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1.
Zeitschrift fur Herz-, Thorax- und Gefasschirurgie ; : 1-5, 2022.
Article in German | EuropePMC | ID: covidwho-1940016

ABSTRACT

Hintergrund Seit Beginn der COVID-19-Pandemie werden die globalen Gesundheitssysteme vor eine Vielzahl neuartiger Probleme gestellt. Die venovenöse extrakorporale Membranoxygenierung (vv-ECMO) stellt bei Krankheitsverläufen mit therapierefraktärem ARDS häufig eine Ultima Ratio der Therapie dar. Für eine verbesserte medizinische Versorgung ist es notwendig, potenzielle Einflussfaktoren auf den Therapieerfolg zu identifizieren. Fragestellung In dieser Arbeit sollen die Erkenntnisse eines ECMO Zentrums vorgestellt werden. Insbesondere interessierte die Frage, durch welche Faktoren das Therapieergebnis einer vv-ECMO-Therapie von COVID-19-Patienten beeinflusst wird. Material und Methoden In der Zeit zwischen März 2020 und Dezember 2021 wurden insgesamt n = 96 Patienten in unserem Zentrum mit einer vv-ECMO aufgrund eines ARDS bei COVID-19 behandelt. Es erfolgte eine retrospektive Auswertung der demografischen und gesundheitsspezifischen Faktoren. Hierbei wurden Patienten mit letalem Therapieausgang (L-Gruppe, n = 62) sowie die Überlebenden (Ü-Gruppe, n = 34) miteinander verglichen. Ergebnisse Insgesamt überlebten n = 34 (35 %) der Patienten den Krankenhausaufenthalt. Die verstorbenen Patienten hatten ein mittleres Alter von 56,7 ± 9,5 Jahren, verglichen mit 47,9 ± 12,9 Jahren bei den Überlebenden. Unter den behandelten Patienten befanden sich n = 72 (75 %) männliche und n = 24 (25 %) weibliche Patienten. In der Gruppe der verstorbenen Patienten waren n = 51 (82,3 %) Männer sowie n = 11 (17,7 %) Frauen (p = 0,047). Die Prävalenz von Vorerkrankungen wie COPD, Diabetes mellitus, Herz-Kreislauf-Erkrankungen sowie chronischer Niereninsuffizienz zeigte keinerlei Unterschiede zwischen den beiden Gruppen. Auch in Bezug auf das Vorliegen von arterieller Hypertonie und Adipositas konnte kein signifikanter Trend für einen negativen Therapieeinfluss nachgewiesen werden. Es zeigte sich für Patienten mit einem Nikotinabusus in der Anamnese jedoch eine negative Tendenz. Die häufigsten Gründe für ein Versterben waren respiratorische Insuffizienz, neurologische Insulte, Multiorganversagen und Sepsis. Diskussion Der Einsatz einer vv-ECMO bei therapierefraktärem ARDS im Rahmen einer COVID-19-Erkrankung geht weiterhin mit einer hohen Sterblichkeit einher und ist somit nur als Ultima Ratio in Betracht zu ziehen. In unserem Patientenkollektiv konnten wir erwartungsgemäß bessere Ergebnisse bei jüngeren Patienten beobachten, jedoch auch bei Frauen. Für die meisten Begleiterkrankungen konnten wir bis dato keinen negativen Einfluss auf das Therapieergebnis nachweisen. Diese Erkenntnisse könnten helfen, zukünftige Risikopatienten zu identifizieren.

