ABSTRACT
Background: Little is known on the impact of COVID-19-associated intensive care medical therapy including extracorporeal life support/membrane oxygenation (ECMO) on the long-term well-being of survivors. The aim of this study is to comprehensively characterize recovery six months after ECMO treatment for COVID-19-associated pulmonary failure. Method(s): All patients requiring veno-venous or veno-arterial ECMO for COVID-19-associated respiratory and/or circulatory failure between April 2020 and September 2021 were included in this retrospective analysis. Parameters included age, gender, time of ECMO treatment, and survival at hospital discharge and 6 months post-ECMO initiation. Comprehensive follow-up covering cardiopulmonary, neurocognitive, psychological, and functional status, as well as the health-related quality of life was assessed in discharged survivors. Result(s): Sixty patients (median age: 60.5 [51.0-65.0] years, range: 20-72 years, 23.3% female) were treated with venovenous or veno-arterial ECMO for severe COVID-19-related pulmonary failure with or without associated circulatory failure. 41.7% (n = 25) were successfully weaned off ECMO after 24.0 (17.5-32.5, range: 10-65) days, and 40.0% (n = 24) survived to hospital discharge. At 6 months post ECMO initiation, 20 patients were alive (33.3% of all patients, 83.3% survival conditioned on survival to discharge). Of these, 19 underwent comprehensive follow-up after 6.0 (5.0-9.0) months (133 months of cumulative follow-up time). 57.9% showed no relevant or only mild deficits, while 26.3% showed moderate, and 15.8% severe deficits. Cardiopulmonary status (mMRC level: 2.0 [1.0-2.0], 84.2% <= 2, NYHA level 2.0 [2.0-3.0], no patient in need of home oxygen) and level of independence (73.7% with no or mild disability and independent in daily life) were satisfactory. The rate of cognitive impairments was substantial (52.6%). In 21.1%, minimal or slight depression was observed, in 26.3% moderate depression, and 15.8% showed signs of post-traumatic stress disorder. Altogether, marked impacts on social and work life were observed. Conclusion(s): ECMO can serve as a salvage therapy for patients with severest COVID-19-related pulmonary failure, but the total burden of deficits six months after ECMO initiation is substantial with effects on social life and work status. The focus of our efforts thus needs to shift from solely acute survival to meaningful long-term recovery.
ABSTRACT
COVID-19 pneumonia and community-acquired pneumonia (CAP) have been associated with morbidity and mortality. The aim of this study was to evaluate the outcome of hospitalized patients with COVID-19 pneumonia versus CAP in terms of mortality. This was a retrospective cohort study conducted between pre-COVID-19 era (May 2019–November 2019) and COVID-19 era (May 2020–November 2020). The study included all adult patients with COVID-19 pneumonia (Group 1) and adult patients with CAP but are COVID-19 negative (Group 2). A total of 106 patients were included in the study, of which 56 were in the COVID-19 pneumonia group and 50 in the CAP group. Patients who developed acute kidney injury (AKI) were 60.7% (n = 34) in Group 1 and 48% (n = 24) in Group 2. Mortality occurred in 37.5% (n = 21) patients in Group 1 and 12.0% (n = 6) in Group 2 (P = 0.003). A total of 52 patients required admission to intensive care unit (ICU), of which 44.6% (n = 25) were in Group 1 and 54.0% (n = 27) in Group 2. Of the 58 patients who developed AKI, 3 (8.8%) patients in Group 1 passed away compared to none in Group 2. Moreover, 58.8% patients (n = 20) in Group 1 and 70.8% patients (n = 17) in Group 2 required ICU admission. Mortality rate in the ICU was 80.0% (n = 16) and 35.3% (n = 6) in Groups 1 and 2, respectively (P = 0.006). The overall mortality rate was higher in case of COVID-19 patients than those with CAP. In case of patients with AKI, mortality rate in the ICU was significantly higher in COVID-19 pneumonia patients compared to CAP patients.
ABSTRACT
INTRODUCTION: COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand. METHODS: We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a 'Virtual Ward' for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care 'Hot Hub'. This allowed the safe and managed readmission of those patients who deteriorated at home. RESULTS: During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month. CONCLUSION: It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.