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Mouzakis FL, Kashefi A, Spillner J, Rütten S, Mottaghy K, Hima F. A new approach towards extracorporeal gas exchange and first in vitro results. BIOMED ENG-BIOMED TE 2024; 69:257-263. [PMID: 37930101 DOI: 10.1515/bmt-2023-0459] [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: 02/19/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Extracorporeal life support (ECLS) pertains to therapeutic and prophylactic techniques utilized in a wide range of medical applications, with severe pulmonary diseases being the most prominent cases. Over the past decades, little progress has been made in advancing the basic principles and properties of gas exchangers. Here, in an unconventional approach, dialysis hollow fibers are handled with silicone to create a purely diffusive coating that prevents plasma leakage and promotes gas exchange. METHODS Commercial dialyzers of varying surface area and fiber diameter have been coated with silicone, to determine the impact of each parameter on performance. The impermeability of the silicone layer has been validated by pressurization and imaging methods. SEM images have revealed a homogeneous silicone film coating the lumen of the capillaries, while fluid dynamic investigations have confirmed its purely diffusive nature. RESULTS The hemodynamic behavior and the gas exchange efficiency of the silicone-coated prototypes have been investigated in vitro with porcine blood under various operating conditions. Their performance has been found to be similar to that of a commercial PMP oxygenator. CONCLUSIONS This novel class of gas exchangers is characterized by high versatility and expeditious manufacturing. Intraoperability between conventional ECLS systems and dialysis machines broadens the range of application infinitely. Ultimately, long-term clinical applicability ought to be determined over in vivo animal investigations.
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Affiliation(s)
| | - Ali Kashefi
- Institute of Physiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Jan Spillner
- Department of Thoracic Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Stephan Rütten
- Electron Microscopy Facility, Institute of Pathology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Khosrow Mottaghy
- Institute of Physiology, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Flutura Hima
- Department of Thoracic Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany
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Li Y, Wang J, Li C, Wang L, Chen Y. Prognostic of red blood cell transfusion during extracorporeal membrane oxygenation therapy on mortality: A meta-analysis. Perfusion 2024; 39:713-721. [PMID: 36800909 DOI: 10.1177/02676591231157234] [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: 02/20/2023]
Abstract
BACKGROUND This meta-analysis aimed to explore the impact of red blood cell (RBC) transfusion on mortality during extracorporeal membrane oxygenation (ECMO). Previous studies investigated the prognostic impact of RBC transfusion during ECMO on the risk of mortality, but no meta-analysis has been published before. METHODS The PubMed, Embase, and the Cochrane library were systematically searched for papers published up to 13 December 2021, using the MeSH terms "ECMO", "'Erythrocytes", and "Mortality" to identify meta-analyses. Total or daily RBC transfusion during ECMO and mortality were examined. RESULTS The random-effect model was used. Eight studies (794 patients, including 354 dead) were included. The total volume of RBC was associated with higher mortality standardized weighted difference (SWD = -0.62, 95% CI: -1.06,-0.18, p = .006; I2 = 79.7%, Pheterogeneity = 0.001). The daily volume of RBC was associated with higher mortality (SWD = -0.77, 95% CI: -1.11,-0.42, p < .001; I2 = 65.7%, Pheterogeneity = 0.020). The total volume of RBC was associated with mortality for venovenous (VV) (SWD = -0.72, 95% CI: -1.23, -0.20, p = .006) but not venoarterial ECMO (p = .126) or when reported together (p = .089). The daily volume of RBC was associated with mortality for VV (SWD = -0.72, 95% CI: -1.18, -0.26, p = 0.002; I2 = 0.0%, Pheterogeneity = 0.642) and venoarterial (SWD = -0.95, 95% CI: -1.32, -0.57, p < .001) ECMO, but not when reported together (p = .067). The sensitivity analysis suggested the robustness of the results. CONCLUSION When considering the total and daily volumes of RBC transfusion during ECMO, the patients who survived received smaller total and daily volumes of RBC transfusion. This meta-analysis suggests that RBC transfusion might be associated with a higher risk of mortality during ECMO.
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Affiliation(s)
- Yuan Li
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Jing Wang
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Chaoyang Li
- Department of Hematology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Lin Wang
- Department of Hematology, Qilu Hospital of Shandong University, Shandong University, Jinan, China
| | - Yuguo Chen
- Department of Emergency, Qilu Hospital of Shandong University, Shandong University, Jinan, China
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Tan Z, Su L, Chen X, He H, Long Y. Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:868. [PMID: 38337562 PMCID: PMC10856383 DOI: 10.3390/jcm13030868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is the etiology of acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is used to support gas exchange in patients who have failed conventional mechanical ventilation. However, there is no clear consensus on the timing of ECMO use in severe COVID-19 patients. OBJECTIVE The aim of this study is to compare the differences in pre-ECMO time and ECMO duration between COVID-19 survivors and non-survivors and to explore the association between them. METHODS PubMed, the Cochrane Library, Embase, and other sources were searched until 21 October 2022. Studies reporting the relationship between ECMO-related time and COVID-19 survival were included. All available data were pooled using random-effects methods. Linear regression analysis was used to determine the correlation between pre-ECMO time and ECMO duration. The meta-analysis was registered with PROSPERO under registration number CRD42023403236. RESULTS Out of the initial 2473 citations, we analyzed 318 full-text articles, and 54 studies were included, involving 13,691 patients. There were significant differences between survivors and non-survivors in the time from COVID-19 diagnosis (standardized mean difference (SMD) = -0.41, 95% confidence interval (CI): [-0.53, -0.29], p < 0.00001), hospital (SMD = -0.53, 95% CI: [-0.97, -0.09], p = 0.02) and intensive care unit (ICU) admission (SMD = -0.28, 95% CI: [-0.49, -0.08], p = 0.007), intubation or mechanical ventilation to ECMO (SMD = -0.21, 95% CI: [-0.32, -0.09], p = 0.0003) and ECMO duration (SMD = -0.18, 95% CI: [-0.30, -0.06], p = 0.003). There was no statistical association between a longer time from symptom onset to ECMO (hazard ratio (HR) = 1.05, 95% CI: [0.99, 1.12], p = 0.11) or time from intubation or mechanical ventilation (MV) and the risk of mortality (highest vs. lowest time groups odds ratio (OR) = 1.18, 95% CI: [0.78, 1.78], p = 0.42; per one-day increase OR = 1.14, 95% CI: [0.86, 1.52], p = 0.36; HR = 0.99, 95% CI: [0.95, 1.02], p = 0.39). There was no linear relationship between pre-ECMO time and ECMO duration. CONCLUSION There are differences in pre-ECMO time between COVID-19 survivors and non-survivors, and there is insufficient evidence to conclude that longer pre-ECMO time is responsible for reduced survival in COVID-19 patients. ECMO duration differed between survivors and non-survivors, and the timing of pre-ECMO does not have an impact on ECMO duration. Further studies are needed to explore the association between pre-ECMO and ECMO time in the survival of COVID-19 patients.
