|
1
|
Lu S, Zhang Y, Wei S, Li J, Li M, Ying J, Mu D, Shi Y, Li Y, Wu X. Extracorporeal membrane oxygenation in pregnancy and the post-partum period: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2025; 38:2457002. [PMID: 39880582 DOI: 10.1080/14767058.2025.2457002] [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: 09/04/2024] [Revised: 01/10/2025] [Accepted: 01/15/2025] [Indexed: 01/31/2025]
Abstract
OBJECTIVE There is an increase in the application data of Extracorporeal Membrane Oxygenation (ECMO) in perinatal women, particularly since the outbreak of coronavirus disease 2019. Therefore, we reviewed publications on the use of ECMO in pregnant and postpartum women and analyzed the maternal and fetal outcomes, updated the progress of ECMO in perinatal women. METHODS We conducted a systematic literature search across PubMed, EMBASE, Cochrane Library, and the International Clinical Trials Registry (ICTRP), yielding 30 eligible clinical studies that investigated the application of ECMO during pregnancy. A comprehensive data extraction process was implemented to retrieve information from these selected studies. A single rate analysis on material survival, material harmonic compilations, and fetus survival were performed by R software. RESULTS Of the 1460 women included, our primary outcome was maternal survival: 74.4% (95% confidence interval [CI]: 67.8%-81.1%). Among them, the survival rate of VV ECMO patients was 83.6% (95% confidence interval [CI]: 76.4%-90.8%); the survival rate of VA ECMO patients was 62.8% (95% confidence interval [CI]: 48.7%-76.8%). The secondary outcomes were maternal hemorrhagic complications: 34.8% (95% [CI]: 24.1%-45.5%), and fetal survival: 73.2% (95% [CI]: 62.0%-84.4%). CONCLUSIONS Our analysis revealed that the outcomes of ECMO (both type) use in pregnant patients may be comparable or superior to those observed in non-pregnant cohorts. Moreover, patients treated with VV ECMO exhibited a significantly higher survival rate compared to those on VA ECMO. DETAILS OF REGISTRATION The protocol for this systematic review was registered on INPLASY (2022110036) in 11 November 2022.
Collapse
Affiliation(s)
- Sijie Lu
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Yantao Zhang
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Shilin Wei
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Jian Li
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Mingming Li
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Junjie Ying
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dezhi Mu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yujun Shi
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiangyang Wu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| |
Collapse
|
|
2
|
Morrison LJ, Hunt EA, Grunau B, Aufderheide TP, Callaway C, Tonna JE, Sasson C, Blewer A, McNally BF, Yannopoulos D, Belohlavek J, Bartos J, Combes A, Idris A, Merchant RM, States L, Tinsley E, Wong R, Youngquist ST, Sopko G, Kern KB. International Consensus on Evidence Gaps and Research Opportunities in Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: A Report From the National Heart, Lung, and Blood Institute Workshop. J Am Heart Assoc 2025; 14:e036108. [PMID: 40040619 DOI: 10.1161/jaha.124.036108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
The increased accessibility of extracorporeal membrane oxygenation following the COVID-19 pandemic and the publication of the first randomized trial of extracorporeal cardiopulmonary resuscitation (ECPR) prompted the National Heart, Lung, and Blood Institute to sponsor a workshop on ECPR. Two more randomized trials have since been published in 2022 and 2023. Based on the combined findings and review of the evidence, an international panel of authors identified gaps in science, inequities in care and diversity in outcomes, and suggested research opportunities and next steps. The science pertaining to ECPR would benefit from the United States contributing uniform data to existing registries and sharing common data with the ELSO (Extracorporeal Life Support Organization) international registry to increase the sample size for observational research. In addition, well-designed efficacy trials, recruiting across different regions of care evaluating long-term follow-up, including patient reported outcomes, cost effectiveness, and equity measures, would contribute significantly to the body of science. Workshop participants defined the population of patients with out-of-hospital cardiac arrest most likely to benefit from ECPR. ECPR-eligible patients include those aged 18 to 75 years functioning independently without comorbidity; before suffering a witnessed out-of-hospital cardiac arrest and without any obvious cause of the cardiac arrest; presenting in a shockable rhythm and transported with mechanical cardiopulmonary resuscitation to an ECPR-capable institute within 30 minutes, which is recommended after 3 rounds of advanced life support treatment without return of spontaneous circulation. There are significant inequities in out-of-hospital cardiac arrest care that need to be addressed such that outcomes are optimized for each target region before implementing ECPR in a clinical or implementation trial.
Collapse
Affiliation(s)
- Laurie J Morrison
- Emergency Medicine, Medicine University of Toronto, Emergency Services, Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Elizabeth A Hunt
- Anesthesiology & Critical Care Medicine and Pediatrics Johns Hopkins University School of Medicine Baltimore MD USA
| | - Brian Grunau
- Department of Emergency Medicine St. Paul's Hospital, and the University of British Columbia (BC), Centre for Advancing Health Outcomes Vancouver BC Canada
| | | | | | - Joseph E Tonna
- Cardiothoracic Critical Care, Division of Cardiothoracic Surgery and Department of Surgery and Department of Emergency Medicine University of Utah Health Salt Lake City UT USA
| | | | - Audrey Blewer
- Department of Family Medicine and Community Health and Population Health Sciences Duke University School of Medicine Durham NC USA
| | | | - Demetris Yannopoulos
- Cardiology University of Minnesota, Minnesota Resuscitation Consortium Minneapolis MN USA
| | - Jan Belohlavek
- Department of Internal Medicine II, Cardiovascular Medicine General University Hospital and 1st Medical School, Charles University Prague Czech Republic
| | - Jason Bartos
- Cardiology University of Minnesota, Minnesota Resuscitation Consortium Minneapolis MN USA
| | - Alain Combes
- Intensive Care Medicine Sorbonne Université, APHP, La Pitié-Salpêtrière Hospital Paris France
| | - Ahamed Idris
- Surgery and Emergency Medicine University of Texas Southwestern Dallas TX USA
| | - Raina M Merchant
- Emergency Medicine, Anesthesiology and Critical Care, Center for Digital Health University of Pennsylvania Philadelphia PA USA
| | - Leith States
- Office of Science and Medicine Office of the Assistant Secretary for Health (OASH) Washington DC USA
| | - Emily Tinsley
- Division of Cardiovascular Sciences NHLBI, NIH Bethesda MD USA
| | - Renee Wong
- Division of Cardiovascular Sciences NHLBI, NIH Bethesda MD USA
| | - Scott T Youngquist
- Emergency Medicine University of Utah Medical Center Salt Lake City UT USA
| | - George Sopko
- Division of Cardiovascular Sciences NHLBI, NIH Bethesda MD USA
| | - Karl B Kern
- Cardiology, Sarver Heart Center University of Arizona Tucson AZ USA
| |
Collapse
|
|
3
|
Hu F, Yang H, Qiu L, Wei S, Hu H, Zhou H. Spatial structure and organization of the medical device industry urban network in China: evidence from specialized, refined, distinctive, and innovative firms. Front Public Health 2025; 13:1518327. [PMID: 40161027 PMCID: PMC11949875 DOI: 10.3389/fpubh.2025.1518327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/21/2025] [Indexed: 04/02/2025] Open
Abstract
Introduction Investigating the network of firms in a specific industry helps explain industrial location and urban functions and provides guidelines for promoting industrial restructuring and high-quality development. Methods This study develops a network model for the relationship between firms and cities based on the data of listed Specialized, Refined, Distinctive, and Innovative (SRDI) medical device manufacturing firms in China to identify the spatial distribution and influencing factors of the urban network of such firms using network analysis and GeoDetector. Results and disscusion Three conclusions are obtained from the study. First, the urban network of listed SRDI medical device manufacturing firms exhibits a sparse structure, with the density decreasing from east to west, and the out-degree presenting significant spatial concentration. Suzhou, Shanghai, and Shenzhen are the core of the network power. The in-degree presents low spatial concentration. Clearly differentiated network functions are observed. Second, significant spatial differences are noted between high- and low-level linkage networks from the perspective of corporate governance structure. Third, economic level, labour costs, level of opening-up, talent base, and technological innovation capability have significant effects on the urban network of listed SRDI medical device manufacturing firms.
Collapse
Affiliation(s)
- Feng Hu
- Institute of International Business & Economics Innovation and Governance, Shanghai University of International Business and Economics, Shanghai, China
| | - Huijie Yang
- International Business School, Shanghai University of International Business and Economics, Shanghai, China
| | - Liping Qiu
- CEEC Economic and Trade Cooperation Institute, Ningbo University, Ningbo, China
| | - Shaobin Wei
- Institute of Digital Economy and Financial Powerhouse Building, Guangdong University of Finance, Guangzhou, China
| | - Hao Hu
- School of Economics, Shanghai University, Shanghai, China
| | - Haiyan Zhou
- Graduate School, Nueva Ecija University of Science and Technology, Cabanatuan, Philippines
| |
Collapse
|
|
4
|
Lilly D, Patel AA, Davison MA, Kashkoush A, Shost M, Moore N, Kshettry VR, Bain M. Neurological Outcomes Following Craniotomy for Extracorporeal Membrane Oxygenation-Associated Intracranial Hemorrhage: Case Series and Literature Review. World Neurosurg 2024; 190:e478-e487. [PMID: 39074583 DOI: 10.1016/j.wneu.2024.07.160] [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: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Intracranial hemorrhage (ICH) is a potential complication associated with extracorporeal membrane oxygenation (ECMO), which has been increasingly utilized in recent years. A paucity of data exists describing patient outcomes following invasive neurosurgical interventions in patients receiving ECMO therapy. The purpose of this study was to assess the clinical and functional outcomes in patients who underwent cranial neurosurgery for the management of an ECMO-associated intracranial complication. METHODS This was a single-institution retrospective review of adult patients who underwent craniotomy or craniectomy after sustaining an intracranial hemorrhagic complication of ECMO therapy from 2008 to 2023. Anticoagulation status, operative indication, surgical details, postoperative course, and functional outcome were recorded. A systematic review of the prior literature was performed to contextualize our institutional results within previous reports. RESULTS Four adult patients were identified at our institution who underwent craniotomy or craniectomy for the neurosurgical management of an ECMO-associated ICH. One patient (25%) ultimately made a satisfactory recovery (Modified Rankin Scale score 3 at 1 year). The surviving patient had a notably higher Glasgow Coma Scale (7T vs. 3T), had not received anticoagulation at the time of surgery, and did not experience postoperative reaccumulation or expansion of their hemorrhage, distinguishing factors from the other 3 included. Review of the existing literature identified 15 adult patients who underwent craniotomy while receiving ECMO therapy, of which 4 (26.7%) had a long-term favorable neurologic outcome. CONCLUSIONS The overall prognosis following neurosurgical intervention for the management of ECMO-associated intracranial complications was poor in our case series, which was corroborated by our literature review.
Collapse
Affiliation(s)
- Daniel Lilly
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.
| | - Arpan A Patel
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark A Davison
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Ahmed Kashkoush
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Michael Shost
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nina Moore
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Varun R Kshettry
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
|
5
|
Shah P, Miller C, Parilla G, Daneshmand M, Creel-Bulos C. Outcomes associated with prolonged ECMO in COVID-19 associated ARDS: A single center experience. Perfusion 2024; 39:1213-1221. [PMID: 37970730 DOI: 10.1177/02676591231184710] [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: 11/17/2023]
Abstract
PURPOSE OF STUDY The COVID-19 pandemic has led to a significant increase in the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a bridge to transplantation versus recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of V-V ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. METHODS Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-transplant free survival, mortality and discharge rates-of patients requiring V-V ECMO support for greater than 50 days. RESULTS The median age of the cohort was 48 years and 13 patients (72%) were males. The median duration of ECMO support was 84 days (IQR 55-106). 11 patients (61%) had right ventricular dysfunction and 13 patients (72%) had pneumothoraces. There was a 33% percent (n = 6) mortality rate within cohort. One patient continues to require ECMO support at time of abstract submission. 11 patients (61%) patients were discharged, of which 3 patients required a lung transplant. SUMMARY Prolonged V-V ECMO can be associated with comparable outcomes to conventional V-V ECMO runs that are relatively shorter in duration. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population.
Collapse
Affiliation(s)
- Purav Shah
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, McKelvey Lung Transplant Center, Emory University School of Medicine, Atlanta, USA
| | - Casey Miller
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Gustavo Parilla
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Mani Daneshmand
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Christina Creel-Bulos
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA
| |
Collapse
|
|
6
|
Ning Y, He L, Pan K, Zhang W, Luo J, Chen Y, Mei Z, Wang D. Predictors associated with successful weaning of veno-venous extracorporeal membrane oxygenation and mortality in adult patients with severe acute lung failure: Protocol of a pooled data analysis of cohort studies. PLoS One 2024; 19:e0303282. [PMID: 38758742 PMCID: PMC11101029 DOI: 10.1371/journal.pone.0303282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/20/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Severe acute lung failure (ALF) often necessitates veno-venous extracorporeal membrane oxygenation (VV-ECMO), where identifying predictors of weaning success and mortality remains crucial yet challenging. The study aims to identify predictors of weaning success and mortality in adults undergoing VV-ECMO for severe ALF, a gap in current clinical knowledge. METHODS AND ANALYSIS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials will be searched for cohort studies examining the predictive factors of successful weaning and mortality in adult patients on VV-ECMO due to severe ALF. Risk of bias assessment will be conducted using the Newcastle-Ottawa scale for each included study. The primary outcomes will be successful weaning from VV-ECMO and all-cause mortality. Between-study heterogeneity will be evaluated using the I2 statistic. Sensitivity, subgroup, and meta-regression analyses will be performed to ascertain potential sources of heterogeneity and assess the robustness of our results. We will use the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool to recommend the level of evidence. DISCUSSION This study seeks to provide clinically significant insights into predictors for weaning and mortality during VV-ECMO treatment for ALF, aiming to support clinical decisions and potentially influence health policy, thereby improving patient outcomes. ETHICS AND DISSEMINATION Given the absence of direct engagement with human subjects or access to personal medical records, ethical approval for this study is deemed unnecessary. The study findings will be shared at a scientific conference either at the global or national level. Alternatively, the results will be presented for publication in a rigorously peer-reviewed journal regarding critical care medicine.
