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Zwaenepoel B, Vandewiele K, Peperstraete H, De Ryck F, Vanpeteghem C, Malfait T, Herck I, Vandenberghe W, Van Laethem L, Defreyne L, Van Braeckel E, Depuydt P, Schaubroeck H. Video-assisted thoracic surgery in critically ill COVID-19 patients on venovenous extracorporeal membrane oxygenation. Perfusion 2023; 38:1577-1583. [PMID: 35969115 PMCID: PMC9379594 DOI: 10.1177/02676591221119319] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) leads to thoracic complications requiring surgery. This is challenging, particularly in patients supported with venovenous extracorporeal membrane oxygenation (VV-ECMO) due to the need for continuous therapeutic anticoagulation. We aim to share our experience regarding the safety and perioperative management of video-assisted thoracic surgery for this specific population. METHODS Retrospective, single-center study between November 2020 and January 2022 at the ICU department of a 1.061-bed tertiary care and VV-ECMO referral center during the COVID-19 pandemic. RESULTS 48 COVID-19 patients were supported with VV-ECMO. A total of 14 video-assisted thoracic surgery (VATS) procedures were performed in seven patients. Indications were mostly hemothorax (85.7%). In eight procedures heparin was stopped at least 1 h before incision. A total of 10 circuit changes due to clot formation or oxygen transfer failure were required in six patients (85.7%). One circuit replacement seemed related to the preceding VATS procedure, although polytransfusion might be a contributing factor. None of the mechanical complications was fatal. Four VATS-patients (57.1%) died, of which two (50%) immediately perioperatively due to uncontrollable bleeding. All three survivors were treated with additional transarterial embolization. CONCLUSION (1) Thoracic complications in COVID-19 patients on VV-ECMO are common. (2) Indication for VATS is mostly hemothorax (3) Perioperative mortality is high, mostly due to uncontrollable bleeding. (4) Preoperative withdrawal of anticoagulation is not directly related to a higher rate of ECMO circuit-related complications, but a prolonged duration of VV-ECMO support and polytransfusion might be. (5) Additional transarterial embolization to control postoperative bleeding may further improve outcomes.
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Affiliation(s)
- Bert Zwaenepoel
- Department of Cardiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Korneel Vandewiele
- Department of Perfusion, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Harlinde Peperstraete
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frederic De Ryck
- Department of Thoracic and Vascular
Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Caroline Vanpeteghem
- Department of Anesthesiology, Ghent
University Hospital, Ghent University, Ghent, Belgium
| | - Thomas Malfait
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ingrid Herck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Wim Vandenberghe
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Lien Van Laethem
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Luc Defreyne
- Department of Interventional
Radiology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Eva Van Braeckel
- Department of Respiratory Medicine,
Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter Depuydt
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
- Department of Internal Medicine and
Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Hannah Schaubroeck
- Department of Intensive Care
Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
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Vandenberghe W, Van Laethem L, Herck I, Peperstraete H, Schaubroeck H, Zarbock A, Meersch M, Dhondt A, Delanghe S, Vanmassenhove J, De Waele JJ, Hoste EAJ. Prediction of cardiac surgery associated - acute kidney injury (CSA-AKI) by healthcare professionals and urine cell cycle arrest AKI biomarkers [TIMP-2]*[IGFBP7]: A single center prospective study (the PREDICTAKI trial). J Crit Care 2021; 67:108-117. [PMID: 34741963 DOI: 10.1016/j.jcrc.2021.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Cardiac surgery associated acute kidney injury (CSA-AKI) is a contributor to adverse outcomes. Preventive measures reduce AKI incidence in high risk patients, identified by biomarkers [TIMP-2]*[IGFBP7] (Nephrocheck®). This study investigate clinical AKI risk assessment by healthcare professionals and the added value of the biomarker result. MATERIALS AND METHODS Adult patients were prospectively included. Healthcare professionals predicted CSA-AKI, with and without biomarker result knowledge. Predicted outcomes were AKI based on creatinine, AKI stage 3 on urine output, anuria and use of kidney replacement therapy (KRT). RESULTS One-hundred patients were included. Consultant and ICU residents were best in AKI prediction, respectively AUROC 0.769 (95% CI, 0.672-0.850) and 0.702 (95% CI, 0.599-0.791). AUROC of NephroCheck® was 0.541 (95% CI, 0.438-0.642). AKI 3 occurred in only 4 patients; there was no anuria or use of KRT. ICU nurses and ICU residents had an AUROC for prediction of AKI 3 of respectively 0.867 (95% CI, 0.780-0.929) and 0.809 (95% CI, 0.716-0.883); for NephroCheck® this was 0.838 (95% CI, 0.750-0.904). CONCLUSIONS Healthcare professionals performed poor or fair in predicting CSA-AKI and knowledge of Nephrocheck® result did not improved prediction. No conclusions could be made for prediction of severe AKI, due to limited number of events.
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Affiliation(s)
- Wim Vandenberghe
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.
| | - Lien Van Laethem
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ingrid Herck
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Harlinde Peperstraete
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hannah Schaubroeck
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive care and Pain Medicine, Muenster University Hospital, Muenster, Germany
| | - Melanie Meersch
- Department of Anaesthesiology, Intensive care and Pain Medicine, Muenster University Hospital, Muenster, Germany
| | - Annemieke Dhondt
- Department of Nephrology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Sigurd Delanghe
- Department of Nephrology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Jill Vanmassenhove
- Department of Nephrology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Eric A J Hoste
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
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