirsch
- Department of Cardiovascular
Surgery, Lausanne
University Hospital (CHUV),
Switzerland
| | - Lars Niclauss
- Department of Cardiovascular
Surgery, Lausanne
University Hospital (CHUV),
Switzerland
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Tran A, Fernando SM, Rochwerg B, Barbaro RP, Hodgson CL, Munshi L, MacLaren G, Ramanathan K, Hough CL, Brochard LJ, Rowan KM, Ferguson ND, Combes A, Slutsky AS, Fan E, Brodie D. Prognostic factors associated with mortality among patients receiving venovenous extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. THE LANCET. RESPIRATORY MEDICINE 2023; 11:235-244. [PMID: 36228638 PMCID: PMC9766207 DOI: 10.1016/s2213-2600(22)00296-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Venovenous extracorporeal membrane oxygenation (ECMO) can be considered for patients with COVID-19-associated acute respiratory distress syndrome (ARDS) who continue to deteriorate despite evidence-based therapies and lung-protective ventilation. The Extracorporeal Life Support Organization has emphasised the importance of patient selection; however, to better inform these decisions, a comprehensive and evidence-based understanding of the risk factors associated with poor outcomes is necessary. We aimed to summarise the association between pre-cannulation prognostic factors and risk of mortality in adult patients requiring venovenous ECMO for the treatment of COVID-19. METHODS In this systematic review and meta-analysis, we searched MEDLINE and Embase from Dec 1, 2019, to April 14, 2022, for randomised controlled trials and observational studies involving adult patients who required ECMO for COVID-19-associated ARDS and for whom pre-cannulation prognostic factors associated with in-hospital mortality were evaluated. We conducted separate meta-analyses of unadjusted and adjusted odds ratios (uORs), adjusted hazard ratios (aHRs), and mean differences, and excluded studies if these data could not be extracted. We assessed the risk of bias using the Quality in Prognosis Studies tool and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. Our protocol was registered with the Open Science Framework registry, osf.io/6gcy2. FINDINGS Our search identified 2888 studies, of which 42 observational cohort studies involving 17 449 patients were included. Factors that had moderate or high certainty of association with increased mortality included patient factors, such as older age (adjusted hazard ratio [aHR] 2·27 [95% CI 1·63-3·16]), male sex (unadjusted odds ratio [uOR] 1·34 [1·20-1·49]), and chronic lung disease (aHR 1·55 [1·20-2·00]); pre-cannulation disease factors, such as longer duration of symptoms (mean difference 1·51 days [95% CI 0·36-2·65]), longer duration of invasive mechanical ventilation (uOR 1·94 [1·40-2·67]), higher partial pressure of arterial carbon dioxide (mean difference 4·04 mm Hg [1·64-6·44]), and higher driving pressure (aHR 2·36 [1·40-3·97]); and centre factors, such as less previous experience with ECMO (aOR 2·27 [1·28-4·05]. INTERPRETATION The prognostic factors identified highlight the importance of patient selection, the effect of injurious lung ventilation, and the potential opportunity for greater centralisation and collaboration in the use of ECMO for the treatment of COVID-19-associated ARDS. These factors should be carefully considered as part of a risk stratification framework when evaluating a patient for potential treatment with venovenous ECMO. FUNDING None.
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Affiliation(s)
- Alexandre Tran
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
| | - Shannon M Fernando
- Department of Medicine, Division of Critical Care, University of Ottawa, Ottawa, ON, Canada; Department of Critical Care, Lakeridge Health Corporation, Oshawa, ON, Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Carol L Hodgson
- Department of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care-Research Centre, Monash University, Melbourne, VIC, Australia
| | - Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Catherine L Hough
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Laurent J Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre, London, UK
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM Unite Mixte de Recherche (UMRS) 1166, Paris, France; Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
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Zaaqoq A, Sallam T, Merley C, Galloway LA, Desale S, Varghese J, Alnababteh M, Kriner E, Kitahara H, Shupp J, Dalton H, Molina E. The interplay of inflammation and coagulation in COVID-19 Patients receiving extracorporeal membrane oxygenation support. Perfusion 2023; 38:384-392. [PMID: 35000466 PMCID: PMC9931882 DOI: 10.1177/02676591211057506] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Bleeding and thrombosis are common complications during Extracorporeal Membrane Oxygenation (ECMO) support for COVID-19 patients. We sought to examine the relationship between inflammatory status, coagulation effects, and observed bleeding and thrombosis in patients receiving venovenous (VV) ECMO for COVID-19 respiratory failure. STUDY DESIGN Cross-sectional cohort study. SETTINGS Quaternary care institution. PATIENTS The study period from April 1, 2020, to January 1, 2021, we included all patients with confirmed COVID-19 who received VV ECMO support. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Thirty-two patients were supported with VV ECMO during the study period, and 17 patients (53%) survived to hospital discharge. The ECMO nonsurvivors mean lactate dehydrogenase (LDH) levels were markedly elevated in comparison to survivors (1046 u/L [IQR = 509, 1305] vs 489 u/L [385 658], p = 0.003). Platelet/fibrinogen dysfunction, as reflected by the low Maximum Amplitude (MA) on viscoelastic testing, was worse in nonsurvivors (65.25 mm [60.68, 67.67] vs 74.80 mm [73.10, 78.40], p = 0.01). Time-group interaction for the first seven days of ECMO support, showed significantly lower platelet count in the nonsurvivors (140 k/ul [103, 170] vs 189.5 k/ul [ 146, 315], p < 0.001) and higher D-dimer in (21 μg/mL [13, 21] vs 14 μg/mL [3, 21], p < 0.001) in comparison to the survivors. Finally, we found profound statistically significant correlations between the clinical markers of inflammation and markers of coagulation in the nonsurvivors group. The ECMO nonsurvivors experienced higher rate of bleeding (73.3% vs 35.3%, p = 0.03), digital ischemia (46.7% vs 11.8%, p = 0.02), acute renal failure (60% vs 11.8%, p = 0.01) and bloodstream infection (60% vs 23.5%, p = 0.03). CONCLUSION The correlation between inflammation and coagulation in the nonsurvivors supported with VV ECMO could indicate dysregulated inflammatory response and worse clinical outcomes.