Collapse
Affiliation(s)
- Yaxin Ning
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Linya He
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Keqi Pan
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
| | - Weiwen Zhang
- Department of Critical Care Medicine, Quzhou People’s Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China
| | - Jian Luo
- Department of Critical Care Medicine, Quzhou People’s Hospital, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou, China
| | - Yan Chen
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zubing Mei
- Department of Anorectal Surgery, Anorectal Disease Institute of Shuguang Hospital, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Danqiong Wang
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
| |
Collapse
|
|
7
|
Milaković D, Kovačević T, Kovačević P, Barišić V, Avram S, Dragić S, Zlojutro B, Momčičević D, Miljković B, Vučićević K. Population Pharmacokinetic Model of Linezolid and Probability of Target Attainment in Patients with COVID-19-Associated Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation-A Step toward Correct Dosing. Pharmaceutics 2024; 16:253. [PMID: 38399307 PMCID: PMC10892643 DOI: 10.3390/pharmaceutics16020253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
During veno-venous extracorporeal membrane oxygenation (vv ECMO) therapy, antimicrobial drugs are frequently used, and appropriate dosing is challenging due to there being limited data to support the dosage. Linezolid is effective against multidrug-resistant Gram-positive pathogens frequently isolated in ECMO patients. In total, 53 steady-state linezolid levels were obtained following 600 mg intravenous (IV) injections every 8 h, and these were used to develop a population pharmacokinetic (PopPK) model in patients with COVID-19-associated acute respiratory distress syndrome (CARDS) on vv ECMO. The data were analyzed using a nonlinear mixed-effects modelling approach. Monte Carlo simulation generated 5000 patients' individual PK parameters and corresponding concentration-time profiles using the PopPK model, following the administration of 600 mg/8 h (a higher-than-standard dosing) and 600 mg/12 h (standard). The probabilities of pharmacokinetic/pharmacodynamic (PK/PD) target attainment (PTA) and the cumulative fraction of responses (CFR) for three pathogens were calculated and compared between the two dosing scenarios. Linezolid 600 mg/8 h was predicted to achieve greater than or equal to 85%Tf>MIC in at least 90% of the patients with CARDS on vv ECMO compared to only approximately two thirds of the patients after dosing every 12 h at a minimal inhibitory concentration (MIC) of 2 mg/L. In addition, for the same MIC, fAUC24/MIC ≥ 80 was achieved in almost three times the number of patients following an 8-h versus a 12-h interval. PopPK simulation predicted that a significantly higher proportion of the patients with CARDS on vv ECMO would achieve the PK/PD targets following the 8-h dosing interval compared to standard linezolid dosing. Nevertheless, the safety concern, in particular, for thrombocytopenia, with higher-than-standard linezolid dosage is reasonable, and consequently, monitoring is essential.
Collapse
Affiliation(s)
- Dragana Milaković
- Department of Nuclear Medicine and Thyroid Gland Diseases, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Tijana Kovačević
- Pharmacy Department, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
| | - Pedja Kovačević
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Vedrana Barišić
- Pharmacy Department, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Sanja Avram
- Institute of Laboratory Diagnostic, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Saša Dragić
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Biljana Zlojutro
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Danica Momčičević
- Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina; (P.K.)
- Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina
| | - Branislava Miljković
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade-Faculty of Pharmacy, 11221 Belgrade, Serbia
| | - Katarina Vučićević
- Department of Pharmacokinetics and Clinical Pharmacy, University of Belgrade-Faculty of Pharmacy, 11221 Belgrade, Serbia
| |
Collapse
|
|
8
|
Stammers AH, Tesdahl EA, Sestokas AK, Mongero LB, Patel K, Barletti S, Firstenberg MS, St. Louis JD, Jain A, Bailey C, Jacobs JP, Weinstein S. Variation in outcomes with extracorporeal membrane oxygenation in the era of coronavirus: A multicenter cohort evaluation. Perfusion 2023; 38:1501-1510. [PMID: 35943298 PMCID: PMC9364073 DOI: 10.1177/02676591221118321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients with coronavirus disease 2019 (COVID-19) with acute respiratory distress syndrome unresponsive to other interventions. However, a COVID-19 infection may result in a differential tolerance to both medical treatment and ECMO management. The aim of this study was to compare outcomes (mortality, organ failure, circuit complications) in patients on ECMO with and without COVID-19 infection, either by venovenous (VV) or venoarterial (VA) cannulation. This is a multicenter, retrospective analysis of a national database of patients placed on ECMO between May 2020 and January 2022 within the United States. Nine-hundred thirty patients were classified as either Pulmonary (PULM, n = 206), Cardiac (CARD, n = 279) or COVID-19 (COVID, n = 445). Patients were younger in COVID groups: PULM = 48.4 ± 15.8 years versus COVID = 44.9 ± 12.3 years, p = 0.006, and CARD = 57.9 ± 15.4 versus COVID = 46.5 ± 11.8 years, p < 0.001. Total hours on ECMO were greatest for COVID patients with a median support time two-times higher for VV support (365 [101, 657] hours vs 183 [63, 361], p < 0.001), and three times longer for VA support (212 [99, 566] hours vs 70 [17, 159], p < 0.001). Mortality was highest for COVID patients for both cannulation types (VA-70% vs 51% in CARD, p = 0.041, and VV-59% vs PULM-42%, p < 0.001). For VA supported patients hepatic failure was more often seen with COVID patients, while for VV support renal failure was higher. Circuit complications were more frequent in the COVID group as compared to both CARD and PULM with significantly higher circuit change-outs, circuit thromboses and oxygenator failures. Anticoagulation with direct thrombin inhibitors was used more often in COVID compared to both CARD (31% vs 10%, p = 0.002) and PULM (43% vs 15%, p < 0.001) groups. This multicenter observational study has shown that COVID patients on ECMO had higher support times, greater hospital mortality and higher circuit complications, when compared to patients managed for either cardiac or pulmonary lesions.
Collapse
Affiliation(s)
| | | | | | | | - Kirti Patel
- Medical Department, SpecialtyCare, Brentwood, TN, USA
| | - Shannon Barletti
- Perfusion Department, Thomas Jefferson University
Hospital, Philadelphia, PA, USA
| | | | | | - Ankit Jain
- Department of Anesthesiology and
Perioperative Medicine, Medical College of
Georgia, Augusta, GA, USA
| | - Caryl Bailey
- Department of Anesthesiology and
Perioperative Medicine, Medical College of
Georgia, Augusta, GA, USA
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division
of Cardiovascular Surgery, University of Florida, Gainesville, FL, USA
| | | |
Collapse
|
|
9
|
Mang S, Reichert L, Muellenbach RM, Riesner J, Lotz C, Supady A, Mutlak H, Bals R, Rixecker TM, Becker AP, Leitner M, Zeiner C, Danziger G, Meybohm P, Seiler F, Lepper PM. Transfer of Veno-venous Extracorporeal Membrane Oxygenation Patients With COVID-19 Associated Acute Respiratory Distress Syndrome. ASAIO J 2023; 69:789-794. [PMID: 37146598 PMCID: PMC10627394 DOI: 10.1097/mat.0000000000001954] [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: 05/07/2023] Open
Abstract
Interhospital transport of acute respiratory distress syndrome (ARDS) patients bears transport-associated risks. It is unknown how interhospital extracorporeal membrane oxygenation (ECMO) transfer of COVID-19 patients by mobile ECMO units affects ARDS mortality. We compared the outcome of 94 COVID-19 patients cannulated in primary care hospitals and retrieved by mobile ECMO-teams to that of 84 patients cannulated at five German ECMO centers. Patients were recruited from March 2020 to November 2021. Twenty-six transports were airborne, 68 were land-based. Age, sex, body-mass-index, Simplified Acute Physiology Score (SAPS) II, days invasively ventilated, and P/F-Ratio before ECMO initiation were similar in both groups. Counting only regional transports (≤250 km), mean transport distance was 139.5 km ± 17.7 km for helicopter (duration 52.5 ± 10.6 minutes) and 69.8 km ± 44.1 km for ambulance or mobile intensive care unit (duration 57.6 ± 29.4 minutes). Overall time of vvECMO support (20.4 ± 15.2 ECMO days for transported patients vs. 21.0 ± 20.5 for control, p = 0.83) and days invasively ventilated (27.9 ± 18.1 days vs. 32.6 ± 25.1 days, p = 0.16) were similar. Overall mortality did not differ between transported patients and controls (57/94 [61%] vs. 51/83 [61%], p = 0.43). COVID-19 patients cannulated and retrieved by mobile ECMO-teams have no excess risk compared with patients receiving vvECMO at experienced ECMO centers. Patients with COVID-19-associated ARDS, limited comorbidities, and no contraindication for ECMO should be referred early to local ECMO centers.
Collapse
Affiliation(s)
- Sebastian Mang
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Lena Reichert
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Ralf M. Muellenbach
- Department of Anesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Jonathan Riesner
- Department of Anesthesiology and Critical Care Medicine, Campus Kassel of the University of Southampton, Kassel, Germany
| | - Christopher Lotz
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Alexander Supady
- Department of Internal medicine, Cardiology, Intensive Care and Emergency Medicine, University Hospital Freiburg, Freiburg, Germany
| | - Haitham Mutlak
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Sana Klinikum Offenbach, Offenbach, Germany
| | - Robert Bals
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Torben M. Rixecker
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - André P. Becker
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Maximilian Leitner
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Carsten Zeiner
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Guy Danziger
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Patrick Meybohm
- Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Frederik Seiler
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| | - Philipp M. Lepper
- From the Interdisciplinary COVID-19-Center, University Medical Centre, Saarland University, Homburg/Saar, Germany
- Department of Internal Medicine V—Pneumology, Allergology, Critical Care and ECMO/ECLS Center Saar, University Medical Centre, Saarland University, Homburg/Saar, Germany
| |
Collapse
|
|
10
|
Khanduja S, Kim J, Kang JK, Feng CY, Vogelsong MA, Geocadin RG, Whitman G, Cho SM. Hypoxic-Ischemic Brain Injury in ECMO: Pathophysiology, Neuromonitoring, and Therapeutic Opportunities. Cells 2023; 12:1546. [PMID: 37296666 PMCID: PMC10252448 DOI: 10.3390/cells12111546] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO), in conjunction with its life-saving benefits, carries a significant risk of acute brain injury (ABI). Hypoxic-ischemic brain injury (HIBI) is one of the most common types of ABI in ECMO patients. Various risk factors, such as history of hypertension, high day 1 lactate level, low pH, cannulation technique, large peri-cannulation PaCO2 drop (∆PaCO2), and early low pulse pressure, have been associated with the development of HIBI in ECMO patients. The pathogenic mechanisms of HIBI in ECMO are complex and multifactorial, attributing to the underlying pathology requiring initiation of ECMO and the risk of HIBI associated with ECMO itself. HIBI is likely to occur in the peri-cannulation or peri-decannulation time secondary to underlying refractory cardiopulmonary failure before or after ECMO. Current therapeutics target pathological mechanisms, cerebral hypoxia and ischemia, by employing targeted temperature management in the case of extracorporeal cardiopulmonary resuscitation (eCPR), and optimizing cerebral O2 saturations and cerebral perfusion. This review describes the pathophysiology, neuromonitoring, and therapeutic techniques to improve neurological outcomes in ECMO patients in order to prevent and minimize the morbidity of HIBI. Further studies aimed at standardizing the most relevant neuromonitoring techniques, optimizing cerebral perfusion, and minimizing the severity of HIBI once it occurs will improve long-term neurological outcomes in ECMO patients.
Collapse
Affiliation(s)
- Shivalika Khanduja
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
| | - Jiah Kim
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.K.); (C.-Y.F.)
| | - Jin Kook Kang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
| | - Cheng-Yuan Feng
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.K.); (C.-Y.F.)
| | - Melissa Ann Vogelsong
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
| | - Romergryko G. Geocadin
- Divisions of Neurosciences Critical Care, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| | - Glenn Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.K.); (J.K.K.); (G.W.)
- Divisions of Neurosciences Critical Care, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA;
| |
Collapse
|
|
11
|
Pollack BE, Kirsch R, Chapman R, Hyslop R, MacLaren G, Barbaro RP. Extracorporeal Membrane Oxygenation Then and Now; Broadening Indications and Availability. Crit Care Clin 2023; 39:255-275. [PMID: 36898772 DOI: 10.1016/j.ccc.2022.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life support technology provided to children to support respiratory failure, cardiac failure, or cardiopulmonary resuscitation after failure of conventional management. Over the decades, ECMO has expanded in use, advanced in technology, shifted from experimental to a standard of care, and evidence supporting its use has increased. The expanded ECMO indications and medical complexity of children have also necessitated focused studies in the ethical domain such as decisional authority, resource allocation, and equitable access.
