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1.
ASAIO Journal ; 68:66, 2022.
Article in English | EMBASE | ID: covidwho-2032185

ABSTRACT

Background: The COVID-19 pandemic has led to a significant increase in the use of Veno-venous extracorporeal membrane oxygenation (VV ECMO) as a bridge to various outcomes including transplantation or recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of VV ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. Methods: Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-mortality, transplantation and discharge rates-of patients requiring VV ECMO support more than 50 days in duration. Data collected between February 15,2020 to February 15, 2022. Results: Reviewed outcomes in 18 patients who required VV support for >50 days. Twenty three percent (n=4) mortality rate within cohort. Three patients (16%) continue to require ECMO support at time of submission. Sixty-one percent (n=11) patients were discharged, of which sixteen percent (n=3) required a lung transplant (Table). Summary: Prolonged VV ECMO at our center was associated with comparable outcomes to the national ELSO pulmonary ECMO cohort. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population (Table Presented).

2.
ASAIO Journal ; 68(SUPPL 1):5, 2022.
Article in English | EMBASE | ID: covidwho-1912945

ABSTRACT

Purpose of study: Due to the high incidence of ARDS in those with COVID-19, ECMO centers began utilizing this therapy in early phases of the pandemic. Although receiving care at a high volume ECMO center has been associated with improved mortality amongst this patient population, there are significant obstacles associated with providing this service to those residing far from such centers. Amidst a pandemic, these challenges are compounded. Our urban, academic medical center serves as one of the highest volume ECMO referral centers in the Southeastern United States;amidst the pandemic we expanded our geographical boundaries to provide aid to those in need. Authors sought to describe characteristics of patients transported, evaluate for potential predictors of treatment success and to review our remote cannulation training and process. Additionally to identify transport associated challenges and lessons learned. Methods: Retrospective case series of critically ill, adult patients (≥18 years of age) with laboratory-confirmed COVID-19 transported to our medical center by our ECMO transport team from March 24, 2020 through June 8, 2021. Our team examined: age, gender, body mass index, ratio of arterial partial pressure to fractional inspired oxygen (P/F ratio);duration of mechanical ventilation, ECMO support and ICU admission. Descriptive statistics including mean, standard deviation, ranges, median, percentages and associated interquartile ranges (IQR) were used. Summary of results: 63 adult patients admitted to the Intensive Care Unit (ICU) with COVID associated ARDS requiring ECMO support were admitted to our ECMO center. The mean age of those transferred was 44 years old [SD 12;IQR 36-56] (Table 1). Fifty nine percent [n=37] of patients were male, fifty two percent [n=33] were African American, and the average body mass index (BMI) of our cohort was 39.7 [SD 11.3;IQR 31-48.5]. Medical history of hypertension and diabetes were commonly noted in forty six and twenty four percent of patients respectively (Table 1). All but one patient [n=62] required mechanical ventilation during their hospitalization. The majority of patients [77.8%;n=35] had severe ARDS -defined as P/F ratio less than 100-on transfer. Median days of admission and mechanical ventilation at the time of ECMO initiation were 8 days [IQR 5-12] and 4 days [IQR 2-6] respectively. Majority of patients [92% n=58] were transferred from facilities outside of our healthcare system and via ambulance [98.3% n=57]. Amidst those, eighty seven percent [n=55] were remotely cannulated (Table 2). Transport distances ranged from 2.2 to 236 miles [median 22.5 miles;IQR 8.3-79] and round trip transport times-not including time for pre cannulation preparation, cannulation, initiation of ECMO support and preparing patients for transport-ranged from 18 to 476 minutes [median 83 min;IQR 44-194]. Median duration of ECMO support was 17 days [IQR 9.5-34.5]. Duration of mechanical ventilator support was a median of 24 days [IQR 14-34]. Length of stay in the intensive care unit (ICU) [median 36 days;IQR 17-49] and hospital [median 39 days;IQR 25-57] varied. Amongst those discharged thus far, sixty percent survived [n=31]. Twenty nine percent percent [n=10] were discharged to their homes, fifty three percent [n=18] to rehabilitation facilities and nine percent [n=3] were back to the referral medical centers for continuation of care once they were determined to no longer have need for ECMO or transplantation. The majority of factors evaluated were not found to be statistically significant predictors of treatment success. Although ICU and hospital duration were noted to have p-values of significance, the associated odds ratios and small sample size make true clinical significance difficult to interpret.