2.
Z Herz Thorax Gefasschir ; : 1-5, 2022 Jul 19.
Article in German | MEDLINE | ID: covidwho-1935766

ABSTRACT

Background: Since the beginning of the COVID-19 pandemic global health systems are confronted with a large number of unknown problems. Venovenous (vv) extracorporeal membrane oxygenation (ECMO) in cases of therapy refractive ARDS often represents a last resort treatment. To improve the health care it is necessary to identify possible influencing factors. Objective: This analysis presents the findings of an ECMO centre and aims to identify potential factors with an impact on vv-ECMO therapy in cases of COVID-19. Material and methods: Between 03/2020 and 01/2022 n = 96 patients were treated with vv-ECMO in cases of a COVID-19 infection in our center. A retrospective analysis of demographic and health-specific data took place. The patients with fatal treatment outcome (L-group, n = 62) were compared to the surviving patients (Ü-group, n = 34). Results: Overall n = 34 (35%) of the patients survived the hospital stay. The patients with a fatal treatment outcome had an average age of 56.7 ± 9.5 years compared to the average age of the surviving patients of 47.9 ± 12.9 years. There were n = 72 (75%) males and n = 24 (25%) females among the treated patients, n = 51 (82.3%) of the deceased patients were male and n = 11 (17.7%) were female. The prevalence of pre-existing illnesses like COPD, diabetes mellitus, cardiovascular diseases and chronic renal insufficiency had shown no significant difference between both groups. Also, in relation to the presence of arterial hypertension and obesity we could not prove a negative influence on the treatment outcome. A nicotine abuse in the patient history showed a negative tendency. The most common reasons for the death of patients were respiratory failure, neurological injury, multiorgan failure and sepsis. Conclusion: The use of vv-ECMO in cases of therapy resistant ARDS in COVID-19 still correlates with a high mortality and as such should only be considered as a last resort of intensive care treatment.According to our expectations we could notice better therapy results for younger patients as well as for women in our patient database. In addition, for most comorbidities we could not prove any negative influence on the therapy outcome. This knowledge could help to identify future high-risk patients.

3.
Z Herz Thorax Gefasschir ; 36(4): 255-259, 2022.
Article in German | MEDLINE | ID: covidwho-1826452

ABSTRACT

Background: The novel coronavirus disease 2019 (COVID-19) can cause a severe and therapy-refractory acute respiratory distress syndrome. Temporary mechanical assistance by veno-venous extracorporeal membrane oxygenation (v.v.-EMCO) is a well-established supportive therapy, but is still associated with a high mortality. Objective: This work aimed to identify potential effects of the ECMO cannulation strategy on the outcome in COVID-19 patients. Material and methods: All patients who were treated in a single center between March 2020 and November 2021 for COVID-19-related ARDS (n = 75) were prospectively entered into an institutional database. The patients were assigned into two groups with respect to the ECMO cannulation (femorofemoral: n = 20, femorojugular: n = 55) and the outcome was retrospectively analyzed. Results: We observed severe therapy-related adverse events in both groups in more than 70% of patients with sepsis being the most common (> 50% each). The outcome (successful ECMO weaning, in-hospital death, 6­month survival) was comparable in both groups. In-hospital mortality was about 70% each; however, the duration of event-free ECMO support seemed to be prolonged in the femorojugular group. Conclusion: Regardless of the support duration, v.v.-ECMO therapy for COVID-19 is associated with high mortality rates. The cannulation strategy did not impact on the outcome; however, femorojugular cannulation might prolong the event-free support duration and facilitate the mobilization of the patients during ECMO support.

