ABSTRACT
Objective: ECMO has acceptable outcomes for severe ARDS and is used for COVID-19 ARDS. This study investigated whether duration of ECMO supported its long-term usage. Method(s): A retrospective, IRB approved single-center study was conducted to review all patients placed on ECMO for refractory ARDS due to COVID-19 from 3/1/2020, to 3/1/2022. The review included demographics, ECMO run days, length of hospital stay, discharge disposition, and mortality (defined as in hospital death). Patient ECMO runs were binned into two categories based on days of ECMO support. Short Runs (SR) were defined as <= 30 days;Long Runs (LR) were > 30 days. Result(s): Overall, 164 patients and 165 ECMO runs comprised the study cohort. Demographics, age, and degree of respiratory failure were similar for both groups. SR were 15.7 days;LR were 80.6 days (p<0.01). Mortality was similar amongst the SR and LR groups (46.9% vs 39.3%, NS) despite duration of support. Discharge location was similar amongst both groups, but LR patients tend to require more use of long-term care (26.2% vs 18.5%, NS). LR was associated with increased use of cannulas (2.1 vs 3.1, p<0.01), increased membrane lungs (1.1 vs 2.9, p<0.01), and increased hospital stay days (94.8 vs 28.4, p<0.01). Conclusion(s): Our study demonstrated that duration of ECMO in COVID-19 was not a factor in mortality. LR patients experienced increased use of resources (cannulation, membrane lungs and length of stay) and were discharged to long term care facilities more often. More studies are needed to explore other aspects of survival.
ABSTRACT
Background: Recently published studies indicate that the Covid-19 pandemic has dramatically increased rates of anxiety, depression, and suicide in adolescents and young adults. Human and animal studies strongly indicate that early life stress leads to lasting changes to cognition and psychiatric outcomes, but less is known about how chronic adolescent stress may alter brain function across the lifespan. Methods: The current study examines the effects of chronic social instability stress (SIS) on male and female mice from 4 to 11 weeks of age. SIS mice (n=52) experienced twice weekly cage changes, preventing the formation of stable social hierarchies, while control mice (n=48) remained with their original cage mates. Mice were subsequently assessed throughout adulthood for changes in behavior associated with anxiety, affect, aggression, motivation, and recognition memory. At 66 weeks of age, levels hippocampal mRNA expression of genes associated with human early life stress were also compared (CRHR1, CRHR2, FKBP5, SLCA4). Results: Mice exposed to SIS showed decreased novel object recognition (p=0.002) and responded more during the progressive ratio task (p=0.033). At 66 weeks, SIS mice had increased hippocampal FKBP5 (p=0.03) and CRHR2 (p=0.005) expression relative to controls;furthermore, these measures negatively correlated with novel object recognition (FKBP: p=0.007;CRHR2: p=0.04). Conclusions: Chronic adolescent social instability stress led to persistent memory deficits and increased hedonic seeking in adulthood, possibly due to hippocampal damage resultant from lasting alterations to the stress cascade. Future studies will determine the cellular, molecular and circuit-level changes underlying these effects. Supported By: Support from an institutional grant from USC department of Psychiatry and Keck School of Medicine Keywords: Early Life Stress, FKBP5, Memory Deficit