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1.
ASAIO Journal ; 68:140, 2022.
Article in English | EMBASE | ID: covidwho-2032190

ABSTRACT

Background: Timing of tracheostomy in COVID-19 patients supported with extracorporeal oxygenation membrane (ECMO) remains unclear. This study aims to compare the short-term outcomes in early (≤7 days from ECMO insertion) (ET) versus late (LT) tracheostomy. Methods: Charts of COVID-19 patients with tracheostomy from 2020 to 2021 were reviewed, retrospectively. Primary endpoint was in-hospital mortality. Secondary endpoints were analgesics/sedatives doses, length of treatment (LOT), and initiation of physiotherapy (PT). Results: Eight patients with ET were compared to six patients with LT. Mean age was 41.4±12.5 (ET) and 49.5±6.9 (LT) years. In both groups, 50% were male with comparable BMI. Twelve patients received venovenous (VV) and two received veno-arterial (VA) ECMO. Tracheostomy post ECMO cannulation was performed in 12 [ET:6(75%);LT:6(100%)] patients, whereas in the remaining two patients, it was performed immediately after initiation of ECMO support. Average duration of ECMO support was 48.0±21.3 (ET) than 42.2±27.0 (LT) days, P=0.34. Requirement of sedatives before [ET:6.4±4.6;LT:9.3±5.3;P=0.15] and after [ET:21.6±11.9;LT:12.2±14.0;P=0.11] along with analgesics before [ET:6.3±4.9;LT:7.0±6.5;P=0.41] and after [ET:19.0±6.9;LT:14.8±15.5;P=0.28] tracheostomy was comparable. No difference was observed in the LOT during sedatives/ analgesics dosing after tracheostomy. However, the LOT before tracheostomy was significantly longer in sedatives [ET:2.9±3.1;LT:11.8±6.2, P<0.01] and analgesics [ET:2.9±2.8;LT:9.8±3.5, P<0.01], explained by the longer interval between ECMO insertion and tracheostomy in LT group. Compared to LT, number of days from ECMO insertion to first PT session was significantly shorter in ET patients [ET:13.6±5.6;LT:26.5±4.5, P<0.01]. In-hospital mortality rate was 21.4% [ET:1(13%);LT:2(33%), P=0.33] patients with comparable ICU stay [ET:56.9±18.6;LT:50.2±26.4, P=0.30] between groups. Conclusion: Although the advantages of ET to reduce the requirement of analgesics and sedatives amongst COVID19 patients supported with ECMO were like LT group, ET was associated with early initiation of PT and improved survival.

2.
Journal of Heart and Lung Transplantation ; 41(4):S184-S184, 2022.
Article in English | Web of Science | ID: covidwho-1849104
3.
Journal of Heart and Lung Transplantation ; 41(4):S313-S313, 2022.
Article in English | Web of Science | ID: covidwho-1849103
4.
Journal of Heart and Lung Transplantation ; 41(4):S480-S480, 2022.
Article in English | Web of Science | ID: covidwho-1848417
5.
Journal of Heart and Lung Transplantation ; 41(4):S309-S310, 2022.
Article in English | Web of Science | ID: covidwho-1848283
6.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S184-S184, 2022.
Article in English | EuropePMC | ID: covidwho-1782143

