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1.
Ann Thorac Surg ; 2022 Feb 18.
Article in English | MEDLINE | ID: covidwho-1693920

ABSTRACT

BACKGROUND: We reviewed our experience with 505 patients with confirmed COVID-19 supported with ECMO at 45 hospitals and estimated risk factors for mortality. METHODS: A multi-institutional database was created and utilized to assess all patients with COVID-19 who were supported with ECMO. A Bayesian mixed-effects logistic regression model was estimated to assess the effect on survival of days between COVID-19 diagnosis and intubation, as well as age at ECMO cannulation. RESULTS: Median time on ECMO was 18 days (interquartile range=10-29). All 505 patients have separated from ECMO: 194 patients (38.4%) survived and 311 patients (61.6%) died. Survival with veno-venous ECMO was 184 of 466 patients (39.5%), while survival with veno-arterial ECMO was 8 of 30 patients (26.7%). Survivors had lower median age (44 versus 51 years, p<0.001) and shorter median time interval from diagnosis to intubation (7 days versus 11 days, p=0.001). Adjusting for several confounding factors, we estimated that an ECMO patient intubated on day 14 post COVID-19 diagnosis vs day 4 had a relative odds of survival of 0.65 (95% Credible Interval [CrI]:0.44-0.96, posterior probability of negative effect: 98.5%). Age was also negatively associated with survival: relative to a 38-year-old we estimated that a 57-year-old patient had a relative odds of survival of 0.43 (95% CrI:0.30-0.61, posterior probability of negative effect: >99.99%). CONCLUSIONS: ECMO facilitates salvage and survival of select critically ill patients with COVID-19. Survivors tend to be younger and have shorter time from diagnosis to intubation. Survival of patients supported with only veno-venous ECMO was 39.5%.

2.
Ann Thorac Surg ; 113(5): 1452-1460, 2022 May.
Article in English | MEDLINE | ID: covidwho-1540376

ABSTRACT

BACKGROUND: The role of extracorporeal membrane oxygenation (ECMO) in the management of patients with COVID-19 continues to evolve. The purpose of this analysis is to review our multi-institutional clinical experience involving 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO. METHODS: This analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 1, 2020. Differences by mortality group were assessed using χ2 tests for categoric variables and Kruskal-Wallis rank sum tests and Welch's analysis of variance for continuous variables. RESULTS: Median ECMO time was 15 days (interquartile range, 9 to 28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with venovenous ECMO was 87 of 188 patients (46.3%), whereas survival with venoarterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, P < .001) and shorter median time from diagnosis to ECMO cannulation (8 versus 12 days, P = .003). For the 90 survivors, adjunctive therapies on ECMO included intravenous steroids (64), remdesivir (49), convalescent plasma (43), anti-interleukin-6 receptor blockers (39), prostaglandin (33), and hydroxychloroquine (22). CONCLUSIONS: Extracorporeal membrane oxygenation facilitates survival of select critically ill patients with COVID-19. Survivors tend to be younger and have a shorter duration from diagnosis to cannulation. Substantial variation exists in drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , COVID-19/therapy , Critical Illness , Extracorporeal Membrane Oxygenation/adverse effects , Humans , Immunization, Passive , Middle Aged , Retrospective Studies , Time Factors
3.
ASAIO J ; 67(5): 496-502, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1201886

ABSTRACT

The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ2 tests for categorical variables and Kruskal-Wallis rank-sum tests and Welch's analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8-22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.


Subject(s)
COVID-19/therapy , Extracorporeal Membrane Oxygenation , SARS-CoV-2 , Adult , Aged , COVID-19/complications , COVID-19/mortality , Cohort Studies , Critical Illness , Extracorporeal Membrane Oxygenation/mortality , Female , Humans , Male , Middle Aged , Prospective Studies
4.
ASAIO J ; 67(4): 392-394, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1153287

ABSTRACT

A subset of patients with coronavirus disease 2019 (COVID-19) develop profound respiratory failure and are treated via invasive mechanical ventilation (IMV). Of these, a smaller subset has severe gas exchange abnormalities that are refractory to maximal levels of IMV support. Extracorporeal membrane oxygenation (ECMO) has been used successfully in these circumstances. However, using ECMO only after failure of IMV exposes patients to the risks of ventilator-induced lung injury. We report a successful outcome using ECMO in the setting of COVID-19 in the absence of IMV failure in an awake, nonintubated patient. This approach may be beneficial for selected patients with COVID-19.