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Affiliation(s)
- Akram Zaaqoq
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA,Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA,Akram Zaaqoq, MD Department of Critical
Care Medicine Georgetown University 110 Irving St NW, suite 4B65 Washington, DC
20010, USA. E-mail:
| | - Tariq Sallam
- Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Caitlin Merley
- Department of Medicine, University of
Pennsylvania, Philadelphia, PA, USA
| | - Lan Anh Galloway
- Department of Urology, Vanderbilt University, Nashville, TN, USA
| | - Sameer Desale
- MedStar Health Research
Institute, Hyattsville, MD, USA
| | - Jobin Varghese
- Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Muhtadi Alnababteh
- Department of Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Eric Kriner
- Department of Critical Care
Medicine, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Hiroto Kitahara
- Department of Cardiac Surgery, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
| | - Jeffrey Shupp
- Department of Biochemistry and
Molecular & Cellular Biology, MedStar Washington Hospital
Center, Georgetown University Medical Center, Washington, DC,
USA,Department of Surgery, MedStar Washington Hospital Center
and MedStar Georgetown University Hospital, Washington, DC, USA
| | - Heidi Dalton
- Department of Pediatrics, Inova Fairfax Hospital, Virginia, USA, USA
| | - Ezequiel Molina
- Department of Cardiac Surgery, MedStar Washington Hospital
Center, Georgetown University, Washington, DC, USA
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34
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Siddiqui S, Lutz G, Tabatabai A, Nathan R, Anders M, Gibbons M, Russo M, Whitehead S, Rock P, Scalea T, Kheirbek RE. Early Guided Palliative Care Communication for Patients With COVID-19 Receiving ECMO. Am J Crit Care 2023; 32:166-174. [PMID: 36775881 DOI: 10.4037/ajcc2023184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) combined with COVID-19 presents challenges (eg, isolation, anticipatory grief) for patients and families. OBJECTIVE To (1) describe characteristics and outcomes of patients with COVID-19 receiving ECMO, (2) develop a practice improvement strategy to implement early, semistructured palliative care communication in ECMO acknowledgment meetings with patients' families, and (3) examine family members' experiences as recorded in clinicians' notes during these meetings. METHODS Descriptive observation of guided, in-depth meetings with families of patients with COVID-19 receiving ECMO, as gathered from the electronic medical record of a large urban academic medical center. Most meetings were held within 3 days of initiation of ECMO. RESULTS Forty-three patients received ECMO between March and October 2020. The mean patient age was 44 years; 63% of patients were Hispanic/Latino, 19% were Black, and 7% were White. Documentation of the ECMO acknowledgment meeting was completed for 60% of patients. Fifty-six percent of patients survived to hospital discharge. Family discussions revealed 7 common themes: hope, reliance on faith, multiple family members with COVID-19, helping children adjust to a new normal, visitation restrictions, gratitude for clinicians and care, and end-of-life discussions. CONCLUSION Early and ongoing provision of palliative care is feasible and useful for highlighting a range of experiences related to COVID-19. Palliative care is also useful for educating patients and families on the benefits and limitations of ECMO therapy.