ABSTRACT

Purpose Physical functioning in patients undergoing extracorporeal membrane oxygenation (ECMO) related to strict bedrest requirements is debilitating. Physical therapy (PT) in these patients can be beneficial. However, the data in COVID-19 associated with acute respiratory distress syndrome (ARDS) is not well characterized. We present our experience with ambulation in patients receiving veno-arterial-venous (VAV) ECMO support. Methods Clinical charts of COVID-19 associated ARDS patients with VAV-ECMO support who received PT sessions between January 2021 and October 2021 were retrospectively reviewed and analyzed. Mobility functions were assessed. Episodes of oxygen saturation and hypotension were noted as primary outcomes. Results Eight patients were placed on VAV-ECMO for decompensated heart failure with right axillary artery cannulation via vascular graft and right internal jugular vein double lumen (Avalon) cannula. Mean age was 46.9 ± 10.3 years, and BMI was 30.6 ± 4.4 kg/m2 with five males. Mean duration of ECMO support was 53.6 ± 13.4 days. Average PT sessions per patient were 22.8 ± 12.2, with average days to PT initiation from ECMO insertion being 19.0 ± 8.1 days. The total average time per daily PT session was 27.2 ± 9.3 minutes. The ability to perform mobility functions with minimal, moderate, total, stand-by, contact-guard assistance for all patients is listed in the table. During PT sessions, a total of 14 episodes of oxygen desaturation and six episodes of hypotension in four patients were noted. There were no events of any cannula displacement. Of all, three are still in the hospital supported by ECMO, three transferred to the lung transplant center, one died in hospital, and one discharged home. Conclusion VAV ECMO support via right axillary and RIJ dual lumen cannulation provides a safe strategy for prolonging support and effective rehabilitation in severe COVID-19 related ARDS patients complicated with RV failure.

7.
Journal of Heart & Lung Transplantation ; 41(4):S480-S480, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783374

ABSTRACT

The role of ECMO support for COVID-19 patients with severe respiratory failure has evolved over the course of the pandemic. Rapid exchange of experience among caregivers led to changes in ECMO support strategies, and patient management that resulted in improved outcomes in recent pandemic waves. We present our 18 months experience comparing patient outcomes in 2020 vs 2021. We present a single institution retrospective analysis of patients receiving ECMO for COVID-19 ARDS. Patient data include demographics, comorbidities, time from admission to intubation and to initiation of ECMO support, type and duration of ECMO support, major patient and ECMO circuit complications, and hospital survival to discharge, or acceptance/transfer to lung transplant center. A total of 20 patients were identified for analysis. The cohort was predominantly male (65%) with an age and body mass index (BMI) average of 49.2±10.2 years and 32.8±5.9 kg/m2, respectively The average length of stay was 44.8±16.3 days and 55%. Most common support mode was veno-venous ECMO (90%) with a right femoral vein/right internal jugular cannulation (60%), and 75% required ECMO-circuit exchange. Comparing patients supported in 2020 vs 2021, time from intubation-to-ECMO, admission-to-tracheostomy, and ECMO-to-discharge were statistically significant (p=0.015;0.014;0.05;CI 95%). Overall survival rate was 65%, with a significant increase to 83% in 2021. Congruently, 55% of all discharged patients underwent ambulatory physical therapy treatment. ECMO-related complications were observed in 30% of the patients, including cardiovascular accident (CVA) (20%), clotting of the system (15%), and hemorrhaging from tracheostomy requiring revision (20%). When comparing groups, early tracheostomy was related to improved survival (p=0.014, CI 95%). 35% patients were accepted / transferred for lung transplantation. Changes in management of patients receiving ECMO for COVID19 ARDS, including anticoagulation with bivalirudin, early tracheostomy and physical therapy, conversion to VAV ECMO, and referral to lung transplant resulted in 60 day hospital survival of 83% in 2021. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

8.
The Journal of Heart and Lung Transplantation ; 41(4):S313-S313, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783361

ABSTRACT

The use of mesenchymal stromal cells (MSC) was recently proposed as a promising intervention for COVID-19 related respiratory failure (RF). Prior studies have suggested that its larger size might lead to entrapment in extracorporeal membrane oxygenation (ECMO), affect circuit function, and attenuate its efficacy. We present a successful case of a severe COVID-19 patient treated with MSC-derived exosomes while receiving veno-venous (VV) ECMO support. 41-year-old unvaccinated obese White male with no past medical history presenting with shortness of breath and a +COVID-19 nasopharyngeal test was admitted receiving high-flow nasal cannula (HFNC), remdesivir, and dexamethasone (Day 1), followed by intubation (day 5), and a peripheral VV ECMO insertion (day 10) due to worsening RF. We used bivalirudin for post-ECMO anticoagulation. Subsequently, he received the first cycle of MSC-derived exosomes on alternative days (day 1, 3, & 5) between days 13-17, followed by the second cycle between days 34-38. After administration of exosomes, the plasma concentration of inflammatory markers reduced, including a decrease of 77% for ferritin, 74% for CRP, and 62% for procalcitonin in approximately one week, along with consistent improvement of PaO 2 /FiO 2 ratio. ECMO membrane oxygenator was exchanged on day 23 at the time of tracheostomy. After successful weaning, ECMO decannulation was performed on day 47, and the patient was discharged home on day 61. ECMO has emerged as a supportive strategy for patients with severe COVID-19 related RF. The patient's inflammatory response has been implicated in the pathophysiology of lung failure. Multiple pharmacological methods are employed to control the severity of this inflammatory response, thus preventing progression to the fibrotic stage of the disease. In our experience, MSC-derived exosomes neither resulted in any side effects nor impaired the function of ECMO and might have enhanced the recovery of the patient. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

