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ASAIO Journal ; 68:62, 2022.
Article in English | EMBASE | ID: covidwho-2032180


Background: Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is increasingly being utilized to manage critical COVID-19 associated ARDS (CCAA) in patients who fail medical optimization and mechanical ventilatory support. The aim of this study was to determine the probability of weaning patients from ECMO over time and whether a subset of patients should be considered for lung transplantation. Additionally, we investigated when lung transplant should be considered after VV ECMO support. Methods: 49 patients with CCAA who required ECMO between January 2020 and September 2021 were investigated. Baseline patient demographics, clinical, laboratory, and follow-up data were compared. The change in probability of ECMO weaning based on duration of ECMO support was studied using a univariate analysis. Additionally, patients who received lung transplantation following VV ECMO for COVID-19 during this same period were studied to compare outcomes to those of patients with only VV ECMO support. Cox proportion hazard analysis was performed to determine predictors of survival in patients who required greater than 28 days of ECMO support. Yuden index was used to determine change in probability of survival with time on ECMO. Results: Of 49 patients, 17 (35%) received lung transplants and 32 (65%) remained on ECMO for >28 days. The probability of weaning patients from ECMO was highest within the first 10 days (60%);beyond 40 days, it was 5.1% (Fig. A). The probability of successfully weaning patients from ECMO significantly decreased over time and ECMO support greater than 28 days (Yuden index, Hazard ratio: 1.09, 95% CI;1.00-1.03) was associated with a significantly increased risk of mortality. Additionally, both survival to hospital discharge (p<0.001, Fig. B) and post-discharge survival (p<0.001, Fig. C) were significantly greater in those who were weaned from ECMO prior to 28 days than those who were weaned after 28 days. In those who could not be weaned from ECMO, lung transplantation (HR:0.47, p<0.01, 95% CI 0.17-0.94), ECMO duration (HR:1.09, p=0.01, 95% CI 1.00-1.03) and higher BUN levels (HR:1.02, p<0.01, 95% CI 1.01- 1.46) prior to ECMO initiation were independent predictors of survival. ECMO support of greater than 8 days was associated with a statistically significant increase in mortality compared to those who received fewer than 8 days of support (Yuden index, HR 1.96, CI 1.06-5.51). Furthermore, the projected survival of patients on ECMO support for greater than 8 days was substantially worse than those requiring fewer than 8 days of support (Fig. C and D). Conclusion: This study suggests that survival and accompanying lung recovery is more probable in patients who require a short duration of ECMO support whereas those who require longer durations, particularly exceeding 28 days, is associated with a lower rate of survival. (Figure Presented).

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S371-S372, 2022.
Article in English | EuropePMC | ID: covidwho-1989197


Purpose Traditionally, severe acute respiratory distress syndrome (ARDS) patients on veno-venous extracorporeal membrane oxygenation (VV ECMO) receive significant sedation and neuromuscular blockade (NMB) to facilitate lung protective mechanical ventilation. However, we previously showed the feasibility of managing these patients without mechanical ventilation, sedation, or NMB. Reduced levels of sedation allows patients to begin physical and occupational therapy (PT/OT) early on. Here, we investigate the impact of early PT/OT initiation on day of discharge (DOD) functional activity for severe ARDS patients managed on VV ECMO. Methods This is a retrospective review of all patients who underwent VV ECMO as management for severe ARDS at a single academic center from February 2018 to June 2021. Data collected included patients’ demographics, co-morbidities, etiology of ARDS, days of ECMO support before PT/OT initiation, and ambulation distance and PT/OT Activity Measure for Post-Acute Care (AMPAC) Six-Clicks score on DOD. Results 67 patients were included in this study. Those with >7 days on VV ECMO had decreased ambulation and AMPAC scores compared to those with < 7 days (N=41, 70.5 ± 113.3ft vs N=26, 162.1 ± 154.1ft, p<0.01, 12.3 ± 5.9 vs 16.4 ± 6.8, p=0.01, respectively). PT/OT initiation within 7 days after starting VV ECMO significantly improved ambulation and AMPAC scores compared to those with >7 days of VV ECMO prior to any PT/OT (N=30, 163.5 ± 160.5ft vs N=37, 59.5 ± 93.5ft, p<0.001, 16.6 ± 7.1 vs 11.8 ± 5.2, p<0.01, respectively). In patients with >7 days on VV ECMO, those who began PT/OT within 10 days of starting VV-ECMO had improved ambulation and AMPAC scores compared to those with >10 days of VV ECMO prior to PT/OT (N=9, 151.8 ± 164.8ft vs N=32, 44.2 ± 77.8ft, p<0.01, 16.5 ± 7.7 vs 11.0 ± 54.5, p<0.01, respectively). Conclusion Early PT/OT initiation in severe ARDS patients managed on VV ECMO is associated with improved patient functional activity on DOD. This may provide benefits such as enhanced recovery, increased ability to complete activities of daily living, and improved cognitive health. Our study further supports the use of VV ECMO in treatment of severe ARDS without mechanical ventilation, sedation or NMB and specifically demonstrates PT/OT should be started early following initiation of VV ECMO to improve patients’ functional outcomes.

Arch Razi Inst ; 76(5): 1165-1174, 2021 11.
Article in English | MEDLINE | ID: covidwho-1744449


The novel coronavirus disease 2019 (COVID-19)-related pandemic has been in existence for almost 2 years now after its possible emergence from a wet market in the city of Wuhan of the Chinese mainland. Evidence of the emergence and transmission of this virus was attributed to bats and pangolins. The causative virus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has rapidly spread globally, affecting humans considerably with its current death toll to be over 4.7 million out of more than 233 confirmed cases as of September 2021. The virus is constantly mutating and continuously trying to establish itself in humans by increasing its transmissibility and virulence through its numerous emerging variants. Several countries have been facing multiple waves of COVID-19 outbreaks one after the other, putting the medical and healthcare establishments under tremendous stress. Although very few drugs and vaccines have been approved for emergency use, their production capabilities need to meet the needs of a huge global population. Currently, not even a quarter of the world population is vaccinated. The situation in India has worsened during the ongoing second wave with the involvement of virus variants with a rapid and huge surge in COVID-19 cases, where the scarcity of hospital infrastructure, antiviral agents, and oxygen has led to increased deaths. Recently, increased surveillance and monitoring, strengthening of medical facilities, campaigns of awareness programs, progressive vaccination drive, and high collaborative efforts have led to limiting the surge of COVID-19 cases in India to a low level. This review outlines the global status of the pandemic with special reference to the Indian scenario.

COVID-19 , Animals , COVID-19/epidemiology , COVID-19/veterinary , Disease Outbreaks , India/epidemiology , SARS-CoV-2
Journal of Heart and Lung Transplantation ; 40(4):S398-S398, 2021.
Article in English | Web of Science | ID: covidwho-1187474