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Affiliation(s)
| | | | | | | | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China; (Z.T.); (L.S.); (X.C.); (H.H.)
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Hima F, Saunders A, Kashefi A, Mouzakis F, Mottaghy K, Spillner J, Zayat R, Kalverkamp S. In vitro evaluation of the performance of an oxygenator depending on the non-standard gas content of the inlet blood with special regard on CO2 elimination. Perfusion 2023:2676591231204565. [PMID: 37739434 DOI: 10.1177/02676591231204565] [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: 09/24/2023]
Abstract
INTRODUCTION The performance of an oxygenator, as found in literature, is evaluated according to protocols that define standard values of the gas content in the inlet blood. However, when dealing with simulations of lung insufficiency, a more extensive evaluation is needed. This work aims to investigate and assess the gas exchange performance of an oxygenator for different input values of gas content in blood. METHODS Three commercially available oxygenators with different membrane surfaces were investigated in a mock loop for three blood flow rates (0.5l/min, 1l/min, and 5l/min) and two gas-to-blood ratios (1:1, and 15:1). The initial CO2 and O2 partial pressures (pCO2 and pO2) in blood were set to ≥ 100 mmHg and ≤10 mmHg, respectively. For each ratio, the efficiency, defined as the ratio between the difference of pressure inlet and outlet and the inlet pCO2 (pCO2(i)), was calculated. RESULTS The CO2 elimination in an oxygenator was higher for higher pCO2(i). While for a pCO2(i) of 100 mmHg, an oxygenator eliminated 80 mmHg, the same oxygenator at the same conditions eliminated 5 mmHg CO2 when pCO2(i) was 10 mmHg. The efficiency of the oxygenator decreased from 76,9% to 49,5%. For simulation reasons, the relation between the pCO2(i) and outlet (pCO2(o)) for each oxygenator at different blood and gas flows, was described as an exponential formula. CONCLUSION The performance of an oxygenator in terms of CO2 elimination depends not only on the blood and gas flow, but also on the initial pCO2 value. This dependence is crucial for simulation studies in the future.
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Affiliation(s)
- Flutura Hima
- Thoracic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Amalia Saunders
- Faculty of Medical and Life Sciences, Hochschule Furtwangen, Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Ali Kashefi
- ECCLab, Institute of Physiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Foivos Mouzakis
- ECCLab, Institute of Physiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Khosrow Mottaghy
- ECCLab, Institute of Physiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Jan Spillner
- Thoracic Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Rachad Zayat
- Thoracic Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Xue B, Shah N, Yang H, Kannampallil T, Payne PRO, Lu C, Said AS. Multi-horizon predictive models for guiding extracorporeal resource allocation in critically ill COVID-19 patients. J Am Med Inform Assoc 2023; 30:656-667. [PMID: 36575995 PMCID: PMC10018267 DOI: 10.1093/jamia/ocac256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/07/2022] [Accepted: 12/27/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) resource allocation tools are currently lacking. We developed machine learning (ML) models for predicting COVID-19 patients at risk of receiving ECMO to guide patient triage and resource allocation. MATERIAL AND METHODS We included COVID-19 patients admitted to intensive care units for >24 h from March 2020 to October 2021, divided into training and testing development and testing-only holdout cohorts. We developed ECMO deployment timely prediction model ForecastECMO using Gradient Boosting Tree (GBT), with pre-ECMO prediction horizons from 0 to 48 h, compared to PaO2/FiO2 ratio, Sequential Organ Failure Assessment score, PREdiction of Survival on ECMO Therapy score, logistic regression, and 30 pre-selected clinical variables GBT Clinical GBT models, with area under the receiver operator curve (AUROC) and precision recall curve (AUPRC) metrics. RESULTS ECMO prevalence was 2.89% and 1.73% in development and holdout cohorts. ForecastECMO had the best performance in both cohorts. At the 18-h prediction horizon, a potentially clinically actionable pre-ECMO window, ForecastECMO, had the highest AUROC (0.94 and 0.95) and AUPRC (0.54 and 0.37) in development and holdout cohorts in identifying ECMO patients without data 18 h prior to ECMO. DISCUSSION AND CONCLUSIONS We developed a multi-horizon model, ForecastECMO, with high performance in identifying patients receiving ECMO at various prediction horizons. This model has potential to be used as early alert tool to guide ECMO resource allocation for COVID-19 patients. Future prospective multicenter validation would provide evidence for generalizability and real-world application of such models to improve patient outcomes.