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Affiliation(s)
- Safanah Siddiqui
- Safanah Siddiqui is a fellow, Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston
| | - Gabriel Lutz
- Gabriel Lutz is an assistant professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine, Baltimore
| | - Ali Tabatabai
- Ali Tabatabai is an adjunct associate professor, Department of Medicine, Division of Education, University of Maryland School of Medicine
| | - Rachel Nathan
- Rachel Nathan is an assistant professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine
| | - Megan Anders
- Megan Anders is an associate professor, Department of Anesthesiology, University of Maryland School of Medicine
| | - Miranda Gibbons
- Miranda Gibbons is a clinical systems analyst, Department of Anesthesiology, University of Maryland School of Medicine
| | - Marguerite Russo
- Marguerite Russo is a nurse practitioner, University of Maryland Medical Center, and an adjunct associate professor, University of Maryland School of Nursing, Baltimore
| | - Sarah Whitehead
- Sarah Whitehead is a nurse practitioner, University of Maryland Medical Center
| | - Peter Rock
- Peter Rock is a professor, Department of Anesthesiology, University of Maryland School of Medicine
| | - Thomas Scalea
- Thomas Scalea is a professor, Department of Surgery, University of Maryland School of Medicine, and director of the R. Adams Cowley Shock Trauma Center, Baltimore
| | - Raya E Kheirbek
- Raya E. Kheirbek is a professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine
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35
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Alessandri F, Di Nardo M, Ramanathan K, Brodie D, MacLaren G. Extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome: a narrative review. J Intensive Care 2023; 11:5. [PMID: 36755270 PMCID: PMC9907879 DOI: 10.1186/s40560-023-00654-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
A growing body of evidence supports the use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) refractory to maximal medical therapy. ARDS may develop in a proportion of patients hospitalized for coronavirus disease 2019 (COVID-19) and ECMO may be used to manage patients refractory to maximal medical therapy to mitigate the risk of ventilator-induced lung injury and provide lung rest while awaiting recovery. The mortality of COVID-19-related ARDS was variously reassessed during the pandemic. Veno-venous (VV) ECMO was the default choice to manage refractory respiratory failure; however, with concomitant severe right ventricular dysfunction, venoarterial (VA) ECMO or mechanical right ventricular assist devices with extracorporeal gas exchange (Oxy-RVAD) were also considered. ECMO has also been used to manage special populations such as pregnant women, pediatric patients affected by severe forms of COVID-19, and, in cases with persistent and seemingly irreversible respiratory failure, as a bridge to successful lung transplantation. In this narrative review, we outline and summarize the most recent evidence that has emerged on ECMO use in different patient populations with COVID-19-related ARDS.
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Affiliation(s)
- Francesco Alessandri
- grid.7841.aDepartment of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - Matteo Di Nardo
- grid.414125.70000 0001 0727 6809Pediatric Intensive Care Unit, Children’s Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Kollengode Ramanathan
- grid.412106.00000 0004 0621 9599Cardiothoracic Intensive Care Unit, National University Hospital, Singapore, Singapore
| | - Daniel Brodie
- grid.21729.3f0000000419368729Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY USA ,grid.239585.00000 0001 2285 2675Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore, Singapore.
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36
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Gannon WD, Trindade AJ, Stokes JW, Casey JD, Benson C, Patel YJ, Pugh ME, Semler MW, Bacchetta M, Rice TW. Extracorporeal Membrane Oxygenation Selection by Multidisciplinary Consensus: The ECMO Council. ASAIO J 2023; 69:167-173. [PMID: 35544441 DOI: 10.1097/mat.0000000000001757] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has increased the demand for extracorporeal membrane oxygenation (ECMO) and introduced distinct challenges to patient selection for ECMO. Standardized processes for patient selection amidst resource limitations are lacking, and data on ECMO consults are underreported. We retrospectively reviewed consecutive adult ECMO consults for acute respiratory failure received at a single academic medical center from April 1, 2020, to February 28, 2021, and evaluated the implementation of a multidisciplinary selection committee (ECMO Council) and standardized framework for patient selection for ECMO. During the 334-day period, there were 202 total ECMO consults; 174 (86.1%) included a diagnosis of COVID-19. Among all consults, 157 (77.7%) were declined and 41 (20.3%) resulted in the initiation of ECMO. Frequent reasons for decline included the presence of multiple relative contraindications (n = 33), age greater than 60 years (n = 32), and resource limitations (n = 27). The ECMO Council deliberated on every case in which an absolute contraindication was not present (n = 96) via an electronic teleconference platform. Utilizing multidisciplinary consensus together with a standardized process for patient selection in ECMO is feasible during a pandemic and may be reliably exercised over time. Whether such an approach is feasible at other centers remains unknown.
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Affiliation(s)
- Whitney D Gannon
- From the Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anil J Trindade
- From the Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John W Stokes
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D Casey
- From the Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clayne Benson
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yatrik J Patel
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Meredith E Pugh
- From the Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew W Semler
- From the Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew Bacchetta
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Todd W Rice
- From the Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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37
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Takahashi Y, Utsumi S, Fujizuka K, Suzuki H, Ushio N, Amemiya Y, Nakamura M. Effect of a systematic lung-protective protocol for COVID-19 pneumonia requiring invasive ventilation: A single center retrospective study. PLoS One 2023; 18:e0267339. [PMID: 36634086 PMCID: PMC9836282 DOI: 10.1371/journal.pone.0267339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 12/27/2022] [Indexed: 01/13/2023] Open
Abstract
The benefits of introducing a systematic lung-protective protocol for coronavirus disease 2019 (COVID-19) pneumonia requiring invasive ventilation in the intensive care unit (ICU) are unknown. Herein, we aimed to evaluate the clinical effects of introducing such a protocol in terms of mortality, duration of ventilation, and length of ICU stay. In this single-centre, retrospective, quality comparison study, we identified patients with COVID-19 pneumonia who received invasive ventilation in our ICU between February 2020 and October 2021. We established a systematic lung-protective protocol for the pre-introduction group until March 2021 and the post-introduction group after April 2021. Patients who did not receive invasive ventilation and who underwent veno-venous extracorporeal membrane oxygenation in a referring hospital were excluded. We collected patient characteristics at the time of ICU admission, including age, sex, body mass index (BMI), comorbidities, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and Murray score. The study outcomes were ICU mortality, length of ICU stay, and duration of ventilation. The pre-introduction and post-introduction groups included 18 and 50 patients, respectively. No significant differences were observed in sex, BMI, SOFA score, APACHE II score, and Murray score; however, age was lower in the post-introduction group (70 vs. 56, P = 0.003). The introduction of this protocol did not improve ICU mortality. However, it reduced the ICU length of stay (26 days vs. 11 days, P = 0.003) and tended to shorten the duration of ventilation (15 days vs. 10 days, P = 0.06). The introduction of the protocol was associated with a decrease in the length of ICU stay and duration of ventilation; however, it did not change mortality. The application of the protocol could improve the security of medical resources during the COVID-19 pandemic. Further prospective multicentre studies are needed.