Collapse
Affiliation(s)
- Blythe E Pollack
- Division of Pediatric Critical Care, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Roxanne Kirsch
- Division Cardiac Critical Care, Department Critical Care Medicine, 555 Univeristy Avenue, Toronto, ON, Canada M5G 1X8; Department of Bioethics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1XB
| | - Rachel Chapman
- Department of Pediatrics, Division of Neonatology and the Fetal and Neonatal Institute, Children's Hospital, 4650 Sunset Blvd., Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Robert Hyslop
- Heart Institute, Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80045, USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Ryan P Barbaro
- Division of Pediatric Critical Care, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA; Susan B. Miester Child Health Evaluation and Research Center, Univeristy of Michigan, NCRC Building 16, 2800 Plymouth Road, Ann Arbor, MI 48109, USA
| |
Collapse
|
|
12
|
Hong L, Hou C, Chen L, Huang X, Huang J, Liu W, Shen X. Developing a competency framework for extracorporeal membrane oxygenation nurses: A qualitative study. Nurs Open 2023; 10:2449-2463. [PMID: 36463394 PMCID: PMC10006586 DOI: 10.1002/nop2.1502] [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: 06/22/2022] [Revised: 10/22/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
AIM To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses. DESIGN A qualitative study was performed following the consolidated criteria for reporting qualitative research. METHODS Semi-structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well-known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022. RESULTS A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items. RELEVANCE TO CLINICAL PRACTICE This framework can be a reference for the assessment and training of ECMO nurses.
Collapse
Affiliation(s)
- Liwei Hong
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Chunyi Hou
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Lihua Chen
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiaoqun Huang
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Jingye Huang
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Weijuan Liu
- Department of PediatricsFirst Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Xiangxiang Shen
- Department of Critical Care MedicineGuangzhou Institute of Respiratory Health First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| |
Collapse
|
|
13
|
Siddiqui S, Lutz G, Tabatabai A, Nathan R, Anders M, Gibbons M, Russo M, Whitehead S, Rock P, Scalea T, Kheirbek RE. Early Guided Palliative Care Communication for Patients With COVID-19 Receiving ECMO. Am J Crit Care 2023; 32:166-174. [PMID: 36775881 DOI: 10.4037/ajcc2023184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) combined with COVID-19 presents challenges (eg, isolation, anticipatory grief) for patients and families. OBJECTIVE To (1) describe characteristics and outcomes of patients with COVID-19 receiving ECMO, (2) develop a practice improvement strategy to implement early, semistructured palliative care communication in ECMO acknowledgment meetings with patients' families, and (3) examine family members' experiences as recorded in clinicians' notes during these meetings. METHODS Descriptive observation of guided, in-depth meetings with families of patients with COVID-19 receiving ECMO, as gathered from the electronic medical record of a large urban academic medical center. Most meetings were held within 3 days of initiation of ECMO. RESULTS Forty-three patients received ECMO between March and October 2020. The mean patient age was 44 years; 63% of patients were Hispanic/Latino, 19% were Black, and 7% were White. Documentation of the ECMO acknowledgment meeting was completed for 60% of patients. Fifty-six percent of patients survived to hospital discharge. Family discussions revealed 7 common themes: hope, reliance on faith, multiple family members with COVID-19, helping children adjust to a new normal, visitation restrictions, gratitude for clinicians and care, and end-of-life discussions. CONCLUSION Early and ongoing provision of palliative care is feasible and useful for highlighting a range of experiences related to COVID-19. Palliative care is also useful for educating patients and families on the benefits and limitations of ECMO therapy.
Collapse
Affiliation(s)
- Safanah Siddiqui
- Safanah Siddiqui is a fellow, Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston
| | - Gabriel Lutz
- Gabriel Lutz is an assistant professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine, Baltimore
| | - Ali Tabatabai
- Ali Tabatabai is an adjunct associate professor, Department of Medicine, Division of Education, University of Maryland School of Medicine
| | - Rachel Nathan
- Rachel Nathan is an assistant professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine
| | - Megan Anders
- Megan Anders is an associate professor, Department of Anesthesiology, University of Maryland School of Medicine
| | - Miranda Gibbons
- Miranda Gibbons is a clinical systems analyst, Department of Anesthesiology, University of Maryland School of Medicine
| | - Marguerite Russo
- Marguerite Russo is a nurse practitioner, University of Maryland Medical Center, and an adjunct associate professor, University of Maryland School of Nursing, Baltimore
| | - Sarah Whitehead
- Sarah Whitehead is a nurse practitioner, University of Maryland Medical Center
| | - Peter Rock
- Peter Rock is a professor, Department of Anesthesiology, University of Maryland School of Medicine
| | - Thomas Scalea
- Thomas Scalea is a professor, Department of Surgery, University of Maryland School of Medicine, and director of the R. Adams Cowley Shock Trauma Center, Baltimore
| | - Raya E Kheirbek
- Raya E. Kheirbek is a professor, Department of Medicine, Division of Palliative Medicine, University of Maryland School of Medicine
| |
Collapse
|
|
14
|
Wei S, Cheng X, Li J, Zhai K, Huang J, Wang S, Li Y, Liu D. Venoarterial extracorporeal membrane oxygenation improves survival in a rat model of acute myocardial infarction. Artif Organs 2023. [PMID: 36638047 DOI: 10.1111/aor.14499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/10/2022] [Accepted: 03/09/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used in high-risk acute myocardial infarction (AMI) patients with promising outcomes. However, the underlying molecular mechanisms remain unknown and a VA-ECMO animal model has not yet been established. The purpose of this study was to establish a VA-ECMO model in AMI rats and evaluate long-term cardiac function. METHODS We first established AMI in 20 Sprague-Dawley (SD) rats by ligating the left anterior descending coronary artery, while five rats underwent a thoracotomy to form the sham group. VA-ECMO was established after 30mins of AMI in 10 rats through the right jugular vein for venous drainage and right femoral artery for arterial infusion. Arterial blood pressure was monitored using a catheter in the left femoral artery, blood gas parameters were measured using a blood gas analyzer, while myocardial enzymes were detected using an ELISA Kit. Cardiac function was assessed through echocardiography on day 15. Masson staining and Western Blot were used for evaluating myocardial fibrosis, while histological injury was evaluated using hematoxylin and eosin staining. RESULTS VA-ECMO support stabilized blood pressure, decreased the levels of myocardial enzymes including cTnI, cTnT, CK-MB, and was associated with a higher survival rate. In the long term, the VA-ECMO group showed improved cardiac function, significantly increased EF and FS but significantly decreased EDV and ESV compared to the AMI group. Furthermore, VA-ECMO significantly alleviated pathological damage and myocardial fibrosis. CONCLUSION We established an economical, reliable, and reproducible VA-ECMO animal model in AMI rats, and demonstrated that VA-ECMO support prevents deteriorated cardiac function.
Collapse
Affiliation(s)
- Shilin Wei
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xingdong Cheng
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Jian Li
- Cuiying Biomedical Research Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Kerong Zhai
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Jian Huang
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Shixiong Wang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yongnan Li
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.,Cuiying Biomedical Research Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Debin Liu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| |
Collapse
|
|
15
|
Gopal PB, Sivapurapu V, Nag DS, Bhatia N, Tandon R, Bhavar T. Recent advances in critical care: Part II. Indian J Anaesth 2023; 67:110-116. [PMID: 36970480 PMCID: PMC10034943 DOI: 10.4103/ija.ija_1006_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/01/2023] [Accepted: 01/01/2023] [Indexed: 01/21/2023] Open
Abstract
With the increasing number of critically ill patients being admitted to intensive care units (ICUs), newer techniques and treatment modalities continue to evolve for their adequate management. Thus, it has become imperative to understand existing tools and resources, and utilise or repurpose them to achieve better results that can decrease morbidity and mortality. In this writeup, we chose five areas of interest, including analgosedation, role of colloids, recent advancements in the management of respiratory failure, the role of extracorporeal membrane oxygenation, and newer antimicrobials. The role of analgosedation in the critically ill has gained importance with focus on post-ICU syndromes, and albumin has re-entered the fray as a possible repairer of the injured glycocalyx. The coronavirus disease 2019 (COVID-19) pandemic forced us to relook at various ventilator strategies and mechanical support for the failing circulation has now become more common with clear end-points. Rising microbial antibiotic resistance has opened up the research on newer antibiotics.
Collapse
Affiliation(s)
- Palepu B. Gopal
- Department of Critical Care Medicine, Citizens Specialty Hospitals, Hyderabad, Telangana, India
| | - Vijayalakshmi Sivapurapu
- Department of Anaesthesiology and Critical Care, Indira Gandhi Medical College and Research Institute, Puducherry, India
| | - Deb Sanjay Nag
- Department of Anaesthesia, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Nidhi Bhatia
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ruchi Tandon
- Department of Emergency Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Tushar Bhavar
- Department of Anaesthesia and Critical Care, DBVPRMC, Loni, Maharashtra, India
| |
Collapse
|
|
16
|
Extracorporeal Membrane Oxygenation Support in COVID-19 Patients: A Propensity Score Analysis. ASAIO J 2022; 68:e224-e229. [PMID: 36368023 DOI: 10.1097/mat.0000000000001829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Revised guidelines clarify indications for extracorporeal membrane oxygenation (ECMO) support in Coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS). Limited data exist to compare clinical outcomes of COVID-19 ARDS patients to non-COVID-19-related ARDS patients when supported with ECMO. An observational propensity-matched study was performed to compare clinical and ECMO-related complications between COVID-19-related ARDS patients (COVID) and non-COVID-19-related ARDS (Control). COVID- patients cannulated from March 1st, 2020, through June 1st, 2021, were included and matched to patients from the historical cohort at our center from 2012 to 2020 based on age, body mass index (BMI), acute physiology and chronic health evaluation (APACHE) II score, and duration ECMO run. The primary outcome was complications during ECMO therapy. A total of 56 patients were propensity matched 1:1 with a mean age of 40.9 years, BMI 32.1 kg/m2, APACHE II score of 26.6, and duration of ECMO support of 22.6 days. In total 18 COVID-19 patients were observed to have more major bleeding complications (18 vs. 9, p = 0.03). Although not statistically significant, they also had more strokes (6 vs. 3) and required more chest tubes (13 vs. 8). Inpatient mortality was not different. ECMO support in COVID-19 patients is associated with more major bleeding complications, strokes, and chest tube placements. The use of ECMO in patients with COVID-19-related ARDS appears to be associated with an increased risk of complications.
Collapse
|
|
17
|
Zhou L, Li L, Xiao S, Yang N. Concern for Patient Safety Culture of ECMO Team in Emergency Department: A Cross-Sectional Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221129168. [PMID: 36217754 PMCID: PMC9558865 DOI: 10.1177/00469580221129168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To evaluate the patient safety culture status of the ECMO team in the emergency department of a tertiary care hospital. A cross-sectional survey was conducted in the emergency department of Xiangya Hospital from September 1st to 30th, 2021. The Chinese version of HSOPSC electronic questionnaire was administered to all staff involved in ECMO management and initiation. A total of 152 ECMO team members completed the survey. Among the 12 dimensions of patient safety culture, 4 dimensions recorded relatively high positive response rates (>50%): organizational learning-continuous improvement (87.1%), teamwork within units (86.8%), feedback and communication about errors (58.5%), and supervisor/manager expectations and actions promoting patient safety (55.6%). 8 dimensions recorded relatively low positive response rates (<50%): nonpunitive responses to errors (24.1%), hospital handoffs and transitions (27.1%), staffing (28.6%), the frequency of event reporting (32.4%), teamwork across units (33.2%), communication openness (39.7%), management support for patient safety (48.7%), and overall perceptions of patient safety (49.3%). The overall level of patient safety culture was measured at 47.6%. The ECMO team should immediately address issues of nonpunitive responses to errors, hospital handoffs and transitions, and staffing to improve the safety of ECMO. Going forward, the head of the ECMO team should regard patient safety culture as a top priority, improve staff satisfaction, standardize the transfer and handover process, and create a blame-free environment to facilitate event reporting.
Collapse
Affiliation(s)
| | - Li Li
- Central South University, Changsha,
China
| | | | - Ning Yang
- Central South University, Changsha,
China,Ning Yang, Department of Emergency
Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha,
Hunan 410008, China.
| |
Collapse
|
|
18
|
Prameswari HS, Putra ICS, Raffaello WM, Nathaniel M, Suhendro AS, Khalid AF, Pranata R. Managing Covid-19 in patients with heart failure: current status and future prospects. Expert Rev Cardiovasc Ther 2022; 20:807-828. [PMID: 36185009 DOI: 10.1080/14779072.2022.2132230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/30/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION COVID-19 may contribute to decompensation of previously stable chronic HF or cause a de-novo heart failure, which may come from the hyperinflammatory response and subsequent increase in metabolic demand. AREAS COVERED Two independent investigators searched MEDLINE (via PubMed), Europe PMC, and ScienceDirect databases with the following search terms: COVID-19, heart failure, COVID-19 drugs, heart failure drugs, and device therapy. All of the included full-text articles were rigorously evaluated by both authors in case there was disagreement about whether research should be included or not. In total, 157 studies were included and underwent extensive reading by the authors. EXPERT OPINION The World Health Organization (WHO) and the National Institute of Health (NIH) have published COVID-19 drug recommendations, although recommendations for HF-specific drug choices in COVID-19 are still lacking. We hope that this review can answer the void of comprehensive research data regarding the management options of HF in the COVID-19 condition so that clinicians can at least choose a more beneficial therapy or avoid combination therapies that have a high burden of side effects on HF; thus, morbidity and mortality in COVID-19 patients with HF may be reduced.
