1
|
Lugthart A, Sandker S, Maas J, López Matta J, Henneman M, Elzo Kraemer C, Werkman M. Recovery of skeletal muscle strength and physical function in a patient with (post) COVID-19 requiring extra-corporeal membrane oxygenation. Physiother Theory Pract 2024; 40:190-196. [PMID: 35946079 DOI: 10.1080/09593985.2022.2107966] [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: 10/25/2021] [Accepted: 07/16/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The ongoing coronavirus-19 disease (COVID-19) has taught us that early mobilization is essential for functional recovery during and after prolonged intensive care unit (ICU) stay. This especially applies for patients receiving a challenging combination of prolonged invasive treatments such as mechanical ventilation (MV) and extra-corporeal membrane oxygenation (ECMO). This case report describes the recovery of skeletal muscle strength and physical function in a patient (post) COVID-19 during ICU stay. CASE DESCRIPTION A 54 year old female patient was diagnosed with COVID-19 pneumonia, and ultimately needed ICU treatment with MV and ECMO for 69 days during which she received physiotherapy treatment. OUTCOMES The patient recovered from intensive care acquired muscle weakness (ICUAW) at day 53, resulting in the ability to walk at day 62. She was discharged from the ICU after 69 days with the ability to walk 20 meters with support of one person and a mobility aid. No evident adverse events were noted during or after physiotherapy sessions. DISCUSSION Early mobilization is feasible and safe in a patient (post) COVID-19 with prolonged ECMO treatment and facilitates functional recovery during ICU stay. This single case observation should be handled with caution and needs further validation.
Collapse
Affiliation(s)
- Annefleur Lugthart
- Department of Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
| | - Stefan Sandker
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jacinta Maas
- Department of Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Jorge López Matta
- Department of Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Marlies Henneman
- Department of Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Carlos Elzo Kraemer
- Department of Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| | - Maarten Werkman
- Department of Physical Therapy, Leiden University Medical Center, Leiden, Netherlands
- Department of Intensive Care, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
2
|
Razia D, Olson MT, Grief K, Walia R, Bremner RM, Smith MA, Tokman S. Hospitalized patients with irreversible lung injury from COVID-19 have higher morbidity but similar 1-year survival after lung transplant compared to hospitalized patients transplanted for restrictive lung disease. J Heart Lung Transplant 2023; 42:255-263. [PMID: 36272894 PMCID: PMC9492395 DOI: 10.1016/j.healun.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/22/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hospitalized lung transplant (LT) recipients (LTRs) have higher post-LT morbidity and mortality than those who are well enough to wait for transplant at home. Outcomes after LT for COVID-19-associated acute respiratory distress syndrome (CARDS) may be even worse; thus, we compared post-LT outcomes between hospitalized LTRs transplanted for CARDS and those transplanted for restrictive lung disease (RLD). METHODS Between 2014 and 2021, hospitalized LTRs ≥18 years old with CARDS or RLD were included. Primary and secondary outcomes were 1-year post-LT survival and postoperative morbidity. For each patient in the CARDS group, an analysis of 1-to-1 matched patients from the RLD group was performed using logistic regression modeling. RESULTS Of 764 LTRs, 163 (21.3%) were hospitalized at the time of LT; 132 met the inclusion criteria: 11 (8.3%) were transplanted for CARDS and 121 (91.7%) for RLD. LTRs with CARDS were younger with longer pre-LT hospitalization stays and higher rates of pretransplant mechanical ventilation, dialysis, and ECMO as a bridge to transplant. A propensity-matched analysis demonstrated comparable rates of intrathoracic adhesions, posttransplant duration of mechanical ventilation, PGD3 at 72 hours, and delayed chest closure. Compared to LTRs with RLD, those with CARDS had significantly longer posttransplant hospital stays and a higher prevalence of ACR ≥A2 and DSA >2000 MFI, but comparable 1-year survival rates. CONCLUSION Even with careful selection, LT for patients with CARDS was associated with significant morbidity; however, 1-year survival of recipients with CARDS was comparable to that of matched hospitalized recipients with RLD.