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Affiliation(s)
- Yoshihiko Takahashi
- Advanced Medical Emergency Department and Critical Care Centre, Maebashi Red Cross Hospital, Gunma, Japan
| | - Shu Utsumi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Centre, Maebashi Red Cross Hospital, Gunma, Japan
| | - Hiroyuki Suzuki
- Advanced Medical Emergency Department and Critical Care Centre, Maebashi Red Cross Hospital, Gunma, Japan
| | - Noritaka Ushio
- Advanced Medical Emergency Department and Critical Care Centre, Maebashi Red Cross Hospital, Gunma, Japan
| | - Yu Amemiya
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Centre, Maebashi Red Cross Hospital, Gunma, Japan
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38
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Roberts SH, Goodwin ML, Bobba CM, Al-Qudsi O, Satyapriya SV, Tripathi RS, Papadimos TJ, Whitson BA. Continuous renal replacement therapy and extracorporeal membrane oxygenation: implications in the COVID-19 era. Perfusion 2023; 38:18-27. [PMID: 34494489 DOI: 10.1177/02676591211042561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (coronavirus Disease 19 (COVID-19)) was identified as the causative agent of viral pneumonias in Wuhan, China in December 2019, and has emerged as a pandemic causing acute respiratory distress syndrome (ARDS) and multiple organ dysfunction. Interim guidance by the World Health Organization states that extracorporeal membrane oxygenation (ECMO) should be considered as a rescue therapy in COVID-19-related ARDS. International registries tracking ECMO in COVID-19 patients reveal a 21%-70% incidence of acute renal injury requiring renal replacement therapy (RRT) during ECMO support. The indications for initiating RRT in patients on ECMO are similar to those for patients not requiring ECMO. RRT can be administered during ECMO via a temporary dialysis catheter, placement of a circuit in-line hemofilter, or direct connection of continuous RRT in-line with the ECMO circuit. Here we review methods for RRT during ECMO, RRT initiation and timing during ECMO, anticoagulation strategies, and novel cytokine filtration approaches to minimize COVID-19's pathophysiological impact.
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Affiliation(s)
- Sophia H Roberts
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Matthew L Goodwin
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Christopher M Bobba
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Omar Al-Qudsi
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Veena Satyapriya
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ravi S Tripathi
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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39
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Tawel R, Altawil L, Hassan Koya S, Jaouni H, Alinier G, Nashwan AJ, Labib A. Risk of COVID-19 infection among mobile extracorporeal membrane oxygenation team. Health Sci Rep 2023; 6:e981. [PMID: 36514330 PMCID: PMC9731299 DOI: 10.1002/hsr2.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/30/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aim The transport of coronavirus-2019 (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) is a challenging situation, especially for healthcare workers (HCWs), due to the risk of cross-infection. Hence, certain precautions are needed for their safety. The study aims to evaluate the risk of COVID-19 transmission to HCWs who transport COVID-19 patients on ECMO device. Methods A retrospective review of adult patients with COVID-19 infection supported with ECMO and transported by ground route to the Medical Intensive Care Unit (MICU) at Hamad General Hospital (HGH) and a survey of HCWs involved in those cases. Results A total of 63 HCWs of the mobile ECMO team were exposed to COVID-19-positive patients on 199 occasions. HCWs exposure time was nearly 110 h, and the total transport distance was 1018 km. During the study period, only two of the mobile ECMO HCWs tested positive for COVID-19. There was zero incidence of transfer-associated injuries or accidents to HCWs. Conclusions The risk of COVID-19 cross-infection to the mobile ECMO team seems to be very low, provided that strict infection prevention and control measures are applied.