4.
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S223-S223, 2022.
Article in English | EuropePMC | ID: covidwho-1781818

ABSTRACT

Introduction We present a case of a 39 year old male with nonischemic cardiomyopathy who was successfully bridged to HeartMate3 Left Ventricular Assist Device (LVAD) despite multiple life threatening complications secondary to Covid-19. Case Report 39-year-old male with past medical history notable for tobacco abuse and recently diagnosed non-ischemic cardiomyopathy presented to our institution with NYHA Class IV symptoms and was found to be in cardiogenic shock. On admission Covid-19 PCR was negative. He initially responded to the initiation of inotropic support and aggressive diuresis with normalization of his end-organ function and improvement in his symptoms over three days. He suddenly experienced rapid hemodynamic decline necessitating escalation of inotropic and mechanical circulatory support with VA ECMO and Impella 5.5. On that day, his wife felt unwell and was found to be positive for Covid-19. The patient's Covid-19 PCR was repeated and also positive. He underwent treatment with Regeneron. His hospital course was further complicated by multiple sequelae of Covid-19 including pneumonia, acute renal failure necessitating hemodialysis (HD), and Guillain Barre Syndrome (GBS) presenting with bilateral ascending paralysis extending to his hip flexors, improved with intravenous immune globulin (IVIG) therapy. Over a period of two weeks, he demonstrated improvement and was weaned from VA ECMO to Impella 5.5. Unfortunately, he was unable to tolerate weaning the Impella 5.5. He was aggressively rehabilitated. After extensive multidisciplinary discussion, LVAD implantation was recommended to the patient. Following insertion of a HeartMate3 LVAD, the patient demonstrated renal recovery and ongoing improvement in physical ability. He was discharged to an acute rehabilitation facility and was subsequently discharged home. He will be monitored for listing for cardiac transplantation pending abstinence from tobacco use. Summary Covid-19 can present with multiple life threatening complications that can add novel challenges to the management of patients with stage D cardiomyopathy. Despite complications of acute renal failure and paralysis secondary to GBS from Covid-19, our patient was successfully supported with temporary mechanical circulatory support, aggressively rehabilitated, and transitioned to a durable HeartMate 3 LVAD.

5.
ASAIO Journal ; 67(SUPPL 3):17, 2021.
Article in English | EMBASE | ID: covidwho-1481524

ABSTRACT

Introduction: Coagulopathy associated with COVID-19 presents a unique challenge when balancing the risk of thromboembolism versus bleeding complications in critically ill patients. This is particularly important in patients receiving extracorporeal membrane oxygenation (ECMO), as anticoagulation is used to offset increased thromboembolic risk, which may put patients at increased risk of periprocedural bleeding. The aim of this study is to evaluate risk of periprocedural bleeding in patients with COVID-19 on ECMO who undergo operative or percutaneous tracheostomy placement. Methods: This is an IRB approved retrospective chart review of the incidence of periprocedural bleeding in morbidly obese patients on ECMO. Participants included adults ≥18 years of age with laboratory-confirmed COVID-19 who were underwent either remote ECMO cannulation and transfer or where cannulated at an ECMO center. All participants were admitted to an ECMO ICU for daily management and subsequently underwent tracheostomy while on ECMO. Results: A total of 36 participants were included, of whom 61% were male. Participants had a median age of 47.5 (IQR 37.5-58) years and a median BMI of 38.5 (IQR 29-49) kg/m2, and 15/36 (42%) of patients had a BMI <35 kg/m2. Tracheostomy-associated bleeding occurred in 9/36 (25.0%) of patients. Subgroup analysis showed that in patients with a BMI <35 kg/m2, only 2/15 (13.3%) had periprocedural bleeding. In patients with BMI ≥35 kg/m2, 7/21 (33.3%) had periprocedural bleeding. All patients who had periprocedural bleeding required transfusion with blood products. Conclusion: Increased BMI is associated with an increased risk of bleeding complications following tracheostomy in patients on ECMO.

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