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SESSION TITLE: ECMO and ARDS in COVID-19 Infections SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of the study is to determine the incidence of bloodstream infections in COVID19 patients treated with ECMO in relation to steroid days and days of ECMO cannulation. METHODS: Retrospective analysis of data for COVID19 patients treated with ECMO in a tertiary academic medical center from January 2020 until July 2021 was performed. Data including baseline patients’ characteristics, type, and duration of ECMO support, type and days of steroids used, blood culture results, and organism type were collected. An institutional review board (IRB) approval was obtained before data collection. A two-tailed T-test was used to calculate the P-value, P-value of <0.05 was considered significant. RESULTS: A Total of 34 patients were analyzed, 3 of them were on (Veno-Arterial) VA ECMO and 31 on (Veno-Venous) VV ECMO, 32 out of 34 (94%) patients received steroids (Dexamethasone alone 16 patients, Methylprednisolone 1 patient and 15 patients received multiple steroid types). Seventeen patients had positive blood cultures (50%), average steroid days for patients with positive blood cultures was 21.6 days compared to 11.8 days for patients with negative blood cultures (P-Value:0.01), Average ECMO days for patients with positive blood cultures was 40.5 days compared to 18.8 days for patients with negative blood cultures ( P-Value:0.01). Staphylococcus epidermidis was found in 47% of the cultures, Enterococcus Faecalis was found in 24% of cultures while MRSA, MSSA, and Candida Albicans were found in 6% of cultures. CONCLUSIONS: Bloodstream Infections during ECMO cannulation are common and carry significant morbidity and mortality in patients. Longer ECMO days and longer duration of steroid use were found to be associated with higher rates of bloodstream infections in our patient’s sample. This could be related to the instrumentation risk or immunosuppression from steroids or other factors not evaluated in this study. CLINICAL IMPLICATIONS: Bloodstream infections are common in patients treated with ECMO, the risk of infections increases with longer ECMO and steroid days. Knowledge of such risks and trying to minimize them such as cautious use of steroids might help in the prevention of infections. Further studies are needed to better assess this risk. DISCLOSURES: No relevant relationships by Varun Halani No relevant relationships Added 03/21/2022 by Ghassan Kamel, value=Honoraria Removed 03/21/2022 by Ghassan Kamel No relevant relationships Added 03/22/2022 by Ghassan Kamel, value=Honoraria Removed 03/22/2022 by Ghassan Kamel No relevant relationships by Ahmad Sharayah
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SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The purpose of this study is to determine the incidence of hospital acquired and ventilator associated pulmonary infections in patients on ECMO for SARS-CoV-2 related ARDS in relation to steroids and ECMO cannulation days. METHODS: A retrospective analysis of COVID19 patients treated with ECMO admitted to a tertiary care academic medical center from January 2020 until July 2021 was conducted. Data including baseline patient characteristics, type, and duration of ECMO support, type and days of steroids use and sputum culture results were collected. An institutional review board (IRB) approval was obtained prior to data collection. A two-tailed T-test was used to calculate the P-value, P-value of <0.05 was considered significant. RESULTS: A total of 34 patients were included in the analysis, of which 3 of them were on (Veno-Arterial) VA-ECMO and 31 were on (Veno-Venous) VV-ECMO. 32 out of 34 (94%) patients received steroids during their hospital course. Total of 20 patients had positive sputum cultures (59%) and average steroid days for patients with positive sputum cultures was 20.75 days as compared to 10.75 days for patients with negative sputum cultures (P-Value: 0.01). Average ECMO days for patients with positive sputum cultures was 26 days as compared to 14.4 days for patients with negative sputum cultures (P Value: 0.0003). Amongst the patients with positive sputum cultures, pseudomonas aeruginosa and methicillin-sensitive staphylococcus aureus (MSSA) were the most isolated organisms (25% of positive cultures), methicillin-resistant staphylococcus aureus (MRSA) and Serratia Marcescens were isolated in 20% of positive cultures, Klebsiella aerogenes was isolated in 15% of positive cultures. CONCLUSIONS: Hospital acquired and ventilator associated pulmonary infections are common in patients on ECMO for SARS-CoV2 related ARDS. Longer ECMO days and a longer duration of steroid use were found to be associated with higher rates of bacterial growth in sputum cultures. Common organisms included Pseudomonas, MSSA, and MRSA. CLINICAL IMPLICATIONS: Our analysis describes the most common bacterial organisms isolated on sputum cultures in this study population. It may also serve as a guide for empiric antibiotics choice when bacterial pneumonia is suspected in similar patients while awaiting sputum culture results. DISCLOSURES: No relevant relationships by Varun Halani No relevant relationships Added 03/21/2022 by Ghassan Kamel, value=Honoraria Removed 03/21/2022 by Ghassan Kamel No relevant relationships Added 03/22/2022 by Ghassan Kamel, value=Honoraria Removed 03/22/2022 by Ghassan Kamel No relevant relationships by Ahmad Sharayah