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Affiliation(s)
- Rabee Tawel
- Medical Intensive Care UnitHamad General HospitalDohaQatar
| | - Lubna Altawil
- Medical Intensive Care UnitHamad General HospitalDohaQatar
| | | | - Hani Jaouni
- Medical Intensive Care UnitHamad General HospitalDohaQatar
| | - Guillaume Alinier
- Ambulance ServiceHamad Medical CorporationDohaQatar
- Weill Cornell Medicine‐QatarDohaQatar
- University of HertfordshireHatfieldUK
- Northumbria UniversityNewcastle upon TyneUK
| | | | - Ahmed Labib
- Medical Intensive Care UnitHamad General HospitalDohaQatar
- Ambulance ServiceHamad Medical CorporationDohaQatar
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40
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Makhoul M, Keizman E, Carmi U, Galante O, Ilgiyaev E, Matan M, Słomka A, Sviri S, Eden A, Soroksky A, Fink D, Sternik L, Bolotin G, Lorusso R, Kassif Y. Outcomes of Extracorporeal Membrane Oxygenation (ECMO) for COVID-19 Patients: A Multi-Institutional Analysis. Vaccines (Basel) 2023; 11:vaccines11010108. [PMID: 36679953 PMCID: PMC9865577 DOI: 10.3390/vaccines11010108] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/18/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In March 2020, COVID-19 was announced as a global pandemic. The first COVID-19 patient was connected to an ECMO device in Israel during that time. Since then, over 200 patients have required ECMO support due to COVID-19 infection. The present study is a multi-institutional analysis of all COVID-19 patients requiring veno-venous (VV) ECMO in Israel. The aim was to characterize and compare the survivors and deceased patients as well as establish risk factors for mortality. METHODS This retrospective multi-institutional study was conducted from March 2020 to March 2021 in eleven of twelve ECMO centers operating in Israel. All COVID-19 patients on VV ECMO support were included in the cohort. The patients were analyzed based on their comorbidities, procedural data, adverse event on ECMO, and outcomes. Univariate and multivariate analyses were used to compare the deceased and the surviving patients. RESULTS The study included 197 patients, of which 150 (76%) were males, and the mean age was 50.7 ± 12 years. Overall mortality was 106 (54%). Compared with the deceased subjects, survivors were significantly younger (48 ± 11 vs. 53 ± 12 years), suffered less from ischemic heart disease (IHD) (3% vs. 12%), and were ventilated for a significantly shorter period (≤4 days) prior to cannulation (77% vs. 63%). Patients in the deceased group experienced more kidney failure and sepsis. Rates of other complications were comparable between groups. CONCLUSIONS Based on this study, we conclude that early cannulation (≤4 days) of younger patients (≤55 years) may improve overall survival and that a history of IHD might indicate a reduced prognosis.
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Affiliation(s)
- Maged Makhoul
- Department of Cardiac Surgery, Rambam Medical Center, Haifa 3525408, Israel
- Correspondence:
| | - Eitan Keizman
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
| | - Uri Carmi
- Division of Anesthesia, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ori Galante
- Medical Intensive Care Unit, Faculty of Health Ben Gurion University, Soroka Medical Center, Beer-Sheva 8400711, Israel
| | - Eduard Ilgiyaev
- Intensive Care Unit, Shamir Medical Center, Zerifin 703301, Israel
| | - Moshe Matan
- Intensive Care Unit, The Baruch Padeh Medical Center, Poriya 1528001, Israel
| | - Artur Słomka
- Department of Pathophysiology, Nicolaus Copernicus University in Toruń, Ludwik Rydygier CollegiumMedicum, 85-094 Bydgoszcz, Poland
| | - Sigal Sviri
- Medical Intensive Care, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Arieh Eden
- Department of Anesthesiology Critical Care and Pain Medicine, Carmel Lady Davis Medical Center, Haifa 3436212, Israel
| | - Arie Soroksky
- Intensive Care Unit, E. Wolfson Medical Center, Tel Aviv 6423906, Israel
| | - Danny Fink
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 91120, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
| | - Gil Bolotin
- Department of Cardiac Surgery, Rambam Medical Center, Haifa 3525408, Israel
| | - Roberto Lorusso
- Cardiovascular Research Institute, Maastricht (CARIM), 6200 Maastricht, The Netherlands
| | - Yigal Kassif
- Department of Cardiac Surgery, The Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Aviv 6423906, Israel
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Time From Infiltrate on Chest Radiograph to Venovenous Extracorporeal Membrane Oxygenation in COVID-19 Affects Mortality. ASAIO J 2023; 69:23-30. [PMID: 36007188 PMCID: PMC9797122 DOI: 10.1097/mat.0000000000001789] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Venovenous extracorporeal membrane oxygenation (VV ECMO) has been used to treat severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome; however, patient selection criteria have evolved throughout the pandemic. In this study, we sought to determine the association of patient mortality with time from positive COVID-19 test and infiltrate on chest radiograph (x-ray) to VV ECMO cannulation. We hypothesized that an increasing duration between a positive COVID-19 test or infiltrates on chest x-ray and cannulation would be associated with increased mortality. This is a single-center retrospective chart review of COVID-19 VV ECMO patients from March 1, 2020 to July 28, 2021. Unadjusted and adjusted multivariate analyses were performed to assess for mortality differences. A total of 93 patients were included in our study. Increased time, in days, from infiltrate on chest x-ray to cannulation was associated with increased mortality in both unadjusted (5-9, P = 0.002) and adjusted regression analyses (odds ratio [OR]: 1.49, 95% CI: 1.22-1.81, P < 0.01). Time from positive test to cannulation was not found to be significant between survivors and nonsurvivors (7.5-11, P = 0.06). Time from infiltrate on chest x-ray to cannulation for VV ECMO should be considered when assessing patient candidacy. Further larger cohort and prospective studies are required.
