ABSTRACT
OBJECTIVE: To understand the implications of a tiered extracorporeal membrane oxygenation (ECMO) criteria framework and the outcomes of patients with COVID-19 acute respiratory distress syndrome who we were consulted on for ECMO but ultimately declined. METHODS: All patients declined for ECMO support by a large regional health care system between March 2020 and July 2021 were included. Restrictive selection criteria were enacted midway through the study stratifying the cohort into 2 groups. Primary outcomes included 30-day mortality. Secondary outcomes included reasons for declining ECMO and survival stratified by phase. RESULTS: One hundred ninety-three patients with COVID-19 acute respiratory distress syndrome were declined for ECMO within the study period out of 260 ECMO consults. At the time of consult, 71.0% (n = 137) were mechanically ventilated and 38% (n = 74) were proned and chemically paralyzed. Thirty-day mortality was 66% (n = 117), which increased from 53% to 73% (P = .010) when restrictive criteria were enacted. Patients with multisystem organ failure, prolonged ventilator time, and advanced age had respectively an 11-fold (odds ratio, 10.6; 95% CI, 1.7-65.2), 4-fold (odds ratio, 3.5; 95% CI, 1.1-12.0), and 4-fold (odds ratio, 4.4; 95% CI, 1.9-10.2) increase in the odds of mortality. CONCLUSIONS: Patients with COVID-19 acute respiratory distress syndrome declined for ECMO represent a critically ill cohort. We observed an increase in the severity of disease and 30-day mortality in consults in the latter phase of our study period. These findings may reflect our use of tiered selection criteria coupled with ongoing education and communication with referring centers, sparing both patients likely to respond to medical therapy and those who were unsalvageable by ECMO.
ABSTRACT
Low-frequency sound from large vessels is a major, global source of ocean noise that can interfere with acoustic communication in a variety of marine animals. Changes in vessel activity provide opportunities to quantify relationships between vessel traffic levels and soundscape conditions in biologically important habitats. Using continuous deep-sea (890 m) recordings acquired ~20 km from offshore shipping lanes, we observed a quieting of low-frequency noise within Monterey Bay National Marine Sanctuary (California, USA) associated with changes in vessel traffic during the onset of the COVID-19 pandemic. The frequency band 31–100 Hz effectively captured large-vessel noise while minimizing potential biases from geological and biological sources. Monthly median spectrum levels (MSL) in this band decreased during January–June 2020, as much as 2.7 dB re 1 uPa2 Hz-1 below levels in the prior two years, and they began returning to those levels by July 2020. During 2020 MSL were strongly correlated with large-vessel total gross tonnage derived from economic data, summed across all California ports (r = 0.89, p < 0.01). They were also highly correlated with regional presence of large vessels, quantified from Automatic Identification System (AIS) line-of-sight vessel tracking data and weighted by vessel speed and inverse distance from the recorder (r = 0.94, p < 0.01). Within the three-year study period, February–June 2020 exhibited anomalously quiet low-frequency noise and anomalously low statewide port activity and regional large-vessel presence. While likely a short-term change, the maximum 2020 quieting represented nearly a halving of acoustic intensity in a frequency band used by baleen whales to communicate. This illustrates the influence of offshore large-vessel traffic on sound and protected species in marine sanctuary habitats.
ABSTRACT
BACKGROUND: The purpose of this study is to examine the effects of the coronavirus disease 2019 (COVID-19) pandemic on adult lung transplants and report practice changes in the United States. METHODS: A retrospective analysis of a public dataset from the United Network for Organ Sharing was performed regarding adult lung transplantation (January 19, 2020-June 30, 2020). Data were stratified into 3 periods: pre-COVID-19 (January 19, 2020-March 14, 2020), first COVID-19 era (March 15, 2020-May 8, 2020), and second COVID-19 era (May 9, 2020-June 30, 2020). Weekly changes in waitlist inactivations (COVID-19 precautions or not), waitlist additions, transplant volume, and donor recovery were examined across eras and changes across era were correlated. RESULTS: During the first COVID-19 era, 301 patients were added to the waitlist, representing a 40% decrease when compared to the prior 8-week period. This was followed by a significant increase in listing during the second COVID-19 era (t = 2.16, P = 0.032). Waitlist inactivations decreased in the second COVID-19 era from the first COVID-19 era (t = 3.60, P < 0.001). There was no difference in waitlist inactivations between the pre-COVID era and the second COVID-19 era (P = 0.10). Weekly volume was not associated with trends in COVID-19 cases across any era, but was negatively associated with waitlist inactivations due to COVID-19 precautions entering the first COVID-19 era (r = -0.73, P = 0.04) and second COVID-19 era (r = -0.89, P = 0.003). CONCLUSIONS: Due to the COVID-19 pandemic, the United States experienced a decrease in lung transplant volume. While overall volume has returned to normal, additional studies are needed to identify areas of improvement to better prepare for future pandemics.