Collapse
Affiliation(s)
- Hawani Sasmaya Prameswari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Iwan Cahyo Santosa Putra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | | | - Michael Nathaniel
- School of Medicine and Health Sciences Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Adrian Sebastian Suhendro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Achmad Fitrah Khalid
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
|
19
|
Tanimoto S, Itoh SG, Okumura H. State-of-the-Art Molecular Dynamics Simulation Studies of RNA-Dependent RNA Polymerase of SARS-CoV-2. Int J Mol Sci 2022; 23:ijms231810358. [PMID: 36142270 PMCID: PMC9499461 DOI: 10.3390/ijms231810358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 01/18/2023] Open
Abstract
Molecular dynamics (MD) simulations are powerful theoretical methods that can reveal biomolecular properties, such as structure, fluctuations, and ligand binding, at the level of atomic detail. In this review article, recent MD simulation studies on these biomolecular properties of the RNA-dependent RNA polymerase (RdRp), which is a multidomain protein, of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are presented. Although the tertiary structures of RdRps in SARS-CoV-2 and SARS-CoV are almost identical, the RNA synthesis activity of RdRp of SARS-CoV is higher than SARS-CoV-2. Recent MD simulations observed a difference in the dynamic properties of the two RdRps, which may cause activity differences. RdRp is also a drug target for Coronavirus disease 2019 (COVID-19). Nucleotide analogs, such as remdesivir and favipiravir, are considered to be taken up by RdRp and inhibit RNA replication. Recent MD simulations revealed the recognition mechanism of RdRp for these drug molecules and adenosine triphosphate (ATP). The ligand-recognition ability of RdRp decreases in the order of remdesivir, favipiravir, and ATP. As a typical recognition process, it was found that several lysine residues of RdRp transfer these ligand molecules to the binding site such as a “bucket brigade.” This finding will contribute to understanding the mechanism of the efficient ligand recognition by RdRp. In addition, various simulation studies on the complexes of SARS-CoV-2 RdRp with several nucleotide analogs are reviewed, and the molecular mechanisms by which these compounds inhibit the function of RdRp are discussed. The simulation studies presented in this review will provide useful insights into how nucleotide analogs are recognized by RdRp and inhibit the RNA replication.
Collapse
Affiliation(s)
- Shoichi Tanimoto
- Institute for Molecular Science, National Institutes of Natural Sciences, Okazaki 444-8787, Aichi, Japan
- Exploratory Research Center on Life and Living Systems, National Institutes of Natural Sciences, Okazaki 444-8787, Aichi, Japan
| | - Satoru G. Itoh
- Institute for Molecular Science, National Institutes of Natural Sciences, Okazaki 444-8787, Aichi, Japan
- Exploratory Research Center on Life and Living Systems, National Institutes of Natural Sciences, Okazaki 444-8787, Aichi, Japan
- Department of Structural Molecular Science, SOKENDAI (The Graduate University for Advanced Studies), Okazaki 444-8787, Aichi, Japan
| | - Hisashi Okumura
- Institute for Molecular Science, National Institutes of Natural Sciences, Okazaki 444-8787, Aichi, Japan
- Exploratory Research Center on Life and Living Systems, National Institutes of Natural Sciences, Okazaki 444-8787, Aichi, Japan
- Department of Structural Molecular Science, SOKENDAI (The Graduate University for Advanced Studies), Okazaki 444-8787, Aichi, Japan
- Correspondence:
| |
Collapse
|
|
20
|
|
|
21
|
Linear regression model and least square method for experimental identification of AMBU bag in simple ventilator. INTERNATIONAL JOURNAL OF INTELLIGENT UNMANNED SYSTEMS 2022. [DOI: 10.1108/ijius-07-2021-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PurposeIn the COVID-19 outbreak periods, people's life has been deranged, leading to disrupt the world. Firstly, the number of deaths is growing and has the potential to surpass the highest level at any time. Secondly, the pandemic broke many countries' fortified lines of epidemic prevention and gave people a more honest view of its seriousness. Finally, the pandemic has an impact on life, and the economy led to a shortage in medical, including a lack of clinicians, facilities and medical equipment. One of those, a simple ventilator is a necessary piece of medical equipment since it might be useful for a COVID-19 patient's treatment. In some cases, the COVID-19 patients require to be treated by modern ventilators to reduce lung damage. Therefore, the addition of simple ventilators is a necessity to relieve high work pressure on medical bureaucracies. Some low-income countries aim to build a simple ventilator for primary care and palliative care using locally accessible and low-cost components. One of the simple principles for producing airflow is to squeeze an artificial manual breathing unit (AMBU) iterative with grippers, which imitates the motion of human fingers. Unfortunately, the squeezing angle of grippers is not proportional to the exhaust air volume from the AMBU bag. This paper aims to model the AMBU bag by a mathematical equation that enables to implement on a simple controller to operate a bag-valve-mask (BVM) ventilator with high accuracy performance.Design/methodology/approachThis paper provides a curvature function to estimate the air volume exhausting from the AMBU bag. Since the determination of the curvature function is sophisticated, the coefficients of the curvature function are approximated by a quadratic function through the experimental identification method. To obtain the high accuracy performance, a linear regression model and a least square method are employed to investigate the characteristic of the BVM ventilator's grippers angle with respect to the airflow volume produced by the AMBU bag.FindingsThis paper investigates the correlation between the exhausting airflow of the AMBU bag and the grippers angle of the BVM ventilator.Originality/valueThe experimental results validated that the regression model of the characteristic of the exhausting airflow of the AMBU bag with respect to the grippers' angle has been fitted with a coefficient over 98% within the range of 350–750 ml.
Collapse
|
|
22
|
Hajage D, Combes A, Guervilly C, Lebreton G, Mercat A, Pavot A, Nseir S, Mekontso-Dessap A, Mongardon N, Mira JP, Ricard JD, Beurton A, Tachon G, Kontar L, Le Terrier C, Richard JC, Mégarbane B, Keogh RH, Belot A, Maringe C, Leyrat C, Schmidt M. Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome Associated with COVID-19: An Emulated Target Trial Analysis. Am J Respir Crit Care Med 2022; 206:281-294. [PMID: 35533052 PMCID: PMC9890253 DOI: 10.1164/rccm.202111-2495oc] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
Rationale: Whether patients with coronavirus disease (COVID-19) may benefit from extracorporeal membrane oxygenation (ECMO) compared with conventional invasive mechanical ventilation (IMV) remains unknown. Objectives: To estimate the effect of ECMO on 90-day mortality versus IMV only. Methods: Among 4,244 critically ill adult patients with COVID-19 included in a multicenter cohort study, we emulated a target trial comparing the treatment strategies of initiating ECMO versus no ECMO within 7 days of IMV in patients with severe acute respiratory distress syndrome (PaO2/FiO2 < 80 or PaCO2 ⩾ 60 mm Hg). We controlled for confounding using a multivariable Cox model on the basis of predefined variables. Measurements and Main Results: A total of 1,235 patients met the full eligibility criteria for the emulated trial, among whom 164 patients initiated ECMO. The ECMO strategy had a higher survival probability on Day 7 from the onset of eligibility criteria (87% vs. 83%; risk difference, 4%; 95% confidence interval, 0-9%), which decreased during follow-up (survival on Day 90: 63% vs. 65%; risk difference, -2%; 95% confidence interval, -10 to 5%). However, ECMO was associated with higher survival when performed in high-volume ECMO centers or in regions where a specific ECMO network organization was set up to handle high demand and when initiated within the first 4 days of IMV and in patients who are profoundly hypoxemic. Conclusions: In an emulated trial on the basis of a nationwide COVID-19 cohort, we found differential survival over time of an ECMO compared with a no-ECMO strategy. However, ECMO was consistently associated with better outcomes when performed in high-volume centers and regions with ECMO capacities specifically organized to handle high demand.
Collapse
Affiliation(s)
- David Hajage
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP
| | - Alain Combes
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Médecine Intensive–Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie, Paris, France
| | - Christophe Guervilly
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L’Hôpital Nord, Assistance Publique hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Faculté de Médecine Centre d’Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Marseille, France
| | - Guillaume Lebreton
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Médecine Intensive–Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie, Paris, France
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L’Hôpital Nord, Assistance Publique hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, Faculté de Médecine Centre d’Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Marseille, France
- Department of Cardiovascular and Thoracic Surgery, Pitié-Salpêtrière Hospital, APHP- Sorbonne University, Paris, France
| | - Alain Mercat
- Département de Médecine Intensive - Réanimation et Médecine Hyperbare, CHU d’Angers, Faculté de Santé, Université d’Angers, Angers, France
| | - Arthur Pavot
- Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Le Kremlin-Bicêtre, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, CHU Lille, Inserm U1285, University of Lille, CNRS, UMR 8576, Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Armand Mekontso-Dessap
- AP-HP (Assistance Publique-Hôpitaux de Paris), Hôpitaux universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, INSERM Unité U955, Créteil, France
- UPEC (Université Paris Est Créteil), Faculté de Santé de Créteil, IMRB, GRC CARMAS, Créteil, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique-Hôpitaux de Paris, Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Jean Paul Mira
- Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire de Paris Centre, Hôpital Cochin, Médecine Intensive Réanimation; Paris Descartes Sorbonne Paris Cité University, Paris, France; Department of Infection, Immunity and Inflammation, Cochin Institute, Inserm U1016, Paris, France
| | - Jean-Damien Ricard
- Université de Paris, APHP, Hôpital Louis Mourier, DMU ESPRIT, Service de Médecine Intensive Réanimation, Colombes, France
| | - Alexandra Beurton
- AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), and Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Guillaume Tachon
- Service de Médecine Intensive Réanimation, Hôpital Foch, Suresnes, France
| | - Loay Kontar
- Department of Intensive Care Medicine, CHU Amiens-Picardie, avenue Laennec, Amiens, France
| | - Christophe Le Terrier
- Division of Intensive Care, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean Christophe Richard
- Service de Médecine Intensive–Réanimation, Hôpital de la Croix-Rousse–Hospices Civils de Lyon, Lyon, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, APHP, INSERM UMRS-1144, Paris University, Paris, France
| | - Ruth H. Keogh
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Camille Maringe
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Clémence Leyrat
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; and
| | - Matthieu Schmidt
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France
- Service de Médecine Intensive–Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie, Paris, France
| |
Collapse
|
|
23
|
Schiavoni L, Mattei A, Pascarella G, Piliego C, Biondo G, Strumia A, Agrò FE. Not just a matter of weight: A case report of ECMO treatment in a severely obese patient. Obes Res Clin Pract 2022; 16:346-348. [PMID: 35909046 PMCID: PMC9445800 DOI: 10.1016/j.orcp.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/15/2022] [Accepted: 07/23/2022] [Indexed: 11/25/2022]
Abstract
The ELSO Guidelines list a BMI ≥ 40 kg/m2 among the relative contraindications to give ECMO treatment in SARS – COV2 patients. We describe a case of a 52-year-old with BMI 50.21 kg/m2, admitted to the intensive care unit (ICU) with severe respiratory conditions and successfully treated with extracorporeal membrane oxygenation (ECMO). The application of veno-venous (VV) ECMO will evolve as far as we understand the pathophysiology of the COVID-19 disease and will probably have a determinant role in management of patient with refractory hypoxemia, whose ventilation management is difficult, even in case of severe obesity.
Collapse
Affiliation(s)
- L Schiavoni
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - A Mattei
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - G Pascarella
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - C Piliego
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Ospedale di Velletri, Via Orti Ginnetti n.7, 00049 Velletri, RM, Italy
| | - G Biondo
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| | - A Strumia
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy.
| | - Felice E Agrò
- Unit of Anesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, via Álvaro del Portillo 21, 00128 Rome, Italy
| |
Collapse
|
|
24
|
Kamal AM, Dumitrescu F, Mită A, Săbiescu DM, Alexandru DO, Gheorghe CE, Filip MM, Ionescu-Ciocâlteu A, Maria DT, Kamal D, Kamal CK. Liver Function Tests and FIB-4 Score as Predictors of Severity in COVID-19 Patients from the South-West of Romania. Life (Basel) 2022; 12:934. [PMID: 35888026 PMCID: PMC9318778 DOI: 10.3390/life12070934] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 pandemic (COVID-19) is the most important global health crisis to date. In this study, we performed an analysis to find the association between liver damage, FIB-4 score and the severity of COVID-19 disease. METHODS We included a total of 580 patients that tested positive for SARS-CoV-2 infection and were hospitalized. No patient included had any known history of liver disease. Liver function tests were performed, and FIB-4 score was calculated in order to assess their involvement in the disease progression. RESULTS More than half of the patients had elevated liver function tests. Age, high body mass index, associated heart disease and diabetes were associated with poor outcome. Corticosteroids, antibiotics, and anticoagulants strongly correlated with liver injuries. Liver impairment and injury, as well as a FIB-4 score higher than 3.5, also correlated with higher degrees of disease severity. CONCLUSION Liver injury and elevated FIB-4 score were associated with poor clinical outcome and disease severity, as well as being a valuable tool to predict COVID-19-related mortality.