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Selection criteria and triage in extracorporeal membrane oxygenation during coronavirus disease 2019. Curr Opin Crit Care 2022; 28:674-680. [PMID: 36302196 DOI: 10.1097/mcc.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Coronavirus disease 2019 (COVID-19) pandemic changed the way we had to approach hospital- and intensive care unit (ICU)-related resource management, especially for demanding techniques required for advanced support, including extracorporeal membrane oxygenation (ECMO). RECENT FINDINGS Availability of ICU beds and ECMO machines widely varies around the world. In critical conditions, such a global pandemic, the establishment of contingency capacity tiers might help in defining to which conditions and subjects ECMO can be offered. A frequent reassessment of the resource saturation, possibly integrated within a regional healthcare coordination system, may be of help to triage the patients who most likely will benefit from advanced techniques, especially when capacities are limited. SUMMARY Indications to ECMO during the pandemic should be fluid and may be adjusted over time. Candidacy of patients should follow the same prepandemic rules, taking into account the acute disease, the burden of any eventual comorbidity and the chances of a good quality of life after recovery; but the current capacity of healthcare system should also be considered, and frequently reassessed, possibly within a wide hub-and-spoke healthcare system. VIDEO ABSTRACT http://links.lww.com/COCC/A43.
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43
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Akkanti B, Suarez EE, O'Neil ER, Rali AS, Hussain R, Dinh K, Tuazon DM, MacGillivray TE, Diaz-Gomez JL, Simpson L, George JK, Kar B, Herlihy JP, Shafii AE, Gregoric ID, Masud F, Chatterjee S. Extracorporeal Membrane Oxygenation for COVID-19: Collaborative Experience From the Texas Medical Center in Houston With 2 Years Follow-Up. ASAIO J 2022; 68:1443-1449. [PMID: 36150083 DOI: 10.1097/mat.0000000000001791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Patients with severe refractory hypoxemic respiratory failure may benefit from extracorporeal membrane oxygenation (ECMO) for salvage therapy. The Coronavirus disease 2019 (COVID-19) pandemic offered three high-volume independent ECMO programs at a large medical center the chance to collaborate to optimize ECMO care at the beginning of the pandemic in Spring 2020. Between March 15, 2020, and May 30, 2020, 3,615 inpatients with COVID-19 were treated at the Texas Medical Center. During this time, 35 COVID-19 patients were cannulated for ECMO, all but one in a veno-venous configuration. At hospital discharge, 23 (66%) of the 35 patients were alive. Twelve patients died of vasodilatory shock (n = 9), intracranial hemorrhage (n = 2), and cannulation-related bleeding and multiorgan dysfunction (n = 1). The average duration of ECMO was 13.6 days in survivors and 25.0 days in nonsurvivors ( p < 0.04). At 1 year follow-up, all 23 discharged patients were still alive, making the 1 year survival rate 66% (23/35). At 2 years follow-up, the overall rate of survival was 63% (22/35). Of those patients who survived 2 years, all were at home and alive and well at follow-up.
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Affiliation(s)
- Bindu Akkanti
- From the Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - Erik E Suarez
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Erika R O'Neil
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Department of Critical Care, Texas Children's Hospital, Houston, Texas
| | - Aniket S Rali
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Rahat Hussain
- From the Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - Kha Dinh
- From the Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - Divina M Tuazon
- Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, Texas
| | | | - Jose L Diaz-Gomez
- Department of Anesthesia, Division of CV Anesthesia & Critical Care Medicine, Baylor College of Medicine, Houston, Texas
| | - Leo Simpson
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Joggy K George
- Department of Cardiology, Texas Heart Institute, Houston, Texas
| | - Biswajit Kar
- The Center for Advanced Heart Failure, Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas McGovern Medical School, University of Texas Health Sciences Center-Houston, Houston, Texas
| | - J Patrick Herlihy
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Alexis E Shafii
- Department of Cardiovascular Surgery, Baylor St. Luke's Medical Center-Texas Medical Center, Houston, Texas
| | - Igor D Gregoric
- Division of Cardiothoracic Transplantation and Circulatory Support, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Faisal Masud
- Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, Texas
| | - Subhasis Chatterjee
- Department of Cardiovascular Surgery, Baylor St. Luke's Medical Center-Texas Medical Center, Houston, Texas
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
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Morales Castro D, Abdelnour-Berchtold E, Urner M, Dragoi L, Cypel M, Fan E, Douflé G. Transesophageal Echocardiography-Guided Extracorporeal Membrane Oxygenation Cannulation in COVID-19 Patients. J Cardiothorac Vasc Anesth 2022; 36:4296-4304. [PMID: 36038441 PMCID: PMC9338225 DOI: 10.1053/j.jvca.2022.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES A paucity of data supports the use of transesophageal echocardiography (TEE) for bedside extracorporeal membrane oxygenation (ECMO) cannulation. Concerns have been raised about performing TEEs in patients with COVID-19. The authors describe the use and safety of TEE guidance for ECMO cannulation for COVID-19. DESIGN Single-center retrospective cohort study. SETTING The study took place in the intensive care unit of an academic tertiary center. PARTICIPANTS The authors included 107 patients with confirmed SARS-CoV-2 infection who underwent bedside venovenous ECMO (VV ECMO) cannulation under TEE guidance between May 2020 and June 2021. INTERVENTIONS TEE-guided bedside VV ECMO cannulation. MEASUREMENTS Patient characteristics, physiologic and ventilatory parameters, and echocardiographic findings were analyzed. The primary outcome was the number of successful TEE-guided bedside cannulations without complications. The secondary outcomes were cannulation complications, frequency of cannula repositioning, and TEE-related complications. MAIN RESULTS TEE-guided cannulation was successful in 99% of the patients. Initial cannula position was adequate in all but 1 patient. Fourteen patients (13%) required cannula repositioning during ECMO support. Forty-five patients (42%) had right ventricular systolic dysfunction, and 9 (8%) had left ventricular systolic dysfunction. Twelve patients (11%) had intracardiac thrombi. One superficial arterial injury and 1 pneumothorax occurred. No pericardial tamponade, hemothorax or intraabdominal bleeding occurred in the authors' cohort. No TEE-related complications or COVID-19 infection of healthcare providers were reported during this study. CONCLUSIONS Bedside TEE guidance for VV ECMO cannulation is safe in patients with severe respiratory failure due to COVID-19. No tamponade or hemothorax, nor TEE-related complications were observed in the authors' cohort.
