ABSTRACT
Background: Use of venous-venous extracorporeal membrane oxygenation (VV-ECMO) increased significantly during the Coronavirus Disease 2019 (COVID-19) pandemic. COVID-19 has been associated with an immunothrombotic phenotype with increased pulmonary angiopathy, hypercoagulability and thrombosis (Patel et al., 2020). We evaluated whether the immunothrombotic phenotype of COVID-19 influenced membrane lung (ML) dysfunction in the Cardiohelp System (Getinge). Methods: Single centre retrospective cohort study comparing incidence and clinical indices prior to first circuit change (CC) for ML dysfunction, between consecutive COVID-19 and non-COVID-19 patients. Results: 210 adult patients (age≥16) treated with VV-ECMO between 20th Feb 2019 and 25th February 2021 with the Cardiohelp System were included. COVID-19 patients (N=96) had a greater incidence of CC compared to non-COVID-19 patients (N=114) (60% vs 37%, P<0.001) (Table 1). Despite no difference in mortality (17% vs 16%;P>0.05), COVID-19 patients who required CC had a significantly longer ECMO duration (19.52 vs 12.38 days;P<0.0001). Both groups had similar time to CC (11.71 vs 9.16 days;P>0.05). COVID-19 patients showed significantly greater increase in MO resistance prior to CC versus non-COVID-19 patients (ΔTransmembrane pressure/blood flow: 1.4 versus 0.7 mmHg/L/minute;P<0.0001). Changes from 5 days prior to day of CC that were different in COVID-19 compared to non-COVID-19 included D-dimer (1328 vs 15190ng/ml;P<0.0001) and fibrinogen (-0.99 vs -1.64g/L;P<0.0001). Conclusion: COVID-19 patients showed increased incidence of MO resistance despite changes in D-dimer and fibrinogen being less obvious compared to non-COVID-19 patients. This may reflect altered pathophysiology and increased immunothrombosis in COVID-19 patients which requires further investigation.
ABSTRACT
China's supply-side conservation efforts in the past decades have led to two bewildering juxtapositions: a rapidly expanding farming industry vs. overexploitation, which remains one of the main threats to Chinese vertebrates. COVID-19 was also the second large-scale zoonotic disease outbreak since the 2002 SARS. Here, we reflect on China's supply-side conservation strategy by examining its policies, laws, and practices concerning wildlife protection and utilization, and identify the unintended consequences that likely have undermined this strategy and made it ineffective in protecting threatened wildlife and preventing zoonotic diseases. We call for China to overhaul its conservation strategy to limit and phase out risky and unsustainable utilization, while improving legislation and enforcement to establish full chain-of-custody regulation over existing utilization.