Collapse
Affiliation(s)
- Adina M. Kamal
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Florentina Dumitrescu
- Department of Infectious Disease, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.D.); (D.M.S.)
| | - Adrian Mită
- Department of Clinical Semiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Denisa M. Săbiescu
- Department of Infectious Disease, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (F.D.); (D.M.S.)
| | - Dragoș O. Alexandru
- Department of Informatics and Biostatistics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Codruța E. Gheorghe
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.E.G.); (C.K.K.)
| | - Monalisa M. Filip
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.F.); (A.I.-C.)
| | - Adriana Ionescu-Ciocâlteu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.M.F.); (A.I.-C.)
| | - Daniela T. Maria
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Diana Kamal
- Department of Physical and Rehabilitation Medicine, Filantropia Municipal Hospital Craiova, 200516 Craiova, Romania;
| | - Constantin K. Kamal
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (C.E.G.); (C.K.K.)
| |
Collapse
|
|
25
|
Baldi E, Cortegiani A, Savastano S. Cardiac arrest and coronavirus disease 2019. Curr Opin Crit Care 2022; 28:237-243. [PMID: 35275877 PMCID: PMC9208745 DOI: 10.1097/mcc.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The impact of the coronavirus disease 2019 (COVID-19) on the cardiovascular system has been highlighted since the very first weeks after the severe acute respiratory syndrome coronavirus 2 identification. We reviewed the influence of COVID-19 pandemic on cardiac arrest, both considering those occurred out of the hospital (OHCA) and in the hospital (IHCA). RECENT FINDINGS An increase in OHCA incidence occurred in different countries, especially in those regions most burdened by the COVID-19, as this seems to be bounded to the pandemic trend. A change of OHCA patients' characteristics, with an increase of the OHCA occurred at home, a decrease in bystander cardiopulmonary resuscitation and automated external defibrillator use before Emergency Medical Service (EMS) arrival and an increase in non-shockable rhythms, have been highlighted. A dramatic drop in the OHCA patients' survival was pointed out in almost all the countries, regardless of the high or low-incidence of COVID-19 cases. Concerning IHCA, a reduction in survival was highlighted in patients with COVID-19 who sustained a cardiac arrest. SUMMARY Cardiac arrest occurrence and survival were deeply affected by the pandemic. Informative campaigns to the population to call EMS in case of need and the re-allocation of the prehospital resources basing on the pandemic trend are needed to improve survival.
Collapse
Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo
- Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| |
Collapse
|
|
26
|
Urner M, Barnett AG, Bassi GL, Brodie D, Dalton HJ, Ferguson ND, Heinsar S, Hodgson CL, Peek G, Shekar K, Suen JY, Fraser JF, Fan E. Venovenous extracorporeal membrane oxygenation in patients with acute covid-19 associated respiratory failure: comparative effectiveness study. BMJ 2022; 377:e068723. [PMID: 35508314 PMCID: PMC9065544 DOI: 10.1136/bmj-2021-068723] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate the effect of extracorporeal membrane oxygenation (ECMO) compared with conventional mechanical ventilation on outcomes of patients with covid-19 associated respiratory failure. DESIGN Observational study. SETTING 30 countries across five continents, 3 January 2020 to 29 August 2021. PARTICIPANTS 7345 adults admitted to the intensive care unit with clinically suspected or laboratory confirmed SARS-CoV-2 infection. INTERVENTIONS ECMO in patients with a partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio <80 mm Hg compared with conventional mechanical ventilation without ECMO. MAIN OUTCOME MEASURE The primary outcome was hospital mortality within 60 days of admission to the intensive care unit. Adherence adjusted estimates were calculated using marginal structural models with inverse probability weighting, accounting for competing events and for baseline and time varying confounding. RESULTS 844 of 7345 eligible patients (11.5%) received ECMO at any time point during follow-up. Adherence adjusted mortality was 26.0% (95% confidence interval 24.5% to 27.5%) for a treatment strategy that included ECMO if the PaO2/FiO2 ratio decreased <80 mm Hg compared with 33.2% (31.8% to 34.6%) had patients received conventional treatment without ECMO (risk difference -7.1%, 95% confidence interval -8.2% to -6.1%; risk ratio 0.78, 95% confidence interval 0.75 to 0.82). In secondary analyses, ECMO was most effective in patients aged <65 years and with a PaO2/FiO2 <80 mm Hg or with driving pressures >15 cmH2O during the first 10 days of mechanical ventilation. CONCLUSIONS ECMO was associated with a reduction in mortality in selected adults with covid-19 associated respiratory failure. Age, severity of hypoxaemia, and duration and intensity of mechanical ventilation were found to be modifiers of treatment effectiveness and should be considered when deciding to initiate ECMO in patients with covid-19.
Collapse
Affiliation(s)
- Martin Urner
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gianluigi Li Bassi
- Critical Care Research Group, Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Intensive Care Unit, St Andrew's War Memorial Hospital and The Wesley Hospital, Uniting Care Hospitals, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Daniel Brodie
- Department of Medicine, Columbia College of Physicians and Surgeons, New York, NY, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Heidi J Dalton
- Pediatric Critical Care Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
- Heart and Vascular Institute, Inova Fairfax Hospital, Falls Church, VA, USA
| | - Niall D Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto, ON, Canada
- Department of Physiology, University of Toronto, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Silver Heinsar
- Critical Care Research Group, Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St Andrew's War Memorial Hospital and The Wesley Hospital, Uniting Care Hospitals, Brisbane, QLD, Australia
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
- Department of Intensive Care, Alfred Health, Melbourne, VIC, Australia
| | - Giles Peek
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | - Kiran Shekar
- Critical Care Research Group, Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jacky Y Suen
- Critical Care Research Group, Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Intensive Care Unit, St Andrew's War Memorial Hospital and The Wesley Hospital, Uniting Care Hospitals, Brisbane, QLD, Australia
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto, ON, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto, ON, Canada
| |
Collapse
|
|
27
|
Microarray Profiling and Co-Expression Network Analysis of LncRNAs and mRNAs in Acute Respiratory Distress Syndrome Mouse Model. Pathogens 2022; 11:pathogens11050532. [PMID: 35631053 PMCID: PMC9143564 DOI: 10.3390/pathogens11050532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/27/2022] [Accepted: 04/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Long noncoding RNAs (LncRNAs) play critical roles in many respiratory diseases. Acute respiratory distress syndrome (ARDS) is a destructive clinical syndrome of respiratory diseases. However, the potential mechanism of LncRNAs on ARDS remains largely unknown. Methods: To identify the profiles of LncRNAs and mRNAs in the LPS-induced ARDS mouse model, the microarray analyses were hired to detect the expression of LncRNAs and mRNAs in present study. Subsequently, microarray data were verified by quantitative qRT-PCR. Functional annotation on DE mRNAs and LncRNAs were carried out by bioinformatics analysis. Furthermore, the role of selected DE LncRNAs on correlated genes was confirmed by si-RNA and Western blot. Results: The expression of 2110 LncRNAs and 2690 mRNAs were significantly changed, which were further confirmed by qRT-PCR. GO and KEGG analysis indicated that the up-regulated mRNAs were mainly related to a defense response and tumor necrosis factor (TNF) signaling pathway, respectively. LncRNA-mRNA co-expression analyses showed that LncRNAs NR_003508, ENSMUST00000131638, ENSMUST00000119467, and ENSMUST00000124853 may correlate to MLKL, RIPK3, RIPK1, Caspase1, and NLRP3, respectively, or cooperatively, which were highly involved in the cell necroptosis process. Furthermore, siRNA for NR_003508 confirmed the co-expression analyses results. Conclusion: To summarize, this study implied that the DE LncRNAs could be potent regulators and target genes of ARDS and will provide a novel insight into the regulation of the pathogenesis of ARDS.
Collapse
|
|
28
|
Al-Hakeim HK, Al-Jassas HK, Morris G, Maes M. Increased ACE2, sRAGE, and Immune Activation, but Lowered Calcium and Magnesium in COVID-19. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2022; 16:32-43. [PMID: 35307003 DOI: 10.2174/2772270816666220318103929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The characterization of new biomarkers that could help externally validate the diagnosis of COVID-19 and optimize treatments is extremely important. Many studies have established changes in immune-inflammatory and antibody levels, but few studies measured the soluble receptor for the advanced glycation end product (sRAGE), angiotensin-converting enzyme 2 (ACE2), calcium, and magnesium in COVID-19. OBJECTIVE To evaluate serum advanced glycation end-product receptor (sRAGE) and angiotensin converting enzyme (ACE)2 and peripheral oxygen saturation (SpO2) and chest CT scan abnormalities (CCTA) in COVID-19. METHODS sRAGE, ACE2, interleukin (IL)-6, IL-10, C-reactive protein (CRP), calcium, magnesium, and albumin were measured in 60 COVID-19 patients and 30 healthy controls. RESULTS COVID-19 is characterized by significantly increased IL-6, CRP, IL-10, sRAGE, ACE2, and lowered SpO2, albumin, magnesium, and calcium. COVID-19 with CCTAs showed lower SpO2 and albumin. SpO2 was significantly inversely correlated with IL-6, IL-10, CRP, sRAGE, and ACE2, and positively with albumin, magnesium, and calcium. Neural networks showed that a combination of calcium, IL-6, CRP, and sRAGE yielded an accuracy of 100% in detecting COVID-19 patients, with calcium being the most important predictor followed by IL-6 and CRP. Patients with positive IgG results showed a significant elevation in the serum level of IL-6, sRAGE, and ACE2 compared to the negatively IgG patient subgroup. CONCLUSION The results show that immune-inflammatory and RAGE pathways biomarkers may be used as an external validating criterion for the diagnosis of COVID-19. Those pathways coupled with lowered SpO2, calcium, and magnesium are drug targets that may help reduce the consequences of COVID-19.
Collapse
Affiliation(s)
| | | | - Gerwyn Morris
- School of Medicine, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, Geelong, Australia
| | - Michael Maes
- School of Medicine, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, Deakin University, Barwon Health, Geelong, Australia.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
|
29
|
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: 29] [Impact Index Per Article: 9.7] [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.
Collapse
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
| |
Collapse
|
|
30
|
Reed CR, Bonadonna D, Otto JC, McDaniel CG, Chabata CV, Kuchibhatla M, Frederiksen J, Layzer JM, Arepally GM, Sullenger BA, Tracy ET. Aptamer-based factor IXa inhibition preserves hemostasis and prevents thrombosis in a piglet model of ECMO. MOLECULAR THERAPY - NUCLEIC ACIDS 2022; 27:524-534. [PMID: 35036063 PMCID: PMC8728519 DOI: 10.1016/j.omtn.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) requires anticoagulation to prevent clotting when the patient’s blood contacts the circuit. Unfractionated heparin (UFH) usually prevents clotting but can cause life-threatening bleeding. An anticoagulant that selectively inhibits the contact activation (intrinsic) pathway while sparing the tissue factor (extrinsic) pathway of coagulation might prevent clotting triggered by the circuit while permitting physiologic coagulation at surgical sites. DTRI-178 is an RNA anticoagulant aptamer conjugated to polyethylene glycol that increases its half-life in circulation. This aptamer is based on a previously described molecule (9.3t) that inhibits intrinsic tenase activity by binding to factor IXa on an exosite. Using a piglet model of pediatric venoarterial (VA) ECMO, we compared thromboprevention and blood loss using a single dose of DTRI-178 versus UFH. In each of five experiments, we subjected two litter-matched piglets, one anticoagulated with DTRI-178 and the other with UFH, to simultaneous 12-h periods of VA ECMO. Both anticoagulants achieved satisfactory and comparable thromboprotection. However, UFH piglets had increased surgical site bleeding and required significantly greater blood transfusion volumes than piglets anticoagulated with DTRI-178. Our results indicate that DTRI-178, an aptamer against factor IXa, may be feasible, safer, and result in fewer transfusions and clinical bleeding events in ECMO.
Collapse
Affiliation(s)
- Christopher R. Reed
- Department of Surgery, Duke University Medical Center and Health System, 2301 Erwin Road, Box 3443, Durham, NC 27710, USA
- Corresponding author Christopher R. Reed, MD, Department of Surgery, Duke University Medical Center and Health System, 2301 Erwin Road, Box 3443, Durham, NC 27710, USA
| | - Desiree Bonadonna
- Extracorporeal Life Support, Duke University Medical Center, Durham, NC 27710, USA
| | - James C. Otto
- Department of Surgery, Duke University Medical Center and Health System, 2301 Erwin Road, Box 3443, Durham, NC 27710, USA
| | | | - Charlene Vongai Chabata
- Departments of Surgery; and Pharmacology and Cancer Biology, Duke University, Durham, NC 27710, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27710, USA
| | - James Frederiksen
- Department of Surgery, Duke University Medical Center and Health System, 2301 Erwin Road, Box 3443, Durham, NC 27710, USA
| | - Juliana M. Layzer
- Duke University Clinical and Translational Science Institute, Durham, NC 27710, USA
| | - Gowthami M. Arepally
- Division of Hematology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Bruce A. Sullenger
- Department of Surgery, Duke University Medical Center and Health System, 2301 Erwin Road, Box 3443, Durham, NC 27710, USA
| | - Elisabeth T. Tracy
- Department of Surgery, Duke University Medical Center and Health System, 2301 Erwin Road, Box 3443, Durham, NC 27710, USA
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| |
Collapse
|
|
31
|
Ferré A, Marquion F, Delord M, Gros A, Lacave G, Laurent V, Merceron S, Paul M, Simon C, Troché G, Charbonnel C, Marque-Juillet S, Bruneel F, Legriel S. Association of ventilator type with hospital mortality in critically ill patients with SARS-CoV2 infection: a prospective study. Ann Intensive Care 2022; 12:10. [PMID: 35133543 PMCID: PMC8821831 DOI: 10.1186/s13613-022-00981-2] [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: 10/01/2021] [Accepted: 01/13/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection), a single-center prospective observational study in France. RESULTS We prospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March 2020 and July 2021. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a sophisticated turbine-based transport ventilator was used. Kaplan-Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality. We included 189 patients (140 [74.1%] men) with a median age of 65 years [IQR, 55-73], of whom 61 (32.3%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were age ≥ 70 years (HR, 2.11; 95% CI, 1.24-3.59; P = 0.006), immunodeficiency (HR, 2.43; 95% CI, 1.16-5.09; P = 0.02) and serum creatinine ≥ 100 µmol/L (HR, 3.01; 95% CI, 1.77-5.10; P < 0.001) but not ventilator type. As compared to conventional ICU (equipped with ICU and anesthesiology ventilators), management in transient ICU (equipped with non-ICU turbine-based ventilators) was associated neither with a longer duration of invasive mechanical ventilation (18 [IQR, 11-32] vs. 21 [13-37] days, respectively; P = 0.39) nor with a longer ICU stay (24 [IQR, 14-40] vs. 27 [15-44] days, respectively; P = 0.44). CONCLUSIONS In ventilated patients with ARDS due to COVID-19, management in transient ICU equipped with non-ICU sophisticated turbine-based ventilators was not associated with worse outcomes compared to standard ICU, equipped with ICU ventilators. Although our study design is not powered to demonstrate any difference in outcome, our results after adjustment do not suggest any signal of harm when using these transport type ventilators as an alternative to ICU ventilators during COVID-19 surge.