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Affiliation(s)
- Bing Xue
- Department of Computer Science & Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Neel Shah
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Hanqing Yang
- Department of Computer Science & Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute of Informatics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Philip Richard Orrin Payne
- Institute of Informatics, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Chenyang Lu
- Department of Computer Science & Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ahmed Sameh Said
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
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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: 32] [Impact Index Per Article: 32.0] [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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Pladet LCA, Barten JMM, Vernooij LM, Kraemer CVE, Bunge JJH, Scholten E, Montenij LJ, Kuijpers M, Donker DW, Cremer OL, Meuwese CL. Prognostic models for mortality risk in patients requiring ECMO. Intensive Care Med 2023; 49:131-141. [PMID: 36600027 PMCID: PMC9944134 DOI: 10.1007/s00134-022-06947-z] [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: 09/15/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To provide an overview and evaluate the performance of mortality prediction models for patients requiring extracorporeal membrane oxygenation (ECMO) support for refractory cardiocirculatory or respiratory failure. METHODS A systematic literature search was undertaken to identify studies developing and/or validating multivariable prediction models for all-cause mortality in adults requiring or receiving veno-arterial (V-A) or veno-venous (V-V) ECMO. Estimates of model performance (observed versus expected (O:E) ratio and c-statistic) were summarized using random effects models and sources of heterogeneity were explored by means of meta-regression. Risk of bias was assessed using the Prediction model Risk Of BiAS Tool (PROBAST). RESULTS Among 4905 articles screened, 96 studies described a total of 58 models and 225 external validations. Out of all 58 models which were specifically developed for ECMO patients, 14 (24%) were ever externally validated. Discriminatory ability of frequently validated models developed for ECMO patients (i.e., SAVE and RESP score) was moderate on average (pooled c-statistics between 0.66 and 0.70), and comparable to general intensive care population-based models (pooled c-statistics varying between 0.66 and 0.69 for the Simplified Acute Physiology Score II (SAPS II), Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Sequential Organ Failure Assessment (SOFA) score). Nearly all models tended to underestimate mortality with a pooled O:E > 1. There was a wide variability in reported performance measures of external validations, reflecting a large between-study heterogeneity. Only 1 of the 58 models met the generally accepted Prediction model Risk Of BiAS Tool criteria of good quality. Importantly, all predicted outcomes were conditional on the fact that ECMO support had already been initiated, thereby reducing their applicability for patient selection in clinical practice. CONCLUSIONS A large number of mortality prediction models have been developed for ECMO patients, yet only a minority has been externally validated. Furthermore, we observed only moderate predictive performance, large heterogeneity between-study populations and model performance, and poor methodological quality overall. Most importantly, current models are unsuitable to provide decision support for selecting individuals in whom initiation of ECMO would be most beneficial, as all models were developed in ECMO patients only and the decision to start ECMO had, therefore, already been made.
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Affiliation(s)
- Lara C A Pladet
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jaimie M M Barten
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisette M Vernooij
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carlos V Elzo Kraemer
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J H Bunge
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erik Scholten
- Department of Intensive Care Medicine, Sint Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Leon J Montenij
- Department of Intensive Care Medicine, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marijn Kuijpers
- Department of Intensive Care Medicine, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - Dirk W Donker
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, the Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christiaan L Meuwese
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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Huespe IA, Lockhart C, Kashyap R, Palizas F, Colombo M, Romero MDP, Prado E, Casabella García CA, Las Heras M, Carboni Bisso I. Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID-19. Artif Organs 2023:10.1111/aor.14493. [PMID: 36582133 PMCID: PMC9880702 DOI: 10.1111/aor.14493] [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: 07/25/2022] [Revised: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID-19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. MATERIALS AND METHODS We evaluated the discrimination (C-statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V-V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy-Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. RESULTS We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8-15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67-0.94]) and calibration (calibration-in-the-large 0.5 [95%CI -1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10. CONCLUSION The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource-demanding and highly invasive organ support.