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Background: Herbs have long been used as natural therapeutics, and recent controlled clinical studies have confirmed some of the presumed benefits. Hedera helix(ivy leaves) is a valuable common form related to the family Araliaceae. Many herbal preparations include extracts from their leaves as the principle active ingredient. Objective: The objective of this article is to summarize the pharmacological activities and phyto-chemical screening of H. helix. Methods: To prepare this article, the data was collected from different sources, including books, th-esis, research and etc. Results: The all-published studies depend on isolation, identification, and characterization of different active constituents of H. helix leaves, followed by the determination of biological activities in vivo and in vivo. Chemical screening has shown that H. helix leaves are a rich source of phytochem-icals demonstrating therapeutic activities, such as sterols, tannins, terpenoids, glycosides, phenols, emetine alkaloids, flavonoids, saponins, volatile and fixed oils, vitamins, carbohydrates, reducing sugars, and minerals. Further, studies of disease models and clinical trials have demonstrated an-ti-inflammatory, analgesic, cough suppressant, expectorant, anticancer, antimicrobial, anticoagu-lant, and smooth muscle relaxant activities. Conclusion: This review summarizes the bioactive constituents of H. helix leaves and their under-lying pharmacological mechanisms, clinical efficacies, and safety profiles. We also suggest potential therapeutic uses for COVID-19.
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Introduction It was traditionally taught that extracorporeal membrane oxygenation (ECMO) should be avoided in the morbidly obese due to the higher risk of mortality. Recently, a few case reports have shown that the mortality risk among this population is not significantly different than in the general population, though there may be selection bias. Veno-venous (VV) ECMO has been a useful technique to improve mortality among those afflicted with the severest forms of acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, caused by the SARS-CoV-2 virus. Case reports of ECMO therapy for ARDS due to COVID-19 in the severely morbidly obese are lacking. This is a case of a male with a body mass index (BMI) of 75 who suffered from severe ARDS and was treated with VV-ECMO successfully. Case A 54-year-old male with a past medical history of severely morbid obesity (BMI of 75), hypertension, diabetes mellitus type II, and obstructive sleep apnea presented to the emergency room with three days of fatigue, cough and dyspnea. His initial vitals revealed a fever of 101.3F, 30 breaths per minute, and hypoxia requiring 4 L O2 via nasal cannula. Initial chest xray demonstrated bilateral multifocal opacities. COVID-19 PCR testing was positive. The patient was started on dexamethasone, remdesivir, and convalescent plasma. He was also treated for community acquired pneumonia. The patient, initially admitted to the floor, continued to decompensate with worsening hypoxia requiring BIPAP and was transferred to the intensive care unit (ICU) three days after admission. Due to persistent oxygen saturations in the mid-80s on CPAP of 20 with FiO2 of 100%, patient was intubated eight days after admission. He continued to decompensate with saturations in the 70s despite maximum inhaled epoprostenol and VV-ECMO was initiated. His ECMO course was without significant events and was decannulated fifteen days after initiation. His course was complicated by an acute kidney injury which eventually required dialysis, as well as prolonged encephalopathy. Stroke work-up was negative. The patient remained ventilator dependent, underwent a tracheostomy and was discharged to a long-term acute care hospital fifty-six days after admission. He eventually was decannulated at the long-term acute care hospital. Discussion This case describes a successful VV-ECMO therapy in a severely morbidly obese 54 year-old male with ARDS due to COVID-19, which has not been previously described in case reports. Obesity should not be considered a contraindication for VV-ECMO in a select group of patients.