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


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.

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


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.

ASAIO Journal ; 66(SUPPL 3):10, 2020.
Article in English | EMBASE | ID: covidwho-984156


Background: Increased rate of thrombotic events have been described in severe COVID-19 disease leading to liberal anticoagulation strategies in patients requiring ECMO support, which might be associated to increased risk of hemorrhagic complications. We present our experience with a conservative anticoagulation approach. Objectives and Methods: Data of eight COVID-19 patients requiring veno-venous (VV) ECMO support between 3/1-8/20/20 was retrospectively analyzed. All patients received anticoagulation with IV heparin with therapeutic target PTT 50-70 seconds. Primary goal was incidence of major hemorrhagic complications, and secondary goals to determine relationship to anticoagulation range, and patient clinical outcome. Results: Mean age was 52 years (36-62). Six (75%) patients were male. Patients received ECMO support for 25 days (10-39). Therapeutic anticoagulation range was achieved 33% (24-49%) of the time, while patients remained sub-therapeutic (PTT<50") 63%, and supratherapeutic (PTT>70") 3% of the time. INR was normal (<1.2) in all patients, and thrombocytopenia (platelet count < 100,000) was observed in 3 patients (37.5%). Major bleeding complications included cerebral in 4 (50%), oro-pharyngeal in 2 (25%), and spontaneous psoas hematoma in 2 (25%) patients. No clear correlation was observed between supratherapeutic anticoagulation and development of hemorrhagic complications. Seven ECMO circuits were exchanged in 6 patients at 13.5 days (9-19). Four (50%) patients were decannulated, and 3 (37.5%) discharged from the hospital alive. Conclusions: Conservative anticoagulation strategies during V-V ECMO support for COVID-19 led to high rate of ECMO circuit exchange but did not prevent hemorrhagic complications. Additional risk factors for bleeding should be considered in these patients.