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Affiliation(s)
- Ivan Alfredo Huespe
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina,Área de investigación en medicina InternaHospital Italiano de Buenos AiresBuenos AiresArgentina,Universidad de Buenos AiresBuenos AiresArgentina,Global Clinical Scholars Research TraineeHarvard Medical SchoolBostonMassachusettsUSA
| | - Carolina Lockhart
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Rahul Kashyap
- Global Clinical Scholars Research TraineeHarvard Medical SchoolBostonMassachusettsUSA,Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA,Department of ResearchWellSpan HealthYorkPennsylvaniaUSA
| | - Fernando Palizas
- Unidad de Terapia Intensiva Adultos, Clínica BazterricaBuenos AiresArgentina
| | - Malena Colombo
- Instituto Universitario del Hospital ItalianoBuenos AiresArgentina
| | | | - Eduardo Prado
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Marcos Las Heras
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina
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Qin R, He L, Yang Z, Jia N, Chen R, Xie J, Fu W, Chen H, Lin X, Huang R, Luo T, Liu Y, Yao S, Jiang M, Li J. Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis. Clin Rev Allergy Immunol 2023; 64:33-65. [PMID: 35040086 PMCID: PMC8763427 DOI: 10.1007/s12016-021-08908-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 01/26/2023]
Abstract
Abnormal immunological indicators associated with disease severity and mortality in patients with COVID-19 have been reported in several observational studies. However, there are marked heterogeneities in patient characteristics and research methodologies in these studies. We aimed to provide an updated synthesis of the association between immune-related indicators and COVID-19 prognosis. We conducted an electronic search of PubMed, Scopus, Ovid, Willey, Web of Science, Cochrane library, and CNKI for studies reporting immunological and/or immune-related parameters, including hematological, inflammatory, coagulation, and biochemical variables, tested on hospital admission of COVID-19 patients with different severities and outcomes. A total of 145 studies were included in the current meta-analysis, with 26 immunological, 11 hematological, 5 inflammatory, 4 coagulation, and 10 biochemical variables reported. Of them, levels of cytokines, including IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, IFN-γ, IgA, IgG, and CD4+ T/CD8+ T cell ratio, WBC, neutrophil, platelet, ESR, CRP, ferritin, SAA, D-dimer, FIB, and LDH were significantly increased in severely ill patients or non-survivors. Moreover, non-severely ill patients or survivors presented significantly higher counts of lymphocytes, monocytes, lymphocyte/monocyte ratio, eosinophils, CD3+ T,CD4+T and CD8+T cells, B cells, and NK cells. The currently updated meta-analysis primarily identified a hypercytokinemia profile with the severity and mortality of COVID-19 containing IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, and IFN-γ. Impaired innate and adaptive immune responses, reflected by decreased eosinophils, lymphocytes, monocytes, B cells, NK cells, T cells, and their subtype CD4+ and CD8+ T cells, and augmented inflammation, coagulation dysfunction, and nonpulmonary organ injury, were marked features of patients with poor prognosis. Therefore, parameters of immune response dysfunction combined with inflammatory, coagulated, or nonpulmonary organ injury indicators may be more sensitive to predict severe patients and those non-survivors.
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Affiliation(s)
- Rundong Qin
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Li He
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Zhaowei Yang
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Nan Jia
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Ruchong Chen
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jiaxing Xie
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Wanyi Fu
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Hao Chen
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Xinliu Lin
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Renbin Huang
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Tian Luo
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Yukai Liu
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Siyang Yao
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Mei Jiang
- grid.470124.4National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
| | - Jing Li
- grid.470124.4Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong China
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10
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Sreenivasan J, Ranka S, Lahan S, Abu-Haniyeh A, Li H, Kaul R, Malik A, Aronow WS, Frishman WH, Lansman S. Extracorporeal Membrane Oxygenation in Patients With COVID-19. Cardiol Rev 2022; 30:129-133. [PMID: 34292184 PMCID: PMC8983617 DOI: 10.1097/crd.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by a clinical spectrum of diseases ranging from asymptomatic or mild cases to severe pneumonia with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. Extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy in appropriate patients with COVID-19 complicated by ARDS refractory to mechanical ventilation. In this study, we review the indications, challenges, complications, and clinical outcomes of ECMO utilization in critically ill patients with COVID-19-related ARDS. Most of these patients required venovenous ECMO. Although the risk of mortality and complications is very high among patients with COVID-19 requiring ECMO, it is similar to that of non-COVID-19 patients with ARDS requiring ECMO. ECMO is a resource-intensive therapy, with an inherent risk of complications, which makes its availability limited and its use challenging in the midst of a pandemic. Well-maintained data registries, with timely reporting of outcomes and evidence-based clinical guidelines, are necessary for the careful allocation of resources and for the development of standardized utilization protocols.
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Affiliation(s)
- Jayakumar Sreenivasan
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Ahmed Abu-Haniyeh
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Heyi Li
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Risheek Kaul
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Aaqib Malik
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Wilbert S. Aronow
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - William H. Frishman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Steven Lansman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
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11
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Bohman JJKK, Seelhammer TG, Mazzeffi M, Gutsche J, Ramakrishna H. The Year in Extracorporeal Membrane Oxygenation: Selected Highlights From 2021. J Cardiothorac Vasc Anesth 2022; 36:1832-1843. [PMID: 35367120 DOI: 10.1053/j.jvca.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/11/2022]
Abstract
This review summarizes the extracorporeal membrane oxygenation (ECMO) or extracorporeal life support literature published in 2021. This Selected Highlights article is not intended to be an exhaustive review of the literature, but rather a summarizing of key themes that developed in the ECMO literature during 2021. The primary topics presented include the following: ECMO for coronavirus disease 2019, extracorporeal cardiopulmonary resuscitation, periprocedural cardiopulmonary support with ECMO, and anticoagulation for ECMO.
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Affiliation(s)
- John J Kyle K Bohman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Troy G Seelhammer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Michael Mazzeffi
- Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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12
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Kurihara C, Manerikar A, Gao CA, Watanabe S, Kandula V, Klonis A, Hoppner V, Karim A, Saine M, Odell DD, Lung K, Garza‐Castillon R, Kim SS, Walter JM, Wunderink RG, Budinger GRS, Bharat A. Outcomes after extracorporeal membrane oxygenation support in COVID-19 and non-COVID-19 patients. Artif Organs 2022; 46:688-696. [PMID: 34694655 PMCID: PMC8653196 DOI: 10.1111/aor.14090] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/21/2021] [Accepted: 10/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation (V-V ECMO) support is increasingly used in the management of COVID-19-related acute respiratory distress syndrome (ARDS). However, the clinical decision-making to initiate V-V ECMO for severe COVID-19 still remains unclear. In order to determine the optimal timing and patient selection, we investigated the outcomes of both COVID-19 and non-COVID-19 patients undergoing V-V ECMO support. METHODS Overall, 138 patients were included in this study. Patients were stratified into two cohorts: those with COVID-19 and non-COVID-19 ARDS. RESULTS The survival in patients with COVID-19 was statistically similar to non-COVID-19 patients (p = .16). However, the COVID-19 group demonstrated higher rates of bleeding (p = .03) and thrombotic complications (p < .001). The duration of V-V ECMO support was longer in COVID-19 patients compared to non-COVID-19 patients (29.0 ± 27.5 vs 15.9 ± 19.6 days, p < .01). Most notably, in contrast to the non-COVID-19 group, we found that COVID-19 patients who had been on a ventilator for longer than 7 days prior to ECMO had 100% mortality without a lung transplant. CONCLUSIONS These findings suggest that COVID-19-associated ARDS was not associated with a higher post-ECMO mortality than non-COVID-19-associated ARDS patients, despite longer duration of extracorporeal support. Early initiation of V-V ECMO is important for improved ECMO outcomes in COVID-19 ARDS patients. Since late initiation of ECMO was associated with extremely high mortality related to lack of pulmonary recovery, it should be used judiciously or as a bridge to lung transplantation.
