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Methodist Debakey Cardiovasc J ; 17(2): e33-e36, 2021.
Article in English | MEDLINE | ID: covidwho-1335453


We present a case describing the use of the AngioVac system (AngioDynamics, Inc.) and SENTINEL™ cerebral protection system (SCPS; Boston Scientific) in a patient with COVID-19 who initially presented with a large deep-vein thrombosis of the left lower extremity, complicated by a pulmonary embolism. Although he initially improved with systemic alteplase, he later developed a second large clot diagnosed in transit in the right atrium. Within 12 hours from initial thrombolysis, this large clot wedged across an incidental patent foramen ovale (PFO), the atrial septum, and the cavotricuspid annulus. We emergently performed a percutaneous clot extraction with preemptive placement of the SCPS in anticipation of cardioembolic phenomenon. A large (> 10 cm) clot was extracted without complication, and the patient was discharged home. The combined use of SCPS and AngioVac in this case suggests a potential role for percutaneous treatment of severe and consequential thromboembolic disease, especially in patients with a PFO, and may be considered as an alternative and less-invasive option in patients with COVID-19. While cerebral embolic protection devices are approved for and widely used in transcatheter aortic valve replacement procedures, there is a theoretical benefit for use in percutaneous thrombolectomies as well.

COVID-19/complications , Endovascular Procedures , Pulmonary Embolism/therapy , Thrombectomy , Adult , COVID-19/diagnosis , Embolic Protection Devices , Endovascular Procedures/instrumentation , Humans , Male , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Thrombectomy/instrumentation , Treatment Outcome
Perfusion ; 36(4): 358-364, 2021 05.
Article in English | MEDLINE | ID: covidwho-945126


The Coronavirus Disease 2019 (COVID-19) pandemic has required rapid and effective protocol adjustments at every level of healthcare. The use of extracorporeal membrane oxygenation (ECMO) is pivotal to COVID-19 treatment in cases of refractory hypoxemic hypercapnic respiratory failure. As such, our large, metropolitan air ambulance system in conjunction with our experts in advanced cardiopulmonary therapies modified protocols to assist peripheral hospitals in evaluation, cannulation and initiation of ECMO for rescue and air transportation of patients with COVID-19 to our quaternary center. The detailed protocol is described alongside initial data of its use. To date, 14 patients have been placed on ECMO support at an outside facility and successfully transported via helicopter to our hub hospital using this protocol.

Air Ambulances , COVID-19/therapy , Extracorporeal Membrane Oxygenation , Transportation of Patients , Adult , Critical Care/methods , Extracorporeal Membrane Oxygenation/methods , Female , Humans , Intensive Care Units , Male , Retrospective Studies , SARS-CoV-2/isolation & purification , Transportation of Patients/methods