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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):S480-S480, 2022.
Article in English | Web of Science | ID: covidwho-1848417
4.
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.

5.
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.)

6.
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.

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