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Affiliation(s)
- Chitaru Kurihara
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Adwaiy Manerikar
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Catherine Aiyuan Gao
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Satoshi Watanabe
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Viswajit Kandula
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Alexandra Klonis
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Vanessa Hoppner
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Azad Karim
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Mark Saine
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - David D. Odell
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Kalvin Lung
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Rafael Garza‐Castillon
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Samuel S. Kim
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - James McCauley Walter
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Richard G. Wunderink
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - G. R. Scott Budinger
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Ankit Bharat
- Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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13
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Zhang Y, Wang L, Fang ZX, Chen J, Zheng JL, Yao M, Chen WY. Mortality in patients with COVID-19 requiring extracorporeal membrane oxygenation: A meta-analysis. World J Clin Cases 2022; 10:2457-2467. [PMID: 35434060 PMCID: PMC8968615 DOI: 10.12998/wjcc.v10.i8.2457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/04/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic and significant public health issue. The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been called into question.
AIM To conduct a meta-analysis on the mortality of COVID-19 patients who require ECMO.
METHODS This analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020 (PRISMA) and has been registered at the International Prospective Register of Systematic Reviews (number CRD42020227414). A quality assessment for all the included articles was performed by the Newcastle-Ottawa Scale (NOS). Studies with tenor more COVID-19 patients undergoing ECMO were included. The random-effects model was used to obtain the pooled incidence of mortality in COVID-19 patients receiving ECMO. The source of heterogeneity was investigated using subgroup and sensitivity analyses.
RESULTS We identified 18 articles with 1494 COVID-19 patients who were receiving ECMO. The score of the quality assessment ranged from 5 to 8 on the NOS. The majority of patients received veno-venous ECMO (93.7%). Overall mortality was estimated to be 0.31 [95% confidence interval (CI): 0.24-0.39; I2 = 84.8%] based on random-effect pooled estimates. There were significant differences in mortality between location groups (33.0% vs 55.0% vs 37.0% vs 18.0%, P < 0.001), setting groups (28.0% vs 34.0%, P < 0.001), sample size (37.0% vs 31.0%, P < 0.001), and NOS groups (39.0% vs 19.0%, P < 0.001). However, both subgroup analyses based on location, setting, and sample size, and sensitivity analysis failed to identify the source of heterogeneity. The funnel plot indicated no evident asymmetry, and the Egger's (P = 0.95) and Begg's (P = 0.14) tests also revealed no significant publication bias.
CONCLUSION With more resource assessment and risk-benefit analysis, our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.
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Affiliation(s)
- Ye Zhang
- Department of General Practice, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Lei Wang
- Department of General Practice, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhi-Xian Fang
- Department of Respiration, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jing Chen
- Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Jia-Lian Zheng
- Department of Oncology, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Ming Yao
- Department of Pain Medicine, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Wen-Yu Chen
- Department of Respiration, Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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14
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Wang J, Zhu K, Xue Y, Wen G, Tao L. Research Progress in the Treatment of Complications and Sequelae of COVID-19. Front Med (Lausanne) 2021; 8:757605. [PMID: 34926504 PMCID: PMC8674502 DOI: 10.3389/fmed.2021.757605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022] Open
Abstract
With the improvement in the understanding of COVID-19 and the widespread vaccination of COVID-19 vaccines in various countries, the epidemic will be brought under control soon. However, multiple viruses could result in the post-viral syndrome, which is also common among patients with COVID-19. Therefore, the long-term consequences and the corresponding treatment of COVID-19 should be the focus in the post-epidemic era. In this review, we summarize the therapeutic strategies for the complications and sequelae of eight major systems caused by COVID-19, including respiratory system, cardiovascular system, neurological system, digestive system, urinary system, endocrine system, reproductive system and skeletal complication. In addition, we also sorted out the side effects reported in the vaccine trials. The purpose of this article is to remind people of possible complications and sequelae of COVID-19 and provide robust guidance on the treatment. It is extremely important to conduct long-term observational prognosis research on a larger scale, so as to have a comprehensive understanding of the impact of the SARS-CoV-2 on the human body and reduce complications to the greatest extent.