Subject(s)
COVID-19/therapy , Extracorporeal Membrane Oxygenation , Lung Injury/etiology , Respiration, Artificial , Respiratory Insufficiency/therapy , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/surgery , COVID-19/complications , Humans , Male , Middle Aged , Treatment Outcome
5.
J Thorac Cardiovasc Surg ; 161(2): e234-e235, 2021 02.
Article in English | MEDLINE | ID: covidwho-1074853
7.
ASAIO J ; 66(7): 722-730, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-647808

ABSTRACT

As coronavirus disease 2019 (COVID-19) cases surge worldwide, an urgent need exists to enhance our understanding of the role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with COVID-19 who develop acute respiratory and cardiac compromise refractory to conventional therapy. The purpose of this manuscript is to review our initial clinical experience in 32 patients with confirmed COVID-19 treated with ECMO. A multi-institutional registry and database was created and utilized to assess all patients who were supported with ECMO provided by SpecialtyCare. Data captured included patient characteristics, pre-COVID-19 risk factors and comorbidities, confirmation of COVID-19 diagnosis, features of ECMO support, specific medications utilized to treat COVID-19, and short-term outcomes through hospital discharge. This analysis includes all of our patients with COVID-19 supported with ECMO, with an analytic window starting March 17, 2020, when our first COVID-19 patient was placed on ECMO, and ending April 9, 2020. During the 24 days of this study, 32 consecutive patients with COVID-19 were placed on ECMO at nine different hospitals. As of the time of analysis, 17 remain on ECMO, 10 died before or shortly after decannulation, and five are alive and extubated after removal from ECMO, with one of these five discharged from the hospital. Adjunctive medication in the surviving patients while on ECMO was as follows: four of five survivors received intravenous steroids, three of five survivors received antiviral medications (Remdesivir), two of five survivors were treated with anti-interleukin-6-receptor monoclonal antibodies (Tocilizumab or Sarilumab), and one of five survivors received hydroxychloroquine. Analysis of these 32 COVID-19 patients with severe pulmonary compromise supported with ECMO suggests that ECMO may play a useful role in salvaging select critically ill patients with COVID-19. Additional patient experience and associated clinical and laboratory data must be obtained to further define the optimal role of ECMO in patients with COVID-19 and acute respiratory distress syndrome (ARDS). These initial data may provide useful information to help define the best strategies to care for these challenging patients and may also provide a framework for much-needed future research about the use of ECMO to treat patients with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Extracorporeal Membrane Oxygenation , Pneumonia, Viral/therapy , Adult , Aged , COVID-19 , Coronavirus Infections/complications , Female , Heart Diseases/therapy , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Receptors, Interleukin-6/antagonists & inhibitors , Respiratory Distress Syndrome/therapy , SARS-CoV-2
9.
ASAIO J ; 66(6): 588-598, 2020 06.
Article in English | MEDLINE | ID: covidwho-154995

ABSTRACT

The severe acute respiratory syndrome (SARS)-CoV-2 is an emerging viral pathogen responsible for the global coronavirus disease 2019 (COVID)-19 pandemic resulting in significant human morbidity and mortality. Based on preliminary clinical reports, hypoxic respiratory failure complicated by acute respiratory distress syndrome is the leading cause of death. Further, septic shock, late-onset cardiac dysfunction, and multiorgan system failure are also described as contributors to overall mortality. Although extracorporeal membrane oxygenation and other modalities of mechanical cardiopulmonary support are increasingly being utilized in the treatment of respiratory and circulatory failure refractory to conventional management, their role and efficacy as support modalities in the present pandemic are unclear. We review the rapidly changing epidemiology, pathophysiology, emerging therapy, and clinical outcomes of COVID-19; and based on these data and previous experience with artificial cardiopulmonary support strategies, particularly in the setting of infectious diseases, provide consensus recommendations from ASAIO. Of note, this is a "living document," which will be updated periodically, as additional information and understanding emerges.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Heart Diseases/therapy , Pneumonia, Viral/therapy , Respiratory Insufficiency/therapy , Animals , COVID-19 , Extracorporeal Membrane Oxygenation , Humans , Pandemics , SARS-CoV-2
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