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Affiliation(s)
- Diana Morales Castro
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | | | - Martin Urner
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Marcelo Cypel
- Department of Thoracic Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada,Department of Medicine, University of Toronto, Toronto, Canada
| | - Ghislaine Douflé
- Interdepartmental Division of Critical Care Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada.
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45
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The Use of ECMO for COVID-19: Lessons Learned. Clin Chest Med 2022; 44:335-346. [PMID: 37085223 PMCID: PMC9705197 DOI: 10.1016/j.ccm.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has seen an increase in global cases of severe acute respiratory distress syndrome (ARDS), with a concomitant increased demand for extracorporeal membrane oxygenation (ECMO). Outcomes of patients with severe ARDS due to COVID-19 infection receiving ECMO support are evolving. The need for surge capacity, practical and ethical limitations on implementing ECMO, and the prolonged duration of ECMO support in patients with COVID-19-related ARDS has revealed limitations in organization and resource utilization. Coordination of efforts at multiple levels, from research to implementation, resulted in numerous innovations in the delivery of ECMO.
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46
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Ohshimo S, Liu K, Ogura T, Iwashita Y, Kushimoto S, Shime N, Hashimoto S, Fujino Y, Takeda S. Trends in survival during the pandemic in patients with critical COVID-19 receiving mechanical ventilation with or without ECMO: analysis of the Japanese national registry data. Crit Care 2022; 26:354. [PMCID: PMC9664428 DOI: 10.1186/s13054-022-04187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The survival rate of patients with critical coronavirus disease-19 (COVID-19) over time is inconsistent in different settings. In Japan, a national database was organized to monitor and share the patient generation across the country in an immediate response to the COVID-19 pandemic. This study aimed to evaluate changes in survival over time and the prognostic factors in critical COVID-19 patients receiving mechanical ventilation with/without extracorporeal membrane oxygenation (ECMO) using the largest database in Japan.
Methods
This is a prospective observational cohort study of patients admitted to intensive care units in Japan with fatal COVID-19 pneumonia receiving mechanical ventilation and/or ECMO. We developed a prospective nationwide registry covering > 80% of intensive care units in Japan, and analyzed the association between patients’ backgrounds, institutional ECMO experience, and timing of treatment initiation and prognosis between February 2020 and November 2021. Prognostic factors were evaluated by Kaplan–Meier analysis and Cox proportional hazards analysis.
Results
A total of 9418 patients were ventilated, of whom 1214 (13%) received ECMO. The overall survival rate for ventilated patients was 79%, 65% for those receiving ECMO. There have been five outbreaks in Japan to date. The survival rate of ventilated patients increased from 76% in the first outbreak to 84% in the fifth outbreak (p < 0.001). The survival rate of ECMO patients remained unchanged at 60–68% from the first to fifth outbreaks (p = 0.084). Age of ≥ 59 (hazard ratio [HR] 2.17; 95% confidence interval [CI] 1.76–2.68), ventilator days of ≥ 3 before starting ECMO (HR 1.91; 95% CI 1.57–2.32), and institutional ECMO experiences of ≥ 11 (HR 0.70; 95% CI 0.58–0.85) were independent prognostic factors for ECMO.
Conclusions
During five COVID-19 outbreaks in Japan, the survival rate of ventilated patients tended to have gradually improved, and that of ECMO patients did not deteriorate. Older age, longer ventilator days before starting ECMO, and fewer institutional ECMO experiences may be independent prognostic factors for critical COVID-19 patients receiving ECMO.
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47
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Assouline B, Combes A, Schmidt M. Extracorporeal membrane oxygenation in COVID-19 associated acute respiratory distress syndrome: A narrative review. JOURNAL OF INTENSIVE MEDICINE 2022; 3:4-10. [PMID: 36785580 PMCID: PMC9531953 DOI: 10.1016/j.jointm.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 12/03/2022]
Abstract
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an established rescue therapy in the management of refractory acute respiratory distress syndrome (ARDS). Although ECMO played an important role in previous respiratory viral epidemics, concerns about the benefits and usefulness of this technique were raised during the coronavirus disease 2019 (COVID-19) pandemic. Indeed, the mortality rate initially reported in small case series from China was concerning and exceeded 90%. A few months later, the critical care community published the findings from several observational cohorts on the use of extracorporeal membrane oxygenation (ECMO) in COVID-19-related ARDS. Contrary to the preliminary results, data from the first surge supported the use of ECMO in experienced centers because the mortality rate was comparable to those from the ECMO to Rescue Lung Injury in Severe ARDS (EOLIA) trial or other large prospective studies. However, the mortality rate of the population with severe disease evolved during the pandemic, in conjunction with changes in the management of the disease and the occurrence of new variants. The results from subsequent studies confirmed that the outcomes mainly depend on strict patient selection and center expertise. In comparison with non-COVID-related ARDS, the duration of ECMO for COVID-related ARDS was longer and increased over time. Clinicians and decision-makers must integrate this finding in the ECMO decision-making process to plan their ICU capacity and resource allocation. This narrative review summarizes the current evidence and specific considerations for ECMO use in COVID-19-associated ARDS.