Collapse
Affiliation(s)
- Deepika Razia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T. Olson
- University of Arizona College of Medicine – Phoenix Campus, Phoenix, Arizona, USA
| | - Katherine Grief
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona,Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Ross M. Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona,Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Michael A. Smith
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona,Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Sofya Tokman
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona.
| |
Collapse
|
3
|
Kim SA, Yun JK, Lee GD, Kim DK, Choi S. Early Outcomes of COVID-19 Lung Transplantation Recipients in Korea: A Single-Center Study. J Chest Surg 2023; 56:6-13. [PMID: 36476445 PMCID: PMC9845857 DOI: 10.5090/jcs.22.055] [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: 07/11/2022] [Revised: 09/26/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has been found to cause life-threatening respiratory failure, which can progress to irreversible lung damage. Lung transplantation can be a life-saving treatment in patients with terminal lung disease (e.g., acute respiratory distress syndrome caused by infection). This study aimed to present the clinical course and results after initial lung transplantation in patients with severe COVID-19 who did not recover even with optimal medical care. Methods From August 2019 to February 2022, this study enrolled 10 patients with COVID-19 (5 men; median age, 55.7 years) who underwent lung transplantation at a single center in Korea. All patients' characteristics, clinical pathway, overall survival, complications, and operative data were collected and analyzed. Results Veno-venous extracorporeal membrane oxygenation or an oxygenator in a right ventricular assist device circuit was applied to 90% of the patients, and the median length of extracorporeal life support before operation was 48.5 days. There were no cases of mortality after a median follow-up of 372.8 days (interquartile range, 262.25-489 days). The major complications included the requirement for postoperative extracorporeal membrane oxygenation support in 2 cases (20%), re-transplantation in 1 case (10%), and re-exploration due to bleeding in 2 cases (20%). During the follow-up period, 3 out of 10 patients died. Conclusion Excellent early outcomes were observed for patients who underwent lung transplantation. Thus, lung transplantation can be an effective and feasible treatment for patients with end-stage lung disease caused by COVID-19.
Collapse
Affiliation(s)
- Shi A Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Corresponding author Sehoon Choi Tel 82-2-3010-3580 Fax 82-2-3010-6966 E-mailORCIDhttps://orcid.org/0000-0002-9961-9289 See Commentary page 14
| |
Collapse
|
4
|
Cho WH. Lung Transplantation for Patients with COVID-19 Acute Respiratory Distress Syndrome. J Chest Surg 2022; 55:357-360. [PMID: 35924544 PMCID: PMC9358166 DOI: 10.5090/jcs.22.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) may exhibit pulmonary fibrosis after the viral illness resolves. Some of these patients may experience severe functional lung impairment, and thus require transplants to prevent death or maintain a tolerable quality of life. Considering the reversibility of COVID-19 ARDS, lung transplant candidates are observed for 1–2 months and must be selected very carefully before transplantation. As the short-term outcomes of such patients are comparable to those of patients with other indications for transplantation, lung transplantation should be actively considered.
Collapse
Affiliation(s)
- Woo Hyun Cho
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| |
Collapse
|
5
|
Lang C, Ritschl V, Augustin F, Lang G, Moser B, Taghavi S, Murakoezy G, Lambers C, Flick H, Koestenberger M, Brooks R, Muhr T, Knotzer J, Mydza D, Kaufmann M, Staudinger T, Zauner C, Krenn C, Schaden E, Bacher A, Rössler B, Faybik P, Tschernko E, Anwar M, Markstaller K, Höfer D, Stamm T, Jaksch P, Hoetzenecker K. Clinical relevance of lung transplantation for COVID-19 ARDS: a nationwide study. Eur Respir J 2022; 60:2102404. [PMID: 35301249 PMCID: PMC8932280 DOI: 10.1183/13993003.02404-2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/13/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although the number of lung transplantations (LTx) performed worldwide for COVID-19 induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of most severly ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx to the pandemic are unknown. METHODS A retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-Cov-2) infection admitted between January 1, 2020 and May 30, 2021 in Austria. Patients referred to one of the two Austrian LTx centers were analyzed and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared to patients who underwent LTx for other indications. RESULTS Between January 1, 2020 and May 30, 2021, 39.485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation, 183 received extra-corporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. With a median follow-up of 134 (47-450) days, 14/19 patients are alive. CONCLUSIONS Early referral of ECMO patients to a LTx center is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.