Collapse
Affiliation(s)
- Alexis Ferré
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.
| | - Fabien Marquion
- Department of Anesthesiology, Versailles Hospital, Le Chesnay, France
| | - Marc Delord
- Clinical Research Center, Versailles Hospital, Le Chesnay, France
- Department of Population Health Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Antoine Gros
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Guillaume Lacave
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Virginie Laurent
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Sybille Merceron
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Marine Paul
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Christelle Simon
- Department of Anesthesiology, Versailles Hospital, Le Chesnay, France
| | - Gilles Troché
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | | | | | - Fabrice Bruneel
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
| | - Stéphane Legriel
- Intensive Care Unit, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France
- University Paris-Saclay, UVSQ, INSERM, CESP, "PsyDev" Team, Villejuif, France
| |
Collapse
|
|
32
|
Ahmad Q, Green A, Chandel A, Lantry J, Desai M, Simou J, Osborn E, Singh R, Puri N, Moran P, Dalton H, Speir A, King C. Impact of Noninvasive Respiratory Support in Patients With COVID-19 Requiring V-V ECMO. ASAIO J 2022; 68:171-177. [PMID: 35089261 PMCID: PMC8796828 DOI: 10.1097/mat.0000000000001626] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The impact of the duration of noninvasive respiratory support (RS) including high-flow nasal cannula and noninvasive ventilation before the initiation of extracorporeal membrane oxygenation (ECMO) is unknown. We reviewed data of patients with coronavirus disease 2019 (COVID-19) treated with V-V ECMO at two high-volume tertiary care centers. Survival analysis was used to compare the effect of duration of RS on liberation from ECMO. A total of 78 patients required ECMO and the median duration of RS and invasive mechanical ventilation (IMV) before ECMO was 2 days (interquartile range [IQR]: 0, 6) and 2.5 days (IQR: 1, 5), respectively. The median duration of ECMO support was 24 days (IQR: 11, 73) and 59.0% (N = 46) remained alive at the time of censure. Patients that received RS for ≥3 days were significantly less likely to be liberated from ECMO (HR: 0.46; 95% CI: 0.26-0.83), IMV (HR: 0.42; 95% CI: 0.20-0.89) or be discharged from the hospital (HR: 0.52; 95% CI: 0.27-0.99) compared to patients that received RS for <3 days. There was no difference in hospital mortality between the groups (HR: 1.12; 95% CI: 0.56-2.26). These relationships persisted after adjustment for age, gender, and duration of IMV. Prolonged duration of RS before ECMO may result in lung injury and worse subsequent outcomes.
Collapse
Affiliation(s)
- Qamar Ahmad
- From the *Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia
| | - Adam Green
- Division of Critical Care Medicine, Cooper University Healthcare, Camden, New Jersey
| | - Abhimanyu Chandel
- Division of Pulmonary and Critical Care Medicine, Walter Reed National Medical Center, Bethesda, Maryland
| | - James Lantry
- Department of Pulmonary and Critical Care Medicine, INOVA Health System, Falls Church, Virginia
| | - Mehul Desai
- Department of Pulmonary and Critical Care Medicine, INOVA Health System, Falls Church, Virginia
| | - Jikerkhoun Simou
- Department of Pulmonary and Critical Care Medicine, INOVA Health System, Falls Church, Virginia
| | - Erik Osborn
- Department of Pulmonary and Critical Care Medicine, INOVA Health System, Falls Church, Virginia
| | - Ramesh Singh
- Cardiothoracic Surgery, INOVA Health System, Falls Church, Virginia
| | - Nitin Puri
- Division of Critical Care Medicine, Cooper University Healthcare, Camden, New Jersey
| | - Patrick Moran
- Cardiothoracic Surgery, INOVA Health System, Falls Church, Virginia
- Innovative ECMO Solutions
| | - Heidi Dalton
- Department of Pulmonary and Critical Care Medicine, INOVA Health System, Falls Church, Virginia
| | - Alan Speir
- Cardiothoracic Surgery, INOVA Health System, Falls Church, Virginia
| | - Christopher King
- Department of Pulmonary and Critical Care Medicine, INOVA Health System, Falls Church, Virginia
| |
Collapse
|
|
33
|
Castaño M, Sbraga F, de la Sota EP, Arribas JM, Luisa Cámara M, Voces R, Donado A, Sandoval E, Morales CA, González-Santos JM, Barquero-Alemán M, Feliu DFS, Rodríguez-Roda J, Molina D, Bellido A, Vigil-Escalera C, Ángeles Tena M, Reyes G, Gómez F, Rivas J, Guevara A, Tauron M, Miguel Borrego J, Castillo L, Miralles A, Cánovas S, Berastegui E, Aramendi JI, Aldámiz G, Pruna R, Silva J, de Ibarra JIS, Legarra JJ, Ballester C, Rodríguez-Lecoq R, Daroca T, Paredes F. Oxigenación con membrana extracorpórea en el paciente COVID-19: resultados del Registro Español ECMO-COVID de la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). CIRUGIA CARDIOVASCULAR 2022. [PMCID: PMC8806126 DOI: 10.1016/j.circv.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introducción y objetivos La oxigenación con membrana extracorpórea (ECMO) ha resultado ser una opción terapéutica en los pacientes con insuficiencia respiratoria o cardiaca severa por COVID-19. Las indicaciones y manejo de estos pacientes están aún por determinar. Nuestro objetivo es evaluar los resultados de la terapia ECMO en pacientes con COVID-19 incluidos en un registro prospectivo e intentar optimizar los resultados. Métodos En marzo de 2020 se inició un registro multicéntrico anónimo prospectivo de pacientes con COVID-19 tratados mediante ECMO veno-arterial (V-A) o veno-venosa (V-V). Se registraron las variables clínicas, analíticas y respiratorias preimplante, datos de implante y evolución de la terapia. El evento primario fue la mortalidad hospitalaria de cualquier causa y los eventos secundarios fueron la recuperación funcional y el evento combinado de recuperación funcional y mortalidad de cualquier causa a partir de los 3 meses de seguimiento tras el alta. Resultados Se analizó a un total de 365 pacientes procedentes de 25 hospitales, 347 V-V y 18 V-A (edad media de 52,7 y 49,4 años, respectivamente). Los pacientes con ECMO V-V fueron más obesos, presentaban menos fracaso orgánico diferente al pulmonar y precisaron menos terapia inotrópica previa al implante. El 33,3% y el 34,9% de los pacientes con ECMO V-A y V-V, respectivamente, fueron dados de alta del hospital (p = NS) y la mortalidad fue similar, del 56,2% y 50,9% de los casos respectivamente, la inmensa mayoría durante la ECMO y sobre todo por fracaso multiorgánico. El 14,0% (51 pacientes) permanecían ingresados. El seguimiento medio fue de 196 ± 101,7 días. En el análisis multivariante, resultaron protectores de evento primario en pacientes con ECMO V-V el peso corporal (OR 0,967; IC 95%: 0,95-0,99; p = 0,004) y la procedencia del propio hospital (OR 0,48; IC 95%: 0,27-0,88; p = 0,018), mientras que la edad (OR 1,063; IC 95%: 1,005-1,12; p = 0,032), la hipertensión arterial (3,593; IC 95%: 1,06-12,19; p = 0,04) y las complicaciones en ECMO globales (2,44; IC 95%: 0,27-0,88; p = 0,019), digestivas (OR 4,23, IC 95%: 1,27-14,07; p = 0,019) y neurológicas (OR 4,66; IC 95%: 1,39-15,62; p = 0,013) fueron predictores independientes de mortalidad. El único predictor independiente de aparición de los eventos secundarios resultó el momento de seguimiento del paciente. Conclusiones La terapia con ECMO permite supervivencias hospitalarias hasta del 50% en pacientes con COVID-19 grave. La edad, la hipertensión arterial y las complicaciones en ECMO son los predictores de mortalidad hospitalaria en pacientes con ECMO V-V. Un mayor peso corporal y la procedencia del propio hospital son factores protectores. La recuperación funcional solo se ve influida por el tiempo de seguimiento transcurrido tras el alta. La estandarización de los criterios de implante y manejo del paciente con COVID grave mejoraría los resultados y la futura investigación clínica.
Collapse
|
|
34
|
Short B, Abrams D, Brodie D. Extracorporeal membrane oxygenation for coronavirus disease 2019-related acute respiratory distress syndrome. Curr Opin Crit Care 2022; 28:90-97. [PMID: 34670997 PMCID: PMC8711309 DOI: 10.1097/mcc.0000000000000901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW To understand the potential role of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), highlighting evolving practices and outcomes. RECENT FINDINGS The role for ECMO in COVID-19-related ARDS has evolved throughout the pandemic. Early reports of high mortality led to some to advocate for withholding ECMO in this setting. Subsequent data suggested mortality rates were on par with those from studies conducted prior to the pandemic. However, outcomes are evolving and mortality in these patients may be worsening with time. SUMMARY ECMO has an established role in the treatment of severe forms of ARDS. Current data suggest adherence to the currently accepted algorithm for management of ARDS, including the use of ECMO. However, planning related to resource utilization and strain on healthcare systems are necessary to determine the feasibility of ECMO in specific regions at any given time. Utilization of national and local networks, pooling of resources and ECMO mobilization units are important to optimize access to ECMO as appropriate. Reported complications of ECMO in the setting of COVID-19-related ARDS have been predominantly similar to those reported in studies of non-COVID-19-related ARDS. Further high-quality research is needed.
Collapse
Affiliation(s)
- Briana Short
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York, USA
| |
Collapse
|
|
35
|
Shemies RS, Nagy E, Younis D, Sheashaa H. Renal replacement therapy for critically ill patients with COVID-19-associated acute kidney injury: A review of current knowledge. Ther Apher Dial 2022; 26:15-23. [PMID: 34378870 PMCID: PMC8420218 DOI: 10.1111/1744-9987.13723] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/08/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. A significant proportion of COVID-19 patients develops severe symptoms, which may include acute respiratory distress syndrome and acute kidney injury as manifestations of multi-organ failure. Acute kidney injury (AKI) necessitating renal replacement therapy (RRT) is increasingly prevalent among critically ill patients with COVID-19. However, few studies have focused on AKI treated with RRT. Many questions are awaiting answers as regards AKI in the setting of COVID-19; whether patients with COVID-19 commonly develop AKI, what are the underlying pathophysiologic mechanisms? What is the best evidence regarding treatment approaches? Identification of the potential indications and the preferred modalities of RRT in this context, is based mainly on clinical experience. Here, we review the current approaches of RRT, required for management of critically ill patients with COVID-19 complicated by severe AKI as well as the precautions that should be adopted by health care providers in dealing with these cases. Electronic search was conducted in MEDLINE, PubMed, ISI Web of Science, and Scopus scientific databases. We searched the terms relevant to this review to identify the relevant studies. We also searched the conference proceedings and ClinicalTrials.gov database.
Collapse
Affiliation(s)
| | - Eman Nagy
- Mansoura Nephrology and Dialysis UnitMansoura UniversityMansouraEgypt
| | - Dalia Younis
- Mansoura Nephrology and Dialysis UnitMansoura UniversityMansouraEgypt
| | | |
Collapse
|
|
36
|
MacLaren G, Fisher D, Brodie D. Treating the Most Critically Ill Patients With COVID-19: The Evolving Role of Extracorporeal Membrane Oxygenation. JAMA 2022; 327:31-32. [PMID: 34919122 DOI: 10.1001/jama.2021.22580] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Graeme MacLaren
- Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Health Systems, Singapore
| | - Dale Fisher
- Division of Infectious Diseases, University Medicine Cluster, National University Health Systems, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York, New York
| |
Collapse
|
|
37
|
Affiliation(s)
- Manuel Tisminetzky
- Department of Medicine, Division of Respirology, Sinai Health System and University Health Network, 585 University Avenue, 9-MaRS-9013, Toronto, Ontario M5G2G2, Canada
| | - Bruno L Ferreyro
- Department of Medicine, Division of Respirology, Sinai Health System and University Health Network, 585 University Avenue, 9-MaRS-9013, Toronto, Ontario M5G2G2, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6, Canada
| | - Eddy Fan
- Department of Medicine, Division of Respirology, Sinai Health System and University Health Network, 585 University Avenue, 9-MaRS-9013, Toronto, Ontario M5G2G2, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6, Canada; Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, 204 Victoria Street, 4th Floor, Room 411, Toronto, Ontario M5B 1T8, Canada.
| |
Collapse
|
|
38
|
Rezabakhsh A, Sadat‐Ebrahimi S, Ala A, Nabavi SM, Banach M, Ghaffari S. A close-up view of dynamic biomarkers in the setting of COVID-19: Striking focus on cardiovascular system. J Cell Mol Med 2022; 26:274-286. [PMID: 34894069 PMCID: PMC8743667 DOI: 10.1111/jcmm.17122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 10/15/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
Based on the recent reports, cardiovascular events encompass a large portion of the mortality caused by the COVID-19 pandemic, which drawn cardiologists into the management of the admitted ill patients. Given that common laboratory values may provide key insights into the illness caused by the life-threatening SARS-CoV-2 virus, it would be more helpful for screening, clinical management and on-time therapeutic strategies. Commensurate with these issues, this review article aimed to discuss the dynamic changes of the common laboratory parameters during COVID-19 and their association with cardiovascular diseases. Besides, the values that changed in the early stage of the disease were considered and monitored during the recovery process. The time required for returning biomarkers to basal levels was also discussed. Finally, of particular interest, we tended to abridge the latest updates regarding the cardiovascular biomarkers as prognostic and diagnostic criteria to determine the severity of COVID-19.
