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Whitmore SP, Cyr KJ, Cohen ES, Schlauch DJ, Gidwani HV, Sterling RK, Castiglia RP, Stell OT, Jarzembowski JL, Kunavarapu CR, McRae AT, Dellavolpe JD. Extracorporeal Membrane Oxygenation for Acute Respiratory Failure Due to COVID-19: A Multicenter Matched Cohort Study. ASAIO J 2023; 69:734-741. [PMID: 37531086 PMCID: PMC10627401 DOI: 10.1097/mat.0000000000001963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Mechanical ventilation for respiratory failure due to COVID-19 is associated with significant morbidity and mortality. Veno-venous extracorporeal membrane oxygenation (ECMO) is an attractive management option. This study sought to determine the effect of ECMO on hospital mortality and discharge condition in this population. We conducted a retrospective multicenter study to emulate a pragmatic targeted trial comparing ECMO to mechanical ventilation without ECMO for severe COVID-19. Data were gathered from a large hospital network database in the US. Adults admitted with COVID-19 were included if they were managed with ECMO or mechanical ventilation for severe hypoxemia and excluded if they had significant comorbidities or lacked functional independence on admission. The groups underwent coarsened exact matching on multiple clinical variables. The primary outcome was adjusted in-hospital mortality; secondary outcomes included ventilator days, intensive care days, and discharge destination. A total of 278 ECMO patients were matched to 2,054 comparison patients. Adjusted in-hospital mortality was significantly less in the ECMO group (38.8% vs. 60.1%, p < 0.001). Extracorporeal membrane oxygenation was associated with higher rates of liberation from mechanical ventilation, intensive care discharge, and favorable discharge destination. These findings support the use of ECMO for well-selected patients with severe acute respiratory failure due to COVID-19.
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Affiliation(s)
- Sage P. Whitmore
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | | | - Elliott S. Cohen
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | | | - Hitesh V. Gidwani
- Department of Critical Care Medicine, Methodist Hospital, San Antonio, Texas
| | - Rachel K. Sterling
- Department of Critical Care Medicine, Methodist Hospital, San Antonio, Texas
| | - Robert P. Castiglia
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | - Owen T. Stell
- From the Department of Critical Care Medicine, TriStar Centennial Medical Center, Nashville, Tennessee
| | | | | | - Andrew T. McRae
- Department of Cardiology, TriStar Centennial Medical Center, Nashville, Tennessee
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Abstract
Orbital abscess generally occurs in older children but it can rarely affect infants and neonates too. We report a case of community acquired methicillin resistant staphylococcus aureus (CA-MRSA) neonatal orbital abscess in a 12-day-old term female neonate with no significant past medical history or risk factor for developing the infection. The case highlights the importance of consideration of CA-MRSA as a causative agent of neonatal orbital cellulitis even in a neonate without any obvious predisposing condition. Prompt initiation of appropriate medical therapy against MRSA and surgical drainage of the abscess prevents life threatening complications of orbital cellulitis which more often tend to be fatal in neonates.
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Affiliation(s)
- Pratik Y Gogri
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Somen L Misra
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Neeta S Misra
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Hitesh V Gidwani
- Department of Internal Medicine, UPMC Mercy, Pennsylvania, Pittsburgh, USA
| | - Akshay J Bhandari
- Department of Ophthalmology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
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