Long-term support of COVID-19 patients with veno-venous extracorporeal membrane oxygenation: Complications, predictors of mortality and long-term outcome

Objectives: Treatment of severe respiratory distress syndrome (ARDS) due to COVID-19 by veno-venous extracorporeal membrane oxygenation (VV-ECMO) had a mortality of up to 70% in Germany. Many patients with COVID-19 need VV-ECMO support longer than 28 days (long-term VV-ECMO). Evidence on mortality, complications during intensive care, functional status after discharge and mortality-predictors for patients supported with long-term VV-ECMO is lacking. Method(s): Retrospective study of 137 consecutive patients treated with VV-ECMO for ARDS due to COVID-19 at University Hospital Regensburg from March 2020 to March 2022. Result(s): 38% (n=52;87% male) of patients needed longterm VV-ECMO support. In these, SOFA score (median [IQR]) at ECMO initiation was 9 [8-11], age 58.2 [50.6- 62.5] years, PaO2/FiO2-ratio 67 [52-88] mmHg, pCO262 [52-74] mmHg, Murray-Score 3.3 [3.0-3.6] and PEEP 15 [13 - 16] cmH2O. Duration of long-term support was 45 [35-65] days. 26 (50%) patients were discharged from the ICU. Only one patient died after hospital discharge. At VVECMO initiation, baseline characteristics did not differ between deceased and survivors. Complications were frequent (acute kidney injury: 31/52, renal replacement therapy: 14/52, pulmonary embolism: 21/52, intracranial hemorrhage 8/52, major bleeding 34/52 and secondary sclerosing cholangitis: 5/52) and more frequent in the deceased. Karnofsky index (normal 100) after rehabilitation was 70 [57.5-82.5]. Twelve of the 18 patients discharged from rehabilitation had a satisfactory quality of life according to their own subjective assessment. Four patients required nursing support. Mortality-predictors within the first 30 days on VV-ECMO only observed in those who deceased later, were: Bilirubin >5mg/dl for > 7 days, pulmonary compliance <10ml/mbar for >14 days, and repeated serum concentrations of interleukin 8 >150ng/L. Conclusion(s): Long-term extracorporeal lung support in patients with COVID-19 resulted in 50 % survival and subsequently lead to a satisfactory quality of life and functionality in the majority of patients. It should preferably be performed in experienced centers because of a high incidence of complications. Several findings during the early course were associated with late mortality but need validation in large prospective studies.

Harnessing technology to respond to the global demand for learning during the COVID-19 pandemic

The COVID-19 pandemic generated an unprecedented global demand for learning about the disease and how to manage it. This paper draws on theWorld Health Organization (WHO)'s experience of COVID-19 knowledge-transfer to a worldwide audience of millions of learners registered on OpenWHO, WHO's massive open online course platform. It aims to illustrate the technological solutions that WHO, in collaboration with the Hasso Plattner Institute (HPI), OpenWHO's platform provider, employed in response to the unique challenges this surge in demand for learning engendered. Data on OpenWHO use, including geographic patterns and certificate attainment, were extracted from OpenWHO's internal and external reporting systems. Descriptive analysis was employed to identify trends and compare OpenWHO use with COVID-19 caseload in each WHO region. Data on the OpenWHO system load were obtained from the OpenWHO load balancer (HAProxy). The OpenWHO team responded to the need for trustworthy, evidence-based knowledge on COVID-19 via three main avenues: increased scale, targeting the needs of affected and underserved communities, and prioritising multilingualism. Each approach brought novel problems, which WHO and HPI leveraged their collaboration to meet by employing technology. This included increasing server bandwidth, expanding support teams, adding new language capabilities, and deploying functions to streamline workflows and boost learner experience. In doing so, the ability to effectively and efficiently harness technology became a critical step towards empowering learning's life-saving potential during the COVID-19 pandemic. © 14th International Conference on ICT, Society, and Human Beings, ICT 2021, 18th International Conference on Web Based Communities and Social Media, WBC 2021 and 13th International Conference on e-Health, EH 2021 - Held at the 15th Multi-Conference on Computer Science and Information Systems, MCCSIS 2021. All rights reserved.