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Affiliation(s)
- Benjamin Assouline
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris 75013, France
| | - Alain Combes
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris 75013, France,INSERM, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris 75013, France
| | - Matthieu Schmidt
- Médecine Intensive Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Paris 75013, France,INSERM, UMRS 1166, ICAN Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris 75013, France,Corresponding author: Matthieu Schmidt, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 47-83 Boulevard de l'Hôpital, Paris 75013, France.
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Trela KC. Mechanical circulatory support devices in noncardiac surgery. Int Anesthesiol Clin 2022; 60:55-63. [PMID: 35972136 DOI: 10.1097/aia.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kristin C Trela
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
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Zechendorf E, Schröder K, Stiehler L, Frank N, Beckers C, Kraemer S, Dreher M, Kersten A, Thiemermann C, Marx G, Simon TP, Martin L. The Potential Impact of Heparanase Activity and Endothelial Damage in COVID-19 Disease. J Clin Med 2022; 11:jcm11185261. [PMID: 36142913 PMCID: PMC9502343 DOI: 10.3390/jcm11185261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
SARS-CoV-2 was first detected in 2019 in Wuhan, China. It has been found to be the most pathogenic virus among coronaviruses and is associated with endothelial damage resulting in respiratory failure. Determine whether heparanase and heparan sulfate fragments, biomarkers of endothelial function, can assist in the risk stratification and clinical management of critically ill COVID-19 patients admitted to the intensive care unit. We investigated 53 critically ill patients with severe COVID-19 admitted between March and April 2020 to the University Hospital RWTH Aachen. Heparanase activity and serum levels of both heparanase and heparan sulfate were measured on day one (day of diagnosis) and day three in patients with COVID-19. The patients were classified into four groups according to the severity of ARDS. When compared to baseline data (day one), heparanase activity increased and the heparan sulfate serum levels decreased with increasing severity of ARDS. The heparanase activity significantly correlated with the lactate concentration on day one (r = 0.34, p = 0.024) and on day three (r = 0.43, p = 0.006). Heparanase activity and heparan sulfate levels correlate with COVID-19 disease severity and outcome. Both biomarkers might be helpful in predicting clinical course and outcomes in COVID-19 patients.
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Affiliation(s)
- Elisabeth Zechendorf
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-(0)241-8035484
| | - Katharina Schröder
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Lara Stiehler
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Nadine Frank
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Christian Beckers
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Sandra Kraemer
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Alexander Kersten
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Christoph Thiemermann
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK
| | - Gernot Marx
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Tim-Philipp Simon
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Lukas Martin
- Department of Intensive and Intermediate Care, University Hospital RWTH Aachen, 52074 Aachen, Germany
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50
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Multi-institutional Analysis of 505 Patients With Coronavirus Disease-2019 Supported With Extracorporeal Membrane Oxygenation: Predictors of Survival. Ann Thorac Surg 2022; 114:61-68. [PMID: 35189111 PMCID: PMC8855605 DOI: 10.1016/j.athoracsur.2022.01.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/18/2021] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND We reviewed our experience with 505 patients with confirmed coronavirus disease-2019 (COVID-19) supported with extracorporeal membrane oxygenation (ECMO) at 45 hospitals and estimated risk factors for mortality. METHODS A multi-institutional database was created and used to assess all patients with COVID-19 who were supported with ECMO. A Bayesian mixed-effects logistic regression model was estimated to assess the effect on survival of multiple potential risk factors for mortality, including age at cannulation for ECMO as well as days between diagnosis of COVID-19 and intubation and days between intubation and cannulation for ECMO. RESULTS Median time on ECMO was 18 days (interquartile range, 10-29 days). All 505 patients separated from ECMO: 194 patients (38.4%) survived and 311 patients (61.6%) died. Survival with venovenous ECMO was 184 of 466 patients (39.5%), and survival with venoarterial ECMO was 8 of 30 patients (26.7%). Survivors had lower median age (44 vs 51 years, P < .001) and shorter median time interval from diagnosis to intubation (7 vs 11 days, P = .001). Adjusting for several confounding factors, we estimated that an ECMO patient intubated on day 14 after the diagnosis of COVID-19 vs day 4 had a relative odds of survival of 0.65 (95% credible interval, 0.44-0.96; posterior probability of negative effect, 98.5%). Age was also negatively associated with survival: relative to a 38-year-old patient, we estimated that a 57-year-old patient had a relative odds of survival of 0.43 (95% credible interval, 0.30-0.61; posterior probability of negative effect, >99.99%). CONCLUSIONS ECMO facilitates salvage and survival of select critically ill patients with COVID-19. Survivors tend to be younger and have shorter time from diagnosis to intubation. Survival of patients supported with only venovenous ECMO was 39.5%.
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