Extracorporeal membrane oxygenation for airway emergencies

Objectives: Extracorporeal membrane oxygenation (ECMO) is well established in cardiorespiratory failure. Here we report the use of ECMO in an airway emergency to provide respiratory support. Method(s): Informed consent was obtained from patient at the time of admission. Result(s): A 48-year-old with COVID-19 requiring venovenous ECMO (VVECMO) for 32 days and tracheostomy for 47 days had developed tracheal stenosis three months after tracheostomy removal, and undergone tracheal resection and reconstruction. He presented two weeks later with acute dyspnea, bloody drainage and a bulge in his neck with coughing. A computerized tomography (CT) of the cervical spine and chest showed dehiscence of the tracheal wound and a gap in the trachea. He was managed with High Flow Nasal Canula and supported on VVECMO support using 25 Fr. right femoral drainage cannula and 23 Fr. left IJ return cannula. A covered stent was placed, neck wound was irrigated and debrided. Patient was decannulated after 10 days on ECMO. Future therapeutic considerations include mediastinal tracheostomy, aortic homograft interposition of the disrupted segment of trachea with stent placement and permanent self-expandable stent with internal silicone stent. Conclusion(s): ECMO is increasingly used in complex thoracic surgery as well as in the perioperative period as salvage support. One of the areas where it has shown promising results is traumatic main bronchial rupture, airway tumor leading to severe airway stenosis, and other complex airway problems. The ease of cannulation, the technological advances and growing confidence in the management of ECMO patients are the main reasons for the expansion of ECMO use beyond conventional indications. The case described above is an example of the use of ECMO in the perioperative management of impending respiratory failure due to airway obstruction or disconnection. (Figure Presented).

DECREASED EXERCISE CAPACITY AS A SEQUELA OF COVID-19: INSIGHTS FROM CARDIOPULMONARY RESPONSES TO MAXIMAL EXERCISE BEFORE AND AFTER RECOVERY FROM THE DISEASE

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: SARS-CoV-2 infection can lead to persistent, long-term sequelae after recovery from the acute disease process. One such reported sequelae is reduced exercise capacity (i.e., low peak pulmonary O2uptake;V̇O2peak). However, only cross-sectional approaches that did not account for baseline (i.e., before COVID-19) V̇O2peak support this assumption. As such, whether reduced exercise capacity is a consequence of or in fact predates SARS-CoV-2 infection remains unknown. Accordingly, we compared the cardiopulmonary responses to maximal incremental exercise (CPET) before and after COVID-19. Specifically, we determined whether COVID-19 is associated with a decrease in V̇O2peak. METHODS: We retrospectively reviewed CPET data collected across the Mayo Clinic Enterprise between Oct 2018 and Mar 2022. 42 individual patients who completed a CPET before and after a COVID-19 diagnosis were included (36, 4, and 2 patients experienced mild, moderate, or severe illness, respectively). In addition, we included a control group of 25 individual patients who performed two separate CPETs but did not contract SARS-CoV-2 (CTL). All patients were clinically stable between the two CPETs, defined as no worsening/change in disease status or medication, and performed the same CPET protocol for both tests. A mixed within- and between-subjects design was used to examine differences in cardiopulmonary responses to CPET both across time and between the COVID-19 and CTL groups. RESULTS: The COVID-19 and CTL groups were matched for sex (36 vs. 32% female;P = 0.757), age (49 ± 15 vs. 50 ± 16 y, P = 0.652), BMI (29.1 ± 5.4 vs. 29.7 ± 5.2 kg/m2;P = 0.868), and time between the two CPETs (489 ± 225 vs. 534 ± 257 days, P = 0.662). In the COVID-19 group, the first and second CPET were performed 312 ± 232 days before and 176 ± 110 days after SARS-CoV-2 infection, respectively. Exercise time, peak heart rate, peak systolic pressure, O2pulse (V̇O2/heart rate), anaerobic threshold, peak ventilation, and ventilatory efficiency (V̇E/V̇CO2 slope) were not different between the groups. There was a small but significant reduction in V̇O2peak from before to after SARS-CoV-2 infection (−1.4 ± 0.5 mL/Kg/min, P = 0.038);however, the change in V̇O2peak between the two CPETs was not different between COVID-19 vs. CTL (−5 ± 13 vs. −3 ± 15%, P = 0.585). The change in V̇O2peak in the groups likely falls within the normal error of the measurement during CPET. CONCLUSIONS: Accounting for baseline measures of V̇O2peak, we find no substantial evidence for decreased exercise capacity within one to 15 months after SARS-CoV-2 infection, especially when compared to patients who did not suffer COVID-19. CLINICAL IMPLICATIONS: Our findings suggest that care may need to be taken when reporting a consequential impairment in exercise capacity secondary to COVID-19 when prior baseline (i.e., before COVID-19) data are not available. DISCLOSURES: No relevant relationships by Arvind Balavenkataraman No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes no disclosure on file for Scott Helgeson;No relevant relationships by Neal Patel Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support