4.
Transpl Infect Dis ; 2022 May 03.
Article in English | MEDLINE | ID: covidwho-1819933

ABSTRACT

BACKGROUND: Heart transplant (HTx) recipients are at increased risk of developing infections or malignancies due to immunosuppressive medication. Thus, regular aftercare in those patients is of utmost importance. The extent of collateral damage due to the COVID-19 pandemic (delayed or canceled clinical visits and diagnostics) on high-risk patients is yet unknown. We believe that, especially for HTx-patients, data acquisition on potential pandemic-related non-attendance is crucial to improve clinical care in the future. Therefore, we aim to decipher possible COVID-19-related alterations in attendance to clinical care post-HTx using a survey-based approach. METHODS: HTx recipients two years beyond transplantation were selected (n = 75). We filed a paper-based questionnaire or an online survey containing nine items about COVID-19 related exceptional circumstances. Fifty-two patients (69%) returned fully answered questionnaires. RESULTS: A perceived impact on daily life was evident with 79% of all patients reporting moderate to severe negative influence of COVID-19 pandemic on daily routine. We detected increased non-attendance of clinical care during the COVID-19 pandemic compared to pre-pandemic time (38% vs. 6%, p<0.0001). The various diagnostic modalities of aftercare were heterogeneously affected, ranging from 2% non-attendance for influence vaccination and 18% for colonoscopy. Off note, non-attendance to clinical care within the pandemic was independent of perceived impact of the pandemia on daily life (p>0.68). CONCLUSIONS: For the first time, we objectively demonstrate significant decrease in attendance to clinical care in HTx recipients during COVID-19 pandemic. Efforts are needed to increase attendance in this highly vulnerable patient cohort. This article is protected by copyright. All rights reserved.

5.
6.
Zeitschrift fur Herz-, Thorax- und Gefasschirurgie ; : 1-3, 2022.
Article in German | EuropePMC | ID: covidwho-1668406
7.
ESC Heart Fail ; 8(6): 5568-5571, 2021 12.
Article in English | MEDLINE | ID: covidwho-1449922

ABSTRACT

Adequate immune response to vaccination remains a challenge in patients after solid organ transplantation. We report a case of a 61-year-old male patient who received a left ventricular assist device as a bridge to transplant therapy. Three months before transplantation, he suffered mild SARS-CoV-2 infection and was successfully discharged thereafter. Eight days before his successful heart transplantation, he received mRNA BNT 162b2 vaccination. Immediately after transplantation, we detected sufficient rise of nucleocapsid and spike antibodies despite immune suppression therapy. We suspect potential booster effects of the previous SARS-CoV-2 infection giving rise to adequate immune response following single vaccination.


Subject(s)
COVID-19 , Heart Transplantation , Antibodies, Viral , Humans , Immunity , Male , Middle Aged , SARS-CoV-2 , Vaccination
8.
Clin Res Cardiol ; 110(8): 1142-1149, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1303315

ABSTRACT

AIMS: Immunocompromised patients have been excluded from studies of SARS-CoV-2 messenger RNA vaccines. The immune response to vaccines against other infectious agents has been shown to be blunted in such patients. We aimed to analyse the humoral and cellular response to prime-boost vaccination with the BNT162b2 vaccine (Pfizer-BioNTech) in cardiothoracic transplant recipients. METHODS AND RESULTS: A total of 50 transplant patients [1-3 years post heart (42), lung (7), or heart-lung (1) transplant, mean age 55 ± 10 years] and a control group of 50 healthy staff members were included. Blood samples were analysed 21 days after the prime and the boosting dose, respectively, to quantify anti-SARS-CoV-2 spike protein (S) immunoglobulin titres (tested by Abbott, Euroimmun and RocheElecsys Immunoassays, each) and the functional inhibitory capacity of neutralizing antibodies (Genscript). To test for a specific T-cell response, heparinized whole blood was stimulated with SARS-CoV-2 specific peptides, covering domains of the viral spike, nucleocapsid and membrane protein, and the interferon-γ release was measured (QuantiFERON Monitor ELISA, Qiagen). The vast majority of transplant patients (90%) showed neither a detectable humoral nor a T-cell response three weeks after the completed two-dose BNT162b2 vaccination; these results are in sharp contrast to the robust immunogenicity seen in the control group: 98% exhibited seroconversion after the prime dose already, with a further significant increase of IgG titres after the booster dose (average > tenfold increase), a more than 90% inhibition capability of neutralizing antibodies as well as evidence of a T-cell responsiveness. CONCLUSIONS: The findings of poor immune responses to a two-dose BNT162b2 vaccination in cardiothoracic transplant patients have a significant impact for organ transplant recipients specifically and possibly for immunocompromised patients in general. It urges for a review of future vaccine strategies in these patients.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/prevention & control , Heart Transplantation/adverse effects , Immunity, Cellular/drug effects , Immunity, Humoral/drug effects , Immunogenicity, Vaccine , Immunosuppressive Agents/adverse effects , Lung Transplantation/adverse effects , Adolescent , Adult , Aged , Antibodies, Neutralizing/blood , Antibodies, Viral/blood , COVID-19/immunology , COVID-19 Vaccines/adverse effects , Case-Control Studies , Female , Heart-Lung Transplantation/adverse effects , Humans , Immunization Schedule , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Male , Middle Aged , T-Lymphocytes/drug effects , T-Lymphocytes/immunology , Transplant Recipients , Vaccination , Young Adult
9.
Transpl Infect Dis ; 23(4): e13681, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1295140