Collapse
Affiliation(s)
- Aysa Rezabakhsh
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Alireza Ala
- Emergency Medicine Research TeamTabriz University of Medical SciencesTabrizIran
| | - Seyed Mohammad Nabavi
- Applied Biotechnology Research CenterBaqiyatallah University of Medical SciencesTehranIran
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and HypertensionMedical University of LodzLodzPoland
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI)LodzPoland
| | - Samad Ghaffari
- Cardiovascular Research CenterTabriz University of Medical SciencesTabrizIran
| |
Collapse
|
|
39
|
Barbaro RP, MacLaren G, Swol J, Slutsky AS, Brodie D. COVID-19 ARDS: getting ventilation right - Authors' reply. Lancet 2022; 399:22-23. [PMID: 34973715 PMCID: PMC8718350 DOI: 10.1016/s0140-6736(21)02448-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Ryan P Barbaro
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Health System, Singapore
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Arthur S Slutsky
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada; Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA; New York-Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
|
40
|
Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly being used for patients with severe respiratory failure and has received particular attention during the coronavirus disease 2019 (COVID-19) pandemic. Evidence from two key randomized controlled trials, a subsequent post hoc Bayesian analysis, and meta-analyses support the interpretation of a benefit of ECMO in combination with ultra-lung-protective ventilation for select patients with very severe forms of acute respiratory distress syndrome (ARDS). During the pandemic, new evidence has emerged helping to better define the role of ECMO for patients with COVID-19. Results from large cohorts suggest outcomes during the first wave of the pandemic were similar to those in non-COVID-19 cohorts. As the pandemic continued, mortality of patients supported with ECMO has increased. However, the precise reasons for this observation are unclear. Known risk factors for mortality in COVID-19 and non-COVID-19 patients are higher patient age, concomitant extra-pulmonary organ failures or malignancies, prolonged mechanical ventilation before ECMO, less experienced treatment teams and lower ECMO caseloads in the treating center. ECMO is a high resource-dependent support option; therefore, it should be used judiciously, and its availability may need to be constrained when resources are scarce. More evidence from high-quality research is required to better define the role and limitations of ECMO in patients with severe COVID-19.
Collapse
|
|
41
|
Piscitello GM, Siegler M, Parker WF. Ethics of Extracorporeal Membrane Oxygenation under Conventional and Crisis Standards of Care. THE JOURNAL OF CLINICAL ETHICS 2022; 33:13-22. [PMID: 35100174 PMCID: PMC9648099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a form of life support for cardiac and/or pulmonary failure with unique ethical challenges compared to other forms of life support. Ethical challenges with ECMO exist when conventional standards of care apply, and are exacerbated during periods of absolute ECMO scarcity when "crisis standards of care" are instituted. When conventional standards of care apply, we propose that it is ethically permissible to withhold placing patients on ECMO for reasons of technical futility or when patients have terminal, short-term prognoses that are untreatable by ECMO. Under crisis standards of care, it is ethically permissible to broaden exclusionary criteria to also withhold ECMO from patients who have a low likelihood of recovery, to maximize the overall number of lives saved. Unilateral withdrawal of ECMO against a patient's preferences is unethical under conventional standards of care, but is ethical under crisis standards of care to increase access to ECMO to others in society. ECMO should only be rationed when true scarcity exists, and allocation protocols should be transparent to the public. When rationing must occur under crisis standards of care, it is imperative that oversight bodies assess for inequities in the allocation of ECMO and make frequent changes to improve any inequities.
Collapse
Affiliation(s)
- Gina M Piscitello
- Assistant Professor, Department of Internal Medicine, Section of Palliative Medicine; and Division of Hospital Medicine at Rush Medical College, Rush University, Chicago, Illinois USA.
| | - Mark Siegler
- Lindy Bergman Distinguished Service Professor of Medicine and Surgery, University of Chicago; Founding Director, University of Chicago's MacLean Center for Clinical Medical Ethics; and Executive Director of the Bucksbaum Institute for Clinical Excellence, Chicago, Illinois USA.
| | - William F Parker
- Assistant Professor of Medicine, Section of Pulmonary/Critical Care, University of Chicago Department of Medicine; and Assistant Director, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois USA.
| |
Collapse
|
|
42
|
Abrams D, MacLaren G, Lorusso R, Price S, Yannopoulos D, Vercaemst L, Bělohlávek J, Taccone FS, Aissaoui N, Shekar K, Garan AR, Uriel N, Tonna JE, Jung JS, Takeda K, Chen YS, Slutsky AS, Combes A, Brodie D. Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications. Intensive Care Med 2022; 48:1-15. [PMID: 34505911 PMCID: PMC8429884 DOI: 10.1007/s00134-021-06514-y] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 01/15/2023]
Abstract
Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.
Collapse
Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 622 W168th St., PH 8E, Room 101, New York, NY 10032 USA ,Center for Acute Respiratory Failure, Columbia University Irving Medical Center, New York, NY USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK ,National Heart and Lung Institute, Imperial College, London, UK
| | - Demetris Yannopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN USA
| | - Leen Vercaemst
- Department of Perfusion, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jan Bělohlávek
- Second Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Fabio S. Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nadia Aissaoui
- Intensive Care Unit, APHP, Hopital Européen Georges Pompidou, Inserm U 970, Université de Paris, Paris, France
| | - Kiran Shekar
- Adult Intensive Care Services, Prince Charles Hospital, Brisbane, Australia ,University of Queensland, Brisbane, Australia ,Bond University, Gold Coast, Australia
| | - A. Reshad Garan
- Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, NY USA
| | - Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT USA ,Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT USA
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medicine, Seoul, Republic of Korea
| | - Koji Takeda
- Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, USA
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Arthur S. Slutsky
- Keenan Research Center, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France ,Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique–Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 622 W168th St., PH 8E, Room 101, New York, NY 10032 USA ,Center for Acute Respiratory Failure, Columbia University Irving Medical Center, New York, NY USA
| |
Collapse
|
|
43
|
How the Middle East is facing COVID-19. COVID-19 PANDEMIC 2022. [PMCID: PMC8175783 DOI: 10.1016/b978-0-323-82860-4.00008-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The rapid spread of coronavirus disease 2019 (COVID-19) across the Middle East countries dictates different preparedness and response plans implemented locally. We aim to emphasize the unique challenges during fighting this pandemic in the region and take the opportunity to enumerate, evaluate, and illustrate the effort done by various countries in this regard. The Middle East region is geographically, politically, economically, and religiously a susceptible area, with very different health-care infrastructures, which imposes unique challenges for effective control of this pandemic. These challenges include compromised health-care systems, prolonged regional conflicts, wars and humanitarian crises, suboptimal cooperation levels, and frequent religious gatherings. These factors are interrelated and collectively influence the response to the pandemic in this region. Here, we extensively emphasize these challenges and take measures toward mitigating the spread of COVID-19.
Collapse
|
|
44
|
Fagbamigbe AF, Tolba MF, Amankwaa EF, Mante PK, Sylverken AA, Zahouli JZB, Goonoo N, Mosi L, Oyebola K, Matoke-Muhia D, de Souza DK, Badu K, Dukhi N. Implications of WHO COVID-19 interim guideline 2020.5 on the comprehensive care for infected persons in Africa Before, during and after clinical management of cases. SCIENTIFIC AFRICAN 2021; 15:e01083. [PMID: 34957351 PMCID: PMC8683379 DOI: 10.1016/j.sciaf.2021.e01083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/11/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa's outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.
Collapse
Key Words
- AFCOR, Africa Task Force for Novel Coronavirus
- AIDS, acquired immune deficiency syndrome
- ARDS, acute respiratory distress syndrome
- Africa
- C02, carbon dioxide
- COVID-19
- Clinical management
- Contact tracing
- ECMO, extracorporeal membrane oxygenation
- GGE, general government expenditure
- GGHE, general government health expenditure
- H2O, Hydrogen
- HIV, Human immunodeficiency virus
- MERS, Middle East Respiratory Syndrome
- NHS, national health services
- O2, Oxygen
- PCR, polymerase chain reaction
- PTSD, post-traumatic stress disorder
- RECOVERY, Randomized Evaluation of COVID-19 Therapy
- SARS, severe acute respiratory syndrome
- Stigmatization
- US-CDC, United States Centre for Disease Control
- WHO guidelines
- WHO, World Health Organization
Collapse
Affiliation(s)
- Adeniyi Francis Fagbamigbe
- The African Academy of Sciences, Nairobi, Kenya.,Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
| | - Mai F Tolba
- The African Academy of Sciences, Nairobi, Kenya.,Department of Pharmacology and Toxicology, Faculty of Pharmacy and The Centre of Drug Discovery Research and Development, Ain Shams University, Cairo 11566, Egypt.,School of Life and Medical Sciences, University of Hertfordshire Hosted by Global Academic Foundation, New Capital City, Egypt
| | - Ebenezer F Amankwaa
- The African Academy of Sciences, Nairobi, Kenya.,Department of Geography and Resource Development, University of Ghana, Accra, Ghana
| | - Priscilla Kolibea Mante
- The African Academy of Sciences, Nairobi, Kenya.,Department of Pharmacology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Augustina Angelina Sylverken
- The African Academy of Sciences, Nairobi, Kenya.,Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Ashanti, UPO/PMB, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Julien Z B Zahouli
- The African Academy of Sciences, Nairobi, Kenya.,Centre d'Entomologie Médicale et Vétérinaire, Université Alassane Ouattara, Bouaké, Côte d'Ivoire
| | - Nowsheen Goonoo
- The African Academy of Sciences, Nairobi, Kenya.,Biomaterials, Drug Delivery and Nanotechnology Unit, Centre for Biomedical Biomaterials Research, University of Mauritius, Reduit, Mauritius
| | - Lydia Mosi
- The African Academy of Sciences, Nairobi, Kenya.,Department of Biochemistry Cell and Molecular Biology, University of Ghana, Ghana.,West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Ghana
| | - Kolapo Oyebola
- The African Academy of Sciences, Nairobi, Kenya.,Nigerian Institute of Medical Research, Lagos, Nigeria.,Department of Zoology, Faculty of Science, University of Lagos, Nigeria
| | - Damaris Matoke-Muhia
- The African Academy of Sciences, Nairobi, Kenya.,Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Dziedzom K de Souza
- The African Academy of Sciences, Nairobi, Kenya.,Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kingsley Badu
- The African Academy of Sciences, Nairobi, Kenya.,Department of Theoretical and Applied Biology, Kwame Nkrumah University of Science and Technology, Ashanti, UPO/PMB, Kumasi, Ghana.,Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Natisha Dukhi
- The African Academy of Sciences, Nairobi, Kenya.,Human and Social Capabilities Division, Human Sciences Research Council, 116-118 Buitengracht Street, Merchant House, 3rd floor, Cape Town, Western Cape 8001, South Africa
| |
Collapse
|
|
45
|
Alhumaid S, Al Mutair A, Alghazal HA, Alhaddad AJ, Al-Helal H, Al Salman SA, Alali J, Almahmoud S, Alhejy ZM, Albagshi AA, Muhammad J, Khan A, Sulaiman T, Al-Mozaini M, Dhama K, Al-Tawfiq JA, Rabaan AA. Extracorporeal membrane oxygenation support for SARS-CoV-2: a multi-centered, prospective, observational study in critically ill 92 patients in Saudi Arabia. Eur J Med Res 2021; 26:141. [PMID: 34886916 PMCID: PMC8655085 DOI: 10.1186/s40001-021-00618-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been used as a rescue strategy in patients with severe with acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 infection, but there has been little evidence of its efficacy. OBJECTIVES To describe the effect of ECMO rescue therapy on patient-important outcomes in patients with severe SARS-CoV-2. METHODS A case series study was conducted for the laboratory-confirmed SARS-CoV-2 patients who were admitted to the ICUs of 22 Saudi hospitals, between March 1, 2020, and October 30, 2020, by reviewing patient's medical records prospectively. RESULTS ECMO use was associated with higher in-hospital mortality (40.2% vs. 48.9%; p = 0.000); lower COVID-19 virological cure (41.3% vs 14.1%, p = 0.000); and longer hospitalization (20.2 days vs 29.1 days; p = 0.000), ICU stay (12.6 vs 26 days; p = 0.000) and mechanical ventilation use (14.2 days vs 22.4 days; p = 0.000) compared to non-ECMO group. Also, there was a high number of patients with septic shock (19.6%) and multiple organ failure (10.9%); and more complications occurred at any time during hospitalization [pneumothorax (5% vs 29.3%, p = 0.000), bleeding requiring blood transfusion (7.1% vs 38%, p = 0.000), pulmonary embolism (6.4% vs 15.2%, p = 0.016), and gastrointestinal bleeding (3.3% vs 8.7%, p = 0.017)] in the ECMO group. However, PaO2 was significantly higher in the 72-h post-ECMO initiation group and PCO2 was significantly lower in the 72-h post-ECMO start group than those in the 12-h pre-ECMO group (62.9 vs. 70 mmHg, p = 0.002 and 61.8 vs. 51 mmHg, p = 0.042, respectively). CONCLUSION Following the use of ECMO, the mortality rate of patients and length of ICU and hospital stay were not improved. However, these findings need to be carefully interpreted, as most of our cohort patients were relatively old and had multiple severe comorbidities. Future randomized trials, although challenging to conduct, are highly needed to confirm or dispute reported observations.