9.
Journal of Heart & Lung Transplantation ; 41(4):S309-S310, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783360

ABSTRACT

Lung transplant is considered a last resource surgical therapy for non-resolving COVID-19-associated acute distress respiratory syndrome (ARDS) and refractory hypoxemia. Google trends (GT) is an ongoing-developing web-kit providing feedback on specific general population's interests. This study uses GT to analyze the United States (US) general population interest in LT as COVD-19/ARDS salvage therapy. GT was used to access data searched for the term lung transplant. The gathered information included data from January 2016 through October 2021 within US territories. Search frequency, time intervals, sub-regions, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, and a value of 100 represented overall peak popularity. The number of Google searches related to the term lung transplant has remained steady interest over time and surged in congruence with the appearance of COVID-19 in the US. From January 2016 until February 2019, interest has ranged from 29 to 58% (average 40%). Following the COVID-19 surge, average interest shifted up to 49%, with an all-time increase in November 2019, February 2020, and June 2020, of 90, 65 and 100%. Over time, the lead frequency of searches in sub-regions, metro areas, and cities, were Pennsylvania, Gainesville, FL, and Philadelphia, PA, respectively. Top related topic and top related query in search frequency, over time are electronic cigarette and lung transplant covid. At a glance, medical-relevant websites fail to provide adequate information for LT patient therapeutic education (PTE). GT complements the understanding of interest in LT, especially in consideration of the COVID-19 pandemic's perspective. When properly interpreted, the use of these trends can potentially improve on PTE and therapy awareness via specific medical relevant websites. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

10.
Journal of the American College of Cardiology ; 79(9):2746, 2022.
Article in English | EMBASE | ID: covidwho-1757980

ABSTRACT

Background: Acute respiratory distress syndrome (ARDS) is characterized by hypoxemia and non-hydrostatic pulmonary edema. While ARDS is associated with a high mortality rate, its conjunction with cardiogenic shock (CS) can lead to devastating outcomes. ARDS is managed via lung protective ventilation with low tidal volumes and positive end expiratory pressures. Prone positioning has emerged as a supplementary strategy with beneficial effects on gas exchange, respiratory mechanics, and hemodynamics. Our case underlines the feasibility of intra-aortic balloon pump counterpulsation (IABP) with concurrent prone positioning in a patient with ARDS and CS. Case: 71-year-old male with history of coronary artery disease, hypertension, hyperlipidemia, and chronic kidney disease, presented to the emergency department with new onset chest pain. EKG showed ST-segment elevations in leads V1-V2 consistent with acute anterior wall myocardial infarction. Patient underwent percutaneous coronary intervention to the left anterior descending artery.Due to worsening hemodynamics and CS, it was decided to place a left axillary IABP. Hospital course was further complicated by acute pulmonary edema and ARDS requiring emergent intubation and mechanical ventilation. Patient was also started on renal replacement therapy given progression of renal failure. Decision-making: Given the onset of ARDS, the patient was placed in prone position for 12-16 hours/day for 5 days. There was no special technique required during proning, other than additional staff to ensure IABP stability. Gradual improvement in hemodynamics was attained, including an increase in cardiac index from 2.1 to 3.4, and a decrease in pulmonary vascular congestion. Conclusion: With the emergence of COVID-19 pandemic, the incidence of ARDS has increased significantly, with simultaneous occurrence of CS in some of these patients. Prone positioning has become one of the main therapeutic modalities in the management of ARDS. Our case highlights the feasibility of axillary IABP while implementing prone positioning in patients with concomitant ARDS and CS.

