ABSTRACT
Introduction: Extracorporeal membrane oxygenation (ECMO) provides advanced cardiopulmonary circulatory support for patients with cardiac and/or respiratory failure. There is an incremental use of ECMO in Latin America in the last years, given recent data on its beneficial effect on cardiogenic shock and also because of the lack of other ventricular assist devices. Method(s): Retrospective analyses of all patients who were supported with Extracorporeal Membrane Oxygenation (ECMO) at a tertiary care institution in Mexico City from January 2014 until March 2022. Result(s): A total of 53 patients were treated with ECMO support, 39 (73.5%) with veno-arterial (VA) ECMO and 14 (26.4%) with veno-venous ECMO. The median patient age was 41.8 and 37 patients were male. Primary ECMO indications were cardiogenic shock (42, 79.2%), acute respiratory distress syndrome related to COVID-19 infection (8, 15%), high-risk TAVI (1, 1.8%), cardiac arrhythmia ablation (1, 1.8%), respiratory failure secondary to pulmonary thromboendarterectomy (1,1.8%). For the case of cardiogenic shock causes, there were divided as follows postcardiotomy (23), post-myocardial infarction (10), myocarditis (3), Takotsubo cardiomyopathy (1), pulmonary thromboendarterectomy and cardiogenic shock (5) (Image). The overall mortality rate of our study was 52.8%. Conclusion(s): Extracorporeal membrane oxygenation is an effective therapy growing in use in our country, provides a therapy that is beneficial for a wide spectrum of diseases. Our study revealed a similar mortality rate according to international registries. Given the lack of other circulatory support devices in our region more efforts are needed in order to expand ECMO therapy.
ABSTRACT
The need to develop high-throughput diagnostic platforms for infectious diseases has never been more evident than with the emergence of SARS-CoV-2 and the ensued COVID-19 pandemic. Microfluidics, in tandem with its multiplexing capabilities, high sensitivity, and potential for automation, provides a unique advantage towards the development of high-throughput serological diagnostic platforms. Here, we present a microfluidic device that detects IgG or IgM raised against four SARS-CoV-2 antigens (spike, S;S1 subunit, S1;the receptor-binding domain, RBD;and nucleocapsid, N) from 50 serum samples in parallel. We validated the platform with a cross-sectional cohort of 66 samples from confirmed COVID-19 patients and a pre-pandemic control of 34 serum samples collected in 2018. The analysis of both antibodies against all four viral antigens provided a sensitivity of 90.4% and a specificity of 94.1%, with both parameters increasing to 100% in late-stage samples (21-30 days after symptoms onset). We expect our device to open the door to massive serological testing, impacting diagnostics, vaccine development, and epidemiological understanding of COVID-19. © 2021 MicroTAS 2021 - 25th International Conference on Miniaturized Systems for Chemistry and Life Sciences. All rights reserved.
ABSTRACT
Background : Heparin-induced thrombocytopenia (HIT) is an antibody-mediated reaction against the heparin-platelet factor 4 complex (H-PF4). Incidence in patients with extracorporeal circulation membrane (ECMO) is unknown. Aims : We describe a case of HIT confirmed during ECMO support in a COVID-19 patient. Methods : N/A A 48 year-old man with severe COVID-19 confirmed by RT-PCR for SARS-CoV2, was admitted to intensive care unit (ICU). After 21 days of the diagnosis he required mechanical ventilation support and V-V ECMO. Since his admission he received anticoagulation with enoxaparin 80 mg SC every 12 h, when ECMO started, he continued anticoagulation with intravenous infusion of 700 U/hour of unfractionated heparin (UFH). On the third day of infusion, there was a decrease in platelets > 50% (nadir 25,000/mm3 ), it was documented 6 points in a 4T HIT score having a probability 64% for HIT. It was confirmed by functional test with platelet aggregometry induced by UFH using the Born method. UFH was suspended and fondaparinux 7.5 mg SC every 24 h. We made serial measurements of anti-Xa (Stago ® ). Therapeutic response to HIT was documented at day 9 from the start of fondaparinux, without requiring an ECMO membrane change. Conclusions : The diagnosis of HIT was made by clinical suspicion, using the 4T HIT score and later confirmation platelet aggregometryUFH induced. The usual pharmacological treatment is based on argatroban, bivalirudin, and lepirudin. To our knowledge, there is only one case reported with fondaparinux as treatment in ECMO. Determination of plasma levels by antiXa activity was used to guide dosing because previous studies have reported bleeding rates between 10 to 22% with fondaparinux. This is a success case of fondaparinux as treatment for HIT in an ICU patient with ECMO support, and the first one in the clinical context of severe COVID -19 infection.