Collapse
Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, 31982, Saudi Arabia.
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia
- School of Nursing, Wollongong University, Wollongong, Australia
| | - Header A Alghazal
- Microbiology Laboratory, Prince Saud Bin Jalawi Hospital, Al-Ahsa, Saudi Arabia
| | - Ali J Alhaddad
- Microbiology Department, Omran General Hospital, Al-Ahsa, Saudi Arabia
| | - Hassan Al-Helal
- Division of Laboratory, Medical Microbiology Department, Maternity and Children Hospital, Al-Ahsa, Saudi Arabia
| | - Sadiq A Al Salman
- Division of Neurology, Internal Medicine Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Jalal Alali
- Internal Medicine Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Sana Almahmoud
- Department of Nursing Education, College of Nursing, Imam Abdulrahman Bin Faisal University, King Faisal Road, Dammam, Saudi Arabia
| | - Zulfa M Alhejy
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, 31982, Saudi Arabia
| | - Ahmad A Albagshi
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, 31982, Saudi Arabia
| | - Javed Muhammad
- Department of Microbiology, The University of Haripur, Haripur, 22620, Khyber Pakhtunkhwa, Pakistan
| | - Amjad Khan
- Department of Public Health/Nutrition, The University of Haripur, Haripur, Pakistan
| | - Tarek Sulaiman
- Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Maha Al-Mozaini
- Immunocompromised Host Research Unit, Department of Infection and Immunity, King Faisal Specialist Hospital and Research Center, Riyadh, 11211, Saudi Arabia
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, 243122, Uttar Pradesh, India
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ali A Rabaan
- Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610, Pakistan
| |
Collapse
|
|
46
|
Blanco-Schweizer P, Sánchez-Ballesteros J, Herrán-Monge R, Prieto-deLamo A, de Ayala-Fernández JA, García-García M. Interhospital transport of COVID-19 patients on ECMO and comparison with historic controls. Med Intensiva 2021; 45:e65-e67. [PMID: 34839888 PMCID: PMC8613977 DOI: 10.1016/j.medine.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- P Blanco-Schweizer
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain.
| | - J Sánchez-Ballesteros
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - R Herrán-Monge
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - A Prieto-deLamo
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - J A de Ayala-Fernández
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| | - M García-García
- Intensive Care Unit, Hospital Universitario Rio Hortega, Dirección: C/ Dulzaina 2, 47012 Valladolid, Spain
| |
Collapse
|
|
47
|
Rausch L, Lutz K, Schifferer M, Winheim E, Gruber R, Oesterhaus EF, Rinke L, Hellmuth JC, Scherer C, Muenchhoff M, Mandel C, Bergwelt‐Baildon M, Simons M, Straub T, Krug AB, Kranich J, Brocker T. Binding of phosphatidylserine-positive microparticles by PBMCs classifies disease severity in COVID-19 patients. J Extracell Vesicles 2021; 10:e12173. [PMID: 34854246 PMCID: PMC8636722 DOI: 10.1002/jev2.12173] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/02/2021] [Indexed: 01/08/2023] Open
Abstract
Infection with SARS-CoV-2 is associated with thromboinflammation, involving thrombotic and inflammatory responses, in many COVID-19 patients. In addition, immune dysfunction occurs in patients characterised by T cell exhaustion and severe lymphopenia. We investigated the distribution of phosphatidylserine (PS), a marker of dying cells, activated platelets and platelet-derived microparticles (PMP), during the clinical course of COVID-19. We found an unexpectedly high amount of blood cells loaded with PS+ PMPs for weeks after the initial COVID-19 diagnosis. Elevated frequencies of PS+ PMP+ PBMCs correlated strongly with increasing disease severity. As a marker, PS outperformed established laboratory markers for inflammation, leucocyte composition and coagulation, currently used for COVID-19 clinical scoring. PS+ PMPs preferentially bound to CD8+ T cells with gene expression signatures of proliferating effector rather than memory T cells. As PS+ PMPs carried programmed death-ligand 1 (PD-L1), they may affect T cell expansion or function. Our data provide a novel marker for disease severity and show that PS, which can trigger the blood coagulation cascade, the complement system, and inflammation, resides on activated immune cells. Therefore, PS may serve as a beacon to attract thromboinflammatory processes towards lymphocytes and cause immune dysfunction in COVID-19.
Collapse
Affiliation(s)
- Lisa Rausch
- Institute for ImmunologyBiomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| | - Konstantin Lutz
- Institute for ImmunologyBiomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| | - Martina Schifferer
- German Center for Neurodegenerative Diseases (DZNE)MunichGermany
- Munich Cluster of Systems Neurology (Synergy)MunichGermany
| | - Elena Winheim
- Institute for ImmunologyBiomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| | - Rudi Gruber
- bene pharmaChem GmbH & Co.KG., GeretsriedGermany
| | - Elina F. Oesterhaus
- COVID‐19 Registry of the LMU Munich (CORKUM)University Hospital, LMU MunichMunichGermany
- Max von Pettenkofer Institute & Gene CenterVirologyNational Reference Center for RetrovirusesLMU MünchenMunichGermany
| | - Linus Rinke
- Institute for ImmunologyBiomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| | - Johannes C. Hellmuth
- COVID‐19 Registry of the LMU Munich (CORKUM)University Hospital, LMU MunichMunichGermany
- Department of Medicine IIIUniversity Hospital, LMU MunichMunichGermany
| | - Clemens Scherer
- COVID‐19 Registry of the LMU Munich (CORKUM)University Hospital, LMU MunichMunichGermany
- Department of Medicine IUniversity Hospital, LMU MunichMunichGermany
| | - Maximilian Muenchhoff
- COVID‐19 Registry of the LMU Munich (CORKUM)University Hospital, LMU MunichMunichGermany
- Max von Pettenkofer Institute & Gene CenterVirologyNational Reference Center for RetrovirusesLMU MünchenMunichGermany
- German Center for Infection Research (DZIF)partner site MunichGermany
| | - Christopher Mandel
- COVID‐19 Registry of the LMU Munich (CORKUM)University Hospital, LMU MunichMunichGermany
- Department of Medicine IVUniversity Hospital, LMU MunichMunichGermany
| | - Michael Bergwelt‐Baildon
- COVID‐19 Registry of the LMU Munich (CORKUM)University Hospital, LMU MunichMunichGermany
- Department of Medicine IIIUniversity Hospital, LMU MunichMunichGermany
| | - Mikael Simons
- German Center for Neurodegenerative Diseases (DZNE)MunichGermany
- Munich Cluster of Systems Neurology (Synergy)MunichGermany
- Institute of Neuronal Cell BiologyTechnical University of MunichMunichGermany
| | - Tobias Straub
- Core facility BioinformaticsBiomedical Center (BMC)Faculty of MedicineLMU MunichMunichGermany
| | - Anne B. Krug
- Institute for ImmunologyBiomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| | - Jan Kranich
- Institute for ImmunologyBiomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| | - Thomas Brocker
- Institute for ImmunologyBiomedical Center (BMC), Faculty of Medicine, LMU MunichMunichGermany
| |
Collapse
|
|
48
|
Hisham IN, Townsend G, Gillard S, Debnath B, Sin J. COVID-19: the perfect vector for a mental health epidemic. BJPsych Bull 2021; 45:332-338. [PMID: 32475375 PMCID: PMC7308597 DOI: 10.1192/bjb.2020.60] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
In times of crisis, people have historically had to band together to overcome. What happens when they cannot? This article examines the reality of people forced to isolate from one another during one of the most turbulent events of their lives: the COVID-19 pandemic. Connecting the dots of topics including fear, social stigmas, global public response and previous disease outbreaks, this article discusses the negative mental health effects that individuals and communities will likely suffer as the result of social distancing, isolation and physical infection.
Collapse
Affiliation(s)
| | | | | | | | - Jacqueline Sin
- St George's, University of London, UK
- University of Reading, UK
| |
Collapse
|
|
49
|
Talikowska M, Ball S, Tohira H, Bailey P, Rose D, Brink D, Bray J, Finn J. No apparent effect of the COVID-19 pandemic on out-of-hospital cardiac arrest incidence and outcome in Western Australia. Resusc Plus 2021; 8:100183. [PMID: 34786566 PMCID: PMC8580810 DOI: 10.1016/j.resplu.2021.100183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/03/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background We examined the incidence, patient and arrest characteristics, and survival outcomes of out-of-hospital cardiac arrest (OHCA) in Western Australia (WA) in the first wave of the COVID-19 pandemic. Methods Adult OHCA cases attended by St John WA Emergency Medical Service (EMS) between 16th March and 17th May 2020 (‘COVID-19 period’) were compared with those for the same period in 2017-9. We calculated crude OHCA incidence for all OHCA cases and modelled the effect of the ‘COVID-19 period’ on 30-day survival for OHCA cases with EMS attempted resuscitation; comparing our results with those published for Victoria (Australia), which had a higher incidence of COVID-19. Results In WA there was no significant difference between the 2020 ‘COVID-19 period’ (n = 423) and the same period in 2017-9 (n = 1,334) in the OHCA incidence in adults (117.9 vs 126.1 per 100,000 person-years, p = 0.23). In OHCA cases with EMS-resuscitation attempted, there was no change in bystander cardiopulmonary resuscitation rates. Despite an increase in EMS response time, neither the crude nor risk-adjusted odds ratio (aOR) for 30-day survival in 2020 was significantly different to 2017-9 (11.7% vs 9.6%; p = 0.45) (aOR = 1.19, 95% confidence interval 0.57-2.51, p = 0.65). This contrasts with a significant reduction in survival to hospital discharge reported in Victoria. Conclusion In WA, with a relatively low incidence of COVID-19, OHCA incidence and survival was not significantly different during the initial wave of the COVID-19 pandemic compared to the three previous years. Our study suggests that OHCA survival may be more closely related to the incidence of COVID-19 in the community, rather than COVID-19 restrictions per se.
Collapse
Affiliation(s)
- Milena Talikowska
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.,St John WA, Belmont, Western Australia, Australia
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.,Medical School (Emergency Medicine), The University of Western Australia, Nedlands, Western Australia, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.,St John WA, Belmont, Western Australia, Australia
| | - Dan Rose
- St John WA, Belmont, Western Australia, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.,St John WA, Belmont, Western Australia, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), Curtin School of Nursing, Curtin University, Bentley, Western Australia, Australia.,St John WA, Belmont, Western Australia, Australia.,Medical School (Emergency Medicine), The University of Western Australia, Nedlands, Western Australia, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
|
50
|
Lai W, Li S, Du Z, Ma X, Lu J, Gao WD, Abbott GW, Hu Z, Kang Y. Severe Patients With ARDS With COVID-19 Treated With Extracorporeal Membrane Oxygenation in China: A Retrospective Study. Front Med (Lausanne) 2021; 8:699227. [PMID: 34746170 PMCID: PMC8563993 DOI: 10.3389/fmed.2021.699227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background: The novel coronavirus disease 2019 (COVID-19) pandemic has become a global health crisis affecting over 200 countries worldwide. Extracorporeal membrane oxygenation (ECMO) has been increasingly used in the management of COVID-19-associated end-stage respiratory failure. However, the exact effect of ECMO in the management of these patients, especially with regards to complications and mortality, is unclear. Methods: This is the largest retrospective study of ECMO treated COVID-19 patients in China. A total of 50 ECMO-treated COVID-19 patients were recruited. We describe the main characteristics, the clinical features, ventilator parameters, ECMO-related variables and management details, and complications and outcomes of COVID-19 patients with severe acute respiratory distress syndrome (ARDS) that required ECMO support. Results: For those patients with ECMO support, 21 patients survived and 29 died (mortality rate: 58.0%). Among those who survived, PaO2 (66.3 mmHg [59.5–74.0 mmHg] and PaO2/FiO2 (68.0 mmHg [61.0–76.0 mmHg]) were higher in the survivors than those of non-survivors (PaO2: 56.8 mmHg (49.0–65.0 mmHg), PaO2/FiO2 (58.2 mmHg (49.0–68.0 mmHg), all P < 0.01) prior to ECMO. Patients who achieved negative fluid balance in the early resuscitation phase (within 3 days) had a higher survival rate than those who did not (P = 0.0003). Conclusions: In this study of 50 cases of ECMO-treated COVID-19 patients, a low PO2/FIO2 ratio before ECMO commencement may indicate a poor prognosis. Negative fluid balance in the early resuscitation phase during ECMO treatment was a predictor of increased survival post-ECMO treatment.
Collapse
Affiliation(s)
- Wei Lai
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shuanglei Li
- Division of Adult Cardiac Surgery, Department of Cardiology, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhongtao Du
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinhua Ma
- Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, China
| | - Junyu Lu
- Intensive Care Unit, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei Dong Gao
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Geoffrey W Abbott
- Bioelectricity Laboratory, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Zhaoyang Hu
- Laboratory of Anesthesiology & Critical Care Medicine, Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|