11.
ASAIO Journal ; 67(SUPPL 3):10, 2021.
Article in English | EMBASE | ID: covidwho-1481520

ABSTRACT

Introduction: Anticoagulation strategies for extracorporeal membrane oxygenation(ECMO) support in COVID-19 patients remains controversial. This study aims to present our experience with anticoagulation management and monitoring strategies including bleeding complications during ECMO support. Methods: Retrospectively, we reviewed charts of twelve patients supported with ECMO for COVID-19 from March 2020 to June 2021. Of these, eight patients with veno-venous(VV) ECMO received intravenous(IV) heparin anticoagulation and four with veno-arterial-venous(VAV) ECMO received IV Bivalirudin. Therapeutic partial thromboplastin time(PTT) goal was 50-70seconds in both groups. Results: Average age was 52 years with nine males. All patients had elevated D-dimer level before and during ECMO support. Mean time on ECMO support was 800.3 hours. Overall, therapeutic PTT was achieved in 38% with significant outcomes in Bivalirudin when compared to Heparin group [Heparin:33%(24-49%);Bivalirudin:51%(24-92%), P<0.00001]. Number of patients remained sub-therapeutic (PTT<50s) was 60% [Heparin:63%;Bivalirudin:48.2%], and supra-therapeutic (PTT>70s) was 2% [Heparin:3%;Bivalirudin:0.9%]. In heparin group, major bleeding complications included cerebral in 4, oropharyngeal in 2, and psoas hematoma in 2 patients. Whereas, in Bivalirudin group, only one patient experienced postoperative anemia from acute blood loss. Overall, six died in hospital [Heparin:5patients;Bivalirudin:1patient];two discharged to another hospital for lung transplant [Heparin:0patient;Bivalirudin:2patients, 1 died before listing];three discharged to home alive [Heparin:3patients;Bivalirudin:0patient], and one still remains in the hospital [Heparin:0patient;Bivalirudin:1patient]. Conclusion: Although results are promising for Bivalirudin in terms of lesser hemorrhagic complications and reduced mortality, smaller sample size may have attenuated the findings. Future studies are warranted.

12.
ASAIO Journal ; 67(SUPPL 3):45, 2021.
Article in English | EMBASE | ID: covidwho-1481481

ABSTRACT

Objective: ECMO is implemented as rescue therapy in patients with ARDS secondary to COVID-19 and refractory hypoxemia. Google Trends(GT) is a consistent development web-tool of data feedback providing information on the specific population's interests. This study aims to use GT to analyze the United States(US) general population interest on ECMO as COVID-19 ARDS salvage therapy. Methods: GT was used to access data searched for the term ECMO and COVID-19. Gathered information included data from March2020 through July2021 within the US. Search frequency, time intervals, locations, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, with a value of 100 representing overall peak popularity. Results: The number of Google searches related to the terms ECMO and COVID-19 surged and sustained interest over time since the initial reports of COVID-19 in the US, from an initial mean of 34% in March2020 to a 100% interest by April, resulting in an up-to-date overall average of 40.6%. Over time, WV, MN, and IA lead frequency of searches in subregion and metro areas. Conversely, Houston leads the city with the highest interest. Top searches terms by frequency include: ECMO-machine, COVID-ECMO, what-is-ECMO, ECMO-medical and ECMO-ventilator. Parallel to this, the related rising terms are: COVID-ECMO, ECMOmachine-COVID, ECMO-for-COVID, and ECMO-treatment-COVID. Websites seemingly fail to properly address these. Conclusions: GT complements the understanding of interest in ECMO for COVID-19. Interpreted properly, the use of GT can potentially improve on patient therapeutic education and therapy awareness via specific official websites.

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