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Affiliation(s)
- Jinpeng Wang
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Kuoyun Zhu
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
| | - Yuchuan Xue
- The First Department of Clinical Medicine, China Medical University, Shenyang, China
| | - Guangfu Wen
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Lin Tao
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, China
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15
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Funakoshi K, Morita T, Kumanogoh A. Longer Prehospitalization and Preintubation Periods in Intubated Non-survivors and ECMO Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:727101. [PMID: 34722567 PMCID: PMC8554002 DOI: 10.3389/fmed.2021.727101] [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: 06/18/2021] [Accepted: 09/20/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose: There is no clear consensus on the clinical course of critical COVID-19 patients. We examined the clinical course among intubated survivors, non-survivors, and extracorporeal membrane oxygenation (ECMO) patients to reveal the standard clinical course and the difference among critical COVID-19 patients. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, and Scopus for original studies published until December 11, 2020, including case accumulation and clinical course reporting. Pregnant patients and children were excluded. We followed PRISMA guidelines and registered them with PROSPERO (CRD42021235534). Results: Of the 11,716 studies identified, 94 met the selection criteria, and 2,549 cases were included in this meta-analysis. The times from intubation to extubation and death were 12.07 days (95% confidence interval 9.80–14.33 days) and 10.14 days (8.18–12.10 days), respectively, and the ECMO duration was 14.72 days (10.57–18.87 days). The time from symptom onset to hospitalization (prehospitalization period) of intubated survivors, non-survivors, and ECMO patients was 6.15 (4.61–7.69 days), 6.45 (4.55–8.34 days), and 7.15 days (6.48–7.81 days), and that from symptom onset to intubation (preintubation period) was 8.58 (7.36–9.80 days), 9.14 (7.26–11.01 days), and 10.54 days (9.18–11.90 days), respectively. Sensitivity analysis showed that the time from intubation to extubation and death was longer in the US and Europe than in East Asia. Conclusion: For COVID-19, we hypothesize that prehospitalization and preintubation periods are longer in intubated non-survivors and ECMO patients than in intubated survivors. These periods may serve as a predictor of disease severity or death and support therapeutic strategy determination.
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Affiliation(s)
- Kenji Funakoshi
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takayoshi Morita
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Japan.,Department of Immunopathology, WPI, Immunology Frontier Research Center (iFReC), Osaka University, Suita, Japan.,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan.,Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Suita, Japan
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16
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Chong WH, Saha BK, Medarov BI. Clinical Characteristics Between Survivors and Nonsurvivors of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation (ECMO) Support: A Systematic Review and Meta-Analysis. J Intensive Care Med 2021; 37:304-318. [PMID: 34636697 DOI: 10.1177/08850666211045632] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The use of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19) for refractory respiratory failure, severe cardiac dysfunction, and bridge to lung transplantation has been steadily increasing during the ongoing global pandemic. Objective: Our meta-analysis aims to compare the clinical characteristics between COVID-19 survivors and nonsurvivors requiring ECMO support. Methods: A systematic search of Pubmed, Cochrane, Embase, Scopus, and Web of Science databases was performed between December first, 2019, to June first, 2021. Studies with comparative data of COVID-19 ECMO patients were selected, in which clinical characteristics and complications were assessed. Results: Sixteen cohort studies involving 706 COVID-19 patients requiring ECMO support with pooled mortality rate of 40% were included. Younger age (mean 51 years vs 55 years; P < .001), fewer comorbidities (23% vs 31%; odds ratio [OR] 0.55; P = .02), and less renal replacement therapy (RRT) (21% vs 39%; OR 0.41; P = .007) and vasopressor (76% vs 92%; OR 0.35; P = .008) requirement were demonstrated in COVID-19 survivors requiring ECMO support than nonsurvivors. Survivors also had higher pre-ECMO pH (mean 7.33 vs 7.26; P < .001) than nonsurvivors. No difference was observed in gender, body mass index, duration of mechanical ventilation (MV) before ECMO support initiation, total ECMO support duration, and pre-ECMO parameters of PaO2/FiO2 ratio, tidal volume (mL/kg), positive end-expiratory pressure, and plateau pressure. The rate of bleeding complications was lower in survivors (32% vs 59%; OR 0.36; P = .001) than nonsurvivors, but no difference was observed in thromboembolism and secondary infections. Conclusions: We found advanced age, multiple comorbidities, lower pre-ECMO pH, greater RRT, and vasopressor requirements, and bleeding are predictors of death in COVID-19 patients requiring ECMO support. The duration of MV before ECMO support initiation and total ECMO support duration was similar among survivors and nonsurvivors. Our study results have important clinical implications when considering ECMO support in critically ill COVID-19 patients.
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Affiliation(s)
| | - Biplab K Saha
- 142530Ozarks Medical Center, West Plains, Missouri, USA
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17
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Nguyen TC, Thourani VH, Nissen AP, Habib RH, Dearani JA, Ropski A, Crestanello JA, Shahian DM, Jacobs JP, Badhwar V. The Effect of COVID-19 on Adult Cardiac Surgery in the United States in 717 103 Patients. Ann Thorac Surg 2021; 113:738-746. [PMID: 34343473 PMCID: PMC8325556 DOI: 10.1016/j.athoracsur.2021.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 07/01/2021] [Indexed: 12/21/2022]
Abstract
Background COVID-19 has changed the world as we know it, and the United States continues to accumulate the largest number of COVID-related deaths worldwide. There exists a paucity of data regarding the effect of COVID-19 on adult cardiac surgery trends and outcomes on regional and national levels. Methods The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried from January 1, 2018, to June 30, 2020. The Johns Hopkins COVID-19 database was queried from February 1, 2020, to January 1, 2021. Surgical and COVID-19 volumes, trends, and outcomes were analyzed on a national and regional level. Observed-to-expected ratios were used to analyze risk-adjustable mortality. Results The study analyzed 717 103 adult cardiac surgery patients and more than 20 million COVID-19 patients. Nationally, there was a 52.7% reduction in adult cardiac surgery volume and a 65.5% reduction in elective cases. The Mid-Atlantic region was most affected by the first COVID-19 surge, with 69.7% reduction in overall case volume and 80.0% reduction in elective cases. In the Mid-Atlantic and New England regions, the observed-to-expected mortality for isolated coronary bypass increased as much as 1.48 times (148% increase) pre-COVID rates. After the first COVID-19 surge, nationwide cardiac surgical case volumes did not return to baseline, indicating a COVID-19–associated deficit of cardiac surgery patients. Conclusions This large analysis of COVID-19–related impact on adult cardiac surgery volume, trends, and outcomes found that during the pandemic, cardiac surgery volume suffered dramatically, particularly in the Mid-Atlantic and New England regions during the first COVID-19 surge, with a concurrent increase in observed-to-expected 30-day mortality.