ABSTRACT

INTRODUCTION AND OBJECTIVES: Patients awaiting heart transplantation (HTx) are at increased risk developing severe coronavirus disease 2019 (COVID-19). Patients supported by a left ventricular assist device (LVAD) face additional risks due to coagulopathies during COVID-19. Following HTx, elevated risk factors for severe COVID-19 persist due to chronic immunosuppression and frequent comorbidities. Taken together, COVID-19 vaccination is of critical importance in all three patient cohorts. Here, we report our experience to deliver COVID-19 vaccination in a German transplant center. METHODS AND RESULTS: We screened 211 patients for contraindications and offered the remaining 186 eligible patients COVID-19 vaccination. Of those, 133 patients (71%) accepted the offer and were vaccinated. Acceptance of vaccination differed between HTx recipients (84 of 113, 74%), patients on the waiting list (34 of 47, 72%), and patients with LVAD support (28 of 50, 56%). The LVAD cohort demonstrated lower acceptance levels for vaccination compared to HTx recipients and patients awaiting HTx (74% vs. 56%; p = 0.028). CONCLUSION: We demonstrate for the first time only moderate acceptance levels of COVID-19 vaccination in HTx recipients and candidates on the waiting list compared to general population, despite perceived high-risk for severe disease. Additionally, those supported by LVAD have even lower adherence. Efforts may need to be made to increase acceptance in this vulnerable as well as cost-intensive patient cohort.


Subject(s)
COVID-19 , Heart Failure , Heart Transplantation , Heart-Assist Devices , COVID-19 Vaccines , Heart Transplantation/adverse effects , Heart-Assist Devices/adverse effects , Humans , SARS-CoV-2 , Treatment Outcome , Vaccination
10.
ASAIO J ; 66(7): 707-721, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-981428

ABSTRACT

Disclaimer: The Extracorporeal Life Support Organization (ELSO) Coronavirus Disease 2019 (COVID-19) Guidelines have been developed to assist existing extracorporeal membrane oxygenation (ECMO) centers to prepare and plan provision of ECMO during the ongoing pandemic. The recommendations have been put together by a team of interdisciplinary ECMO providers from around the world. Recommendations are based on available evidence, existing best practice guidelines, ethical principles, and expert opinion. This is a living document and will be regularly updated when new information becomes available. ELSO is not liable for the accuracy or completeness of the information in this document. These guidelines are not meant to replace sound clinical judgment or specialist consultation but rather to strengthen provision and clinical management of ECMO specifically, in the context of the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/therapy , Practice Guidelines as Topic , COVID-19 , Humans , Pandemics , SARS-CoV-2
11.
Clin Res Cardiol ; 109(12): 1531-1539, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-708875

ABSTRACT

AIMS: Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. METHODS AND RESULTS: A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). CONCLUSION: Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.


Subject(s)
COVID-19/epidemiology , Heart Transplantation/adverse effects , Immunosuppressive Agents/adverse effects , Opportunistic Infections/epidemiology , Aged , COVID-19/immunology , COVID-19/mortality , COVID-19/therapy , Female , Germany/epidemiology , Health Care Surveys , Humans , Immunocompromised Host , Male , Middle Aged , Opportunistic Infections/immunology , Opportunistic Infections/mortality , Opportunistic Infections/therapy , Risk Factors , Time Factors , Transplant Recipients , Treatment Outcome
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