ABSTRACT
Lung transplantation (LTx) had been the only survival option in selected Covid-19 infected ARDS patients. We evaluated surgical outcome in such group from multi-center ECLS study. LTx patient data (n=1488)were collected from multiple institutions through the National ECLS Registry and was stratified on presence of COVID-19 infection. LTx procedure details, patient demographics and post-operative outcomes were compared between COVID-19 and non-COVID-19 patients along with pre-op ECMO vs. no ECMO COVID-19 patients using Wilcoxon rank sum test or Chi-square testing to determine distribution. Time to 30-day post-operative survival was analyzed in combination with Kaplan-Meier survival curves with log-rank testing to assess mortality in these groups of patients. P values <0.05 were considered statistically significant. Out of 1488 LTx patients, our results included a total of 34 patients infected with COVID-19 at time of LTx. When compared between covid LTx (n=34) vs. non-covid LTx (n=1,454), demographic data revealed significant differences in tracheostomy (p=0.0001), lung allocation score (p=0.0001), type of pre-op ECMO support (p=0.0001), type of ECMO support (p=0.001), conversion (p=0.006), and ventilator support time (p=0.0001);but no significant differences in gender (p=0.30), BMI (p=0.32), EVLP (p=0.078), PGD score at T24 (p=0.13), and waitlist time (p=0.75). 30-day post-operative mortality analysis showed K-M graph with no statistical significance (p=0.41) in COVID-19 and non-COVID-19 patients. In addition, we compared pre-ECMO utilized COVID-19 patients (n=21) vs. non-ECMO utilized COVID-19 patients (n=13) who were transplanted. Covid-19 infected patients when transplanted showed no significant differences in survival. Propensity score matched study indicated similar results. Selective ARDS patients may benefit from end-stage surgical options like lung transplantation. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Introduction: The acquired coagulopathy associated with cardiac surgery and cardiopulmonary bypass (CPB) has been associated with increased perioperative transfusion requirements, morbidity, and mortality. As the COVID-19 pandemic put significant strain on blood bank resources, our institution implemented recommendations to utilize prothrombin complex concentrate (PCC) and fibrinogen concentrate to either replace or supplement intraoperative FFP and cryoprecipitate administration, respectively during cardiac surgery. Herein, we describe the transfusion patterns when FFP, cryoprecipitate, PCC, and fibrinogen concentrate are available to the intraoperative care team. Methods: On March 4, 2020, the Division of Cardiothoracic Anesthesia in collaboration with the Department of Cardiac Surgery recommended the use of PCC and Fibryga as first-line therapy for non-surgical coagulopathy based on viscoelastic and static testing and visual inspection of the surgical field in all consecutive cardiac surgical patients older than 18 years having coronary artery bypass grafting (CABG), valve surgery, aortic surgery, heart or lung transplantation, left ventricular assist device (LVAD) placement, or some combination of these procedures. We recommended administering PCC 500 units up to 2000 units, and Fibryga 1 gram up to 4 grams in divided doses until the TEG R-value and alpha angle, respectively returned to normal or bleeding in the surgical field stopped. We collected patient demographic information, clinical variables, and outcomes retrospectively from the electronic medical record. Data are described as means (± SD) and percentages. Results: From March 4, 2020, to October 30, 2020, we analyzed 224 patients. The mean age was 58 years ±14.4 and 79 (35.7%) were women. Three patients were excluded, as they had cardiac surgeries without CPB. The majority of patients had CABG and/or valve surgery;29 (13.1%) patients had complex surgery, 37 (16.7 %) had heart or lung transplantation surgery, and 26 (11.7%) an LVAD placed. One hundred and eighteen (53.3%) patients received no blood product or concentrate (NP Group), 40 (18%) patients received factor concentrates with or without platelets (FC Group), 33 (14.9%) patients received FC and allogenic blood product (FC+ABP Group), and 30 (13.3%) patients received only APB (ABP Group). There was no meaningful difference in platelet administration or chest tube output between groups. Group 2 patients who received both FC and ABP received more RBCs (Table 1). There was no clinically meaningful difference between the baseline static and viscoelastic test results (Table 2). Conclusion: In this single-academic center experience, we demonstrate that non-surgical coagulopathy can be managed safely and effectively with factor and fibrinogen concentrates, allogeneic blood products, and combinations thereof in consecutive patients undergoing varying complexities of cardiac surgery. Future analysis will focus on stratifying surgical procedures to identify patterns of administration as they relate to operational and clinical outcomes.