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Affiliation(s)
- Tom C Nguyen
- Department of Surgery, Division of Cardiothoracic Surgery, University of California San Francisco, San Francisco, California.
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Alexander P Nissen
- Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Robert H Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Allan Ropski
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | | | - David M Shahian
- Division of Cardiac Surgery, Department of Surgery, and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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18
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Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature. MEMBRANES 2021; 11:membranes11080584. [PMID: 34436348 PMCID: PMC8400963 DOI: 10.3390/membranes11080584] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/21/2022]
Abstract
(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute-refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative-advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ -2 points, PRESET score ≥ 6 points, and "do not attempt resuscitation" order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.
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Ramanathan K, Shekar K, Ling RR, Barbaro RP, Wong SN, Tan CS, Rochwerg B, Fernando SM, Takeda S, MacLaren G, Fan E, Brodie D. Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Crit Care 2021; 25:211. [PMID: 34127027 PMCID: PMC8201440 DOI: 10.1186/s13054-021-03634-1] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research. METHODS We searched MEDLINE, Embase, Cochrane and Scopus databases from 1 December 2019 to 10 January 2021 for observational studies or randomised clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and meta-regression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO. RESULTS We included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI 32.3-42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI 30.7-40.7%, high certainty). Meta-regression found that age and ECMO duration were associated with increased mortality. Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI 13.4-18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI 50.5-82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common. CONCLUSION The majority of patients received venovenous ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1% during the first year of the pandemic, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS. PROSPERO CRD42020192627.
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Affiliation(s)
- Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, 119228, Singapore.
| | - Kiran Shekar
- Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ryan P Barbaro
- Division of Paediatric Critical Care Medicine, University of Michigan, Ann Arbor, USA
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Suei Nee Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chuen Seng Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shinhiro Takeda
- Japan ECMOnet for COVID-19 & President, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, 119228, Singapore
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Daniel Brodie
- 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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20
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Suwalski P, Staromłyński J, Brączkowski J, Bartczak M, Mariani S, Drobiński D, Szułdrzyński K, Smoczyński R, Franczyk M, Sarnowski W, Gajewska A, Witkowska A, Wierzba W, Zaczyński A, Król Z, Olek E, Pasierski M, Ravaux JM, de Piero ME, Lorusso R, Kowalewski M. Transition from Simple V-V to V-A and Hybrid ECMO Configurations in COVID-19 ARDS. MEMBRANES 2021; 11:membranes11060434. [PMID: 34207598 PMCID: PMC8228471 DOI: 10.3390/membranes11060434] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/27/2022]
Abstract
In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine (p = 0.007) and a shorter ICU duration (p = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank p = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.
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Affiliation(s)
- Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Jakub Staromłyński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Jakub Brączkowski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Maciej Bartczak
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (S.M.); (J.M.R.); (M.E.d.P.); (R.L.)
| | - Dominik Drobiński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Konstanty Szułdrzyński
- Department of Anesthesiology and Intensive Care, Central Clinical Hospital of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland;
| | - Radosław Smoczyński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Marzena Franczyk
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Wojciech Sarnowski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Agnieszka Gajewska
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Anna Witkowska
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Waldemar Wierzba
- Central Clinical Hospital of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland; (W.W.); (A.Z.); (Z.K.)
- Satellite Campus in Warsaw, University of Humanities and Economics in Lodz, 90-212 Warsaw, Poland
| | - Artur Zaczyński
- Central Clinical Hospital of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland; (W.W.); (A.Z.); (Z.K.)
| | - Zbigniew Król
- Central Clinical Hospital of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland; (W.W.); (A.Z.); (Z.K.)
| | - Ewa Olek
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Michał Pasierski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
| | - Justine Mafalda Ravaux
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (S.M.); (J.M.R.); (M.E.d.P.); (R.L.)
| | - Maria Elena de Piero
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (S.M.); (J.M.R.); (M.E.d.P.); (R.L.)
- Department Anaesthesia-Intensive Care, San Giovanni Bosco Hospital, 80144 Turin, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (S.M.); (J.M.R.); (M.E.d.P.); (R.L.)
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, 02-507 Warsaw, Poland; (P.S.); (J.S.); (J.B.); (M.B.); (D.D.); (R.S.); (M.F.); (W.S.); (A.G.); (A.W.); (E.O.); (M.P.)
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (S.M.); (J.M.R.); (M.E.d.P.); (R.L.)
- Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, 87-100 Bydgoszcz, Poland
- Correspondence: ; Tel.: +48-502269240
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21
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Autschbach T, Hatam N, Durak K, Grottke O, Dreher M, Nubbemeyer K, Rossaint R, Marx G, Marx N, Spillner J, Zayat R, Kalverkamp S, Kersten A. Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis. J Clin Med 2021; 10:2547. [PMID: 34207573 PMCID: PMC8227073 DOI: 10.3390/jcm10122547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 05/21/2021] [Accepted: 06/07/2021] [Indexed: 02/07/2023] Open
Abstract
It remains unclear to what extent the outcomes and complications of extracorporeal membrane oxygenation (ECMO) therapy in COVID-19 patients with acute respiratory distress syndrome (ARDS) differ from non-COVID-19 ARDS patients. In an observational, propensity-matched study, outcomes after ECMO support were compared between 19 COVID-19 patients suffering from ARDS (COVID group) and 34 matched non-COVID-19 ARDS patients (NCOVID group) from our historical cohort. A 1:2 propensity matching was performed based on respiratory ECMO survival prediction (RESP) score, age, gender, bilirubin, and creatinine levels. Patients' characteristics, laboratory parameters, adverse events, and 90-day survival were analyzed. Patients' characteristics in COVID and NCOVID groups were similar. Before ECMO initiation, fibrinogen levels were significantly higher in the COVID group (median: 493 vs. 364 mg/dL, p < 0.001). Median ECMO support duration was similar (16 vs. 13 days, p = 0.714, respectively). During ECMO therapy, patients in the COVID group developed significantly more thromboembolic events (TEE) than did those in the NCOVID group (42% vs. 12%, p = 0.031), which were mainly pulmonary artery embolism (PAE) (26% vs. 0%, p = 0.008). The rate of major bleeding events (42% vs. 62%, p = 0.263) was similar. Fibrinogen decreased significantly more in the COVID group than in the NCOVID group (p < 0.001), whereas D-dimer increased in the COVID group (p = 0.011). Additionally, 90-day mortality did not differ (47% vs. 74%; p = 0.064) between COVID and NCOVID groups. Compared with that in non-COVID-19 ARDS patients, ECMO support in COVID-19 patients was associated with comparable in-hospital mortality and similar bleeding rates but a higher incidence of TEE, especially PAE. In contrast, coagulation parameters differed between COVID and NCOVID patients.
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Affiliation(s)
- Teresa Autschbach
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (T.A.); (N.H.); (K.D.); (K.N.); (J.S.); (S.K.)
- Department of Anesthesiology, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (O.G.); (R.R.)
| | - Nima Hatam
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (T.A.); (N.H.); (K.D.); (K.N.); (J.S.); (S.K.)
| | - Koray Durak
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (T.A.); (N.H.); (K.D.); (K.N.); (J.S.); (S.K.)
| | - Oliver Grottke
- Department of Anesthesiology, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (O.G.); (R.R.)
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany;
| | - Katharina Nubbemeyer
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (T.A.); (N.H.); (K.D.); (K.N.); (J.S.); (S.K.)
| | - Rolf Rossaint
- Department of Anesthesiology, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (O.G.); (R.R.)
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care Medicine, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany;
| | - Nikolaus Marx
- Department of Cardiology, Angiology and Intensive Care, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (N.M.); (A.K.)
| | - Jan Spillner
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (T.A.); (N.H.); (K.D.); (K.N.); (J.S.); (S.K.)
| | - Rashad Zayat
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (T.A.); (N.H.); (K.D.); (K.N.); (J.S.); (S.K.)
| | - Sebastian Kalverkamp
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (T.A.); (N.H.); (K.D.); (K.N.); (J.S.); (S.K.)
| | - Alex Kersten
- Department of Cardiology, Angiology and Intensive Care, RWTH University Hospital Aachen, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; (N.M.); (A.K.)
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22
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Nagaoka E, Arai H, Ugawa T, Masuda T, Ochiai K, Tamaoka M, Kurashima N, Oi K, Fujiwara T, Yoshida M, Shigemitsu H, Otomo Y. Efficacy of multidisciplinary team approach with extracorporeal membrane oxygenation for COVID-19 in a low volume ECMO center. Artif Organs 2021; 45:1061-1067. [PMID: 33656783 PMCID: PMC8014198 DOI: 10.1111/aor.13947] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 12/14/2022]
Abstract
Veno-venous extracorporeal membrane oxygenation (VV ECMO) is an effective and proven adjunct support for various severe respiratory failures requiring invasive mechanical ventilation and cardiovascular support. In response to the rapidly increasing number of COVID-19 patients in Japan, we launched an ECMO support team comprised of multidisciplinary experts including physicians, nurses, perfusionists, and bioethicists in preparation for the threat of a pandemic. From April 2 to July 15, 2020, Tokyo Medical and Dental University hospital treated 104 PCR confirmed COVID-19 patients. Among those, 34 patients were admitted to intensive care unit (ICU) and 5 patients required VV ECMO. All management related to ECMO was decided by the ECMO support team in addition to participation of the ECMO support team in daily multidisciplinary rounds in the ICU. Median age was 54 years old. Duration from onset to mechanical ventilation (MV) and MV to ECMO were 8 and 7 days, respectively. Four patients (80%) were successfully weaned off from ECMO. One patient died after 81 days of ECMO run. Four patients were discharged and recovered to their prehospital quality of life without major disability. We achieved a high survival rate using ECMO in our low volume ECMO institution during the COVID-19 pandemic. Multidisciplinary decision-making and a team approach for the unclear pathology with an emerging infectious disease was effective and contributed to the survival rate.
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Affiliation(s)
- Eiki Nagaoka
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toyomu Ugawa
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Masuda
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kanae Ochiai
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Physiology and Sleep Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Kurashima
- Medical Engineering Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Oi
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masayuki Yoshida
- Division of Medical Genetics, Medical Hospital of Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidenobu Shigemitsu
- Department of Intensive Care Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University, Tokyo, Japan
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