Collapse
Affiliation(s)
- Christian Lang
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gyoergy Lang
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Moser
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabriella Murakoezy
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Christopher Lambers
- Department of Pneumology, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Markus Koestenberger
- Department of Anaesthesiology and Intensive Care, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Roxane Brooks
- Intensive Care Unit 1, Clinic of Anesthesiology and Intensive Care Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Tina Muhr
- Intensive Care Unit, Division of Cardiology, Department of Internal Medicine, State Hospital (LKH) Graz II, Graz, Austria
| | - Johann Knotzer
- Department of Anaesthesiology and Critical Care Medicine, Klinikum Wels - Grieskirchen, Wels, Austria
| | - Daniel Mydza
- 1st Medical Department, Klinik Favoriten, Vienna, Austria
| | - Marc Kaufmann
- Department of Anaesthesiology & Intensive Care Unit, Bozen Central Hospital, Bozen, Italy
| | - Thomas Staudinger
- Intensive Care Unit 13i2, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Intensive Care Unit 13H1, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claus Krenn
- Intensive Care Unit 13C1, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Intensive Care Unit 13C1, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety (LBI-DHPS), Medical University of Vienna, Vienna, Austria
| | - Andreas Bacher
- Intensive Care Unit 13C2, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Rössler
- Intensive Care Unit 9D, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Faybik
- Intensive Care Unit 13C3, Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Maria Anwar
- Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Klaus Markstaller
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Höfer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
6
|
Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature. CURRENT TRANSPLANTATION REPORTS 2022; 9:95-107. [PMID: 35284204 PMCID: PMC8904162 DOI: 10.1007/s40472-022-00362-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
Purpose of Review As the coronavirus disease 2019 (COVID-19) pandemic continues to surge, determining the safety and timing of proceeding with solid organ transplantation (SOT) in transplant candidates who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and who are otherwise transplant eligible is an important concern. We reviewed the current status of protocols and the outcomes of SOT in SARS-CoV-2 recovered patients. Recent Findings We identified 44 published reports up through 7 September 2021, comprising 183 SOT [kidney = 115; lung = 27; liver = 36; heart = 3; simultaneous pancreas-kidney (SPK) = 1, small bowel = 1] transplants in SARS-CoV-2 recovered patients. The majority of these were living donor transplants. A positive SARS-CoV-2 antibody test, although not obligatory in most reports, was a useful tool to strengthen the decision to proceed with transplant. Two consecutive real-time polymerase chain test (RT-PCR) negative tests was one of the main prerequisites for transplant in many reports. However, some reports suggest that life-saving transplantation can proceed in select circumstances without waiting for a negative RT-PCR. In general, the standard immunosuppression regimen was not changed. Summary In select cases, SOT in COVID-19 recovered patients appears successful in short-term follow-up. Emergency SOT can be performed with active SARS-CoV-2 infection in some cases. In general, continuing standard immunosuppression regimen may be reasonable, except in cases of inadvertent transplantation with active SARS-CoV-2. Available reports are predominantly in kidney transplant recipients, and more data for other organ transplants are needed.
Collapse
|
7
|
Polastri M, Swol J, Loforte A, Dell'Amore A. Extracorporeal membrane oxygenation and rehabilitation in patients with COVID-19: A scoping review. Artif Organs 2021; 46:30-39. [PMID: 34778984 PMCID: PMC8652633 DOI: 10.1111/aor.14110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/18/2021] [Accepted: 10/29/2021] [Indexed: 12/13/2022]
Abstract
Background and purpose The coronavirus diseases 2019 (COVID‐19) pandemic posed severe difficulties in managing critically ill patients in hospital care settings. Extracorporeal membrane oxygenation (ECMO) support has been proven to be lifesaving support during the SARS‐CoV‐2 outbreak. The purpose of this review was to describe the rehabilitative treatments provided to patients undergoing ECMO support during the COVID‐19 pandemic. Methods We searched PubMed and Scopus for English‐language studies published from the databases’ inception until June 30, 2021. We excluded editorials, letters to the editor, and studies that did not describe rehabilitative procedures during ECMO support. We also excluded those articles not written in English. Results A total of 50 articles were identified. We ultimately included nine studies, seven of which were case reports. Only two studies had more than one patient; an observational design analyzing the clinical course of 19 patients and a case series of three patients. Extracorporeal support duration varied from 9 to 49 days, and the primary indication was acute respiratory distress syndrome COVID‐19‐related. Rehabilitative treatment mainly consisted of in‐bed mobilization, postural transfers (including sitting), and respiratory exercises. After hospital discharge, patients were referred to rehabilitation facilities. Physiotherapeutic interventions provided during ECMO support and after its discontinuation were feasible and safe. Conclusion The physiotherapeutic treatment of patients undergoing ECMO support includes several components and must be provided in a multidisciplinary context. The optimal approach depends on the patient’s status, including sedation, level of consciousness, ECMO configuration, types of cannulas, and cannulation site.
Collapse
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University General Hospital, Nuremberg, Germany
| | - Antonio Loforte
- Department of Cardiac, Thoracic, Vascular Diseases, Cardiac Surgery and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Andrea Dell'Amore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Division of Thoracic Surgery, University of Padua, Padua, Italy
| |
Collapse
|