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1.
Annals of Intensive Care ; 12(1), 2022.
Article in English | ProQuest Central | ID: covidwho-1837376

ABSTRACT

BackgroundDuration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults treated with ECMO due to severe COVID-19-related ARDS between 01/2020 and 05/2021. The primary objective was to determine whether duration of IMV prior to ECMO cannulation influenced ICU mortality.ResultsDuring the study period, 101 patients (mean age 56 [SD ± 10] years;70 [69%] men;median RESP score 2 [IQR 1–4]) were treated with ECMO for COVID-19. Sixty patients (59%) survived to ICU discharge. Median ICU length of stay was 31 [IQR 20.7–51] days, median ECMO duration was 16.4 [IQR 8.7–27.7] days, and median time from intubation to ECMO start was 7.7 [IQR 3.6–12.5] days. Fifty-three (52%) patients had a pre-ECMO IMV duration of > 7 days. Pre-ECMO IMV duration had no effect on survival (p = 0.95). No significant difference in survival was found when patients with a pre-ECMO IMV duration of < 7 days (< 10 days) were compared to ≥ 7 days (≥ 10 days) (p = 0.59 and p = 1.0).ConclusionsThe role of prolonged pre-ECMO IMV duration as a contraindication for ECMO in patients with COVID-19-related ARDS should be scrutinised. Evaluation for ECMO should be assessed on an individual and patient-centred basis.

2.
Am J Respir Crit Care Med ; 2022 Apr 15.
Article in English | MEDLINE | ID: covidwho-1794309

ABSTRACT

RATIONALE: Prostaglandin E1 (alprostadil; PGE1), in addition to low-dose unfractionated heparin, increases the biocompatibility of extracorporeal systems and enhances the efficacy of artificial organs without increasing bleeding risk. OBJECTIVES: We investigated the safety and efficacy of PGE1 in adults receiving venovenous extracorporeal membrane oxygenation. METHODS: This study was a randomized, double-blind, placebo-controlled phase-II-pilot trial at two medical intensive care units at the Medical University of Vienna, Austria. Adults with venovenous extracorporeal membrane oxygenation were randomly assigned to receive an intravenous infusion of 5 ng/kg/min PGE1 or placebo (0.9% saline), in addition to standard anticoagulation with unfractionated heparin. MEASUREMENTS: The primary outcome was the rate of transfused packed red blood cells per ECMO day. Secondary outcomes were the incidence of and the time to clinically overt bleeding and thromboembolic events. A post-hoc subgroup analysis included only patients with COVID-19. MAIN RESULTS: Between September 2016 and April 2021, of 133 screened patients, 50 patients were randomized, of whom 48 received the assigned study medication (24 per group). The transfusion rate was similar between groups (0.41vs.0.39;p=0.733). Prostaglandin E1 was associated with fewer thromboembolic events (7vs.16;p=0.020) and longer thromboembolism-free time (HR 0.302;p=0.01), fewer clinically overt bleeding events (2vs.11;p=0.017), and longer bleeding-free time (HR 0.213;p=0.047). In COVID-19 patients (n=25), the hazard ratios for clinically significant bleeding and thromboembolism were 0.276 (95% CI 0.035-2.186) and 0.521 (95% CI 0.149-1.825), respectively. CONCLUSION: Add-on treatment with PGE1 was safe but did not meet the primary endpoint of reducing the rate of red blood cell transfusions in patients on venovenous ECMO. Larger studies need to evaluate the safety and efficacy of additional PGE1 in ECMO. Clinical trial registration available at www. CLINICALTRIALS: gov, ID: NCT02895373.

3.
Front Cell Infect Microbiol ; 11: 651484, 2021.
Article in English | MEDLINE | ID: covidwho-1430688

ABSTRACT

This study aimed to determine the specific cytokine profile in peripheral blood during the early onset of COVID-19 infection. This was a cross-sectional exploratory, single center study. A total of 55 plasma samples were studied. Serum samples of adults showing symptoms of COVID-19 infection who were tested positive for SARS-CoV-2 infection (CoV+, n=18) at the COVID-19 outpatient clinic of the Medical University of Vienna were screened for immune activation markers by Luminex technology. Additionally, age and gender-matched serum samples of patients displaying COVID-19 associated symptoms, but tested negative for SARS-CoV-2 (CoV-, n=16) as well as healthy controls (HC, n=21) were analyzed. COVID-19 positive (CoV+) patients showed a specific upregulation of BLC (141; 74-189 pg/mL), SCD30 (273; 207-576 pg/mL), MCP-2 (18; 12-30 pg/mL) and IP-10 (37; 23-96 pg/mL), compared to patients with COVID19-like symptoms but negative PCR test (CoV-), BLC (61; 22-100 pg/mL), sCD30L (161; 120-210 pg/mL), MCP-2 (8; 5-12 pg/mL) and IP-10 (9; 6-12 pg/mL) and healthy controls (HC) (BLC 22; 11-36 pg/mL, sCD30 74; 39-108 pg/mL, MCP-2 6; 3-9. pg/mL, IP-10 = 8; 5-13). The markers APRIL, sIL-2R, IL7, MIF, MIP-1b, SCF, SDF-1a, sTNF-RII were elevated in both CoV+ and CoV- patient groups compared to healthy controls. HGF, MDC and VEGF-A were elevated in CoV- but not CoV+ compared to healthy controls. BLC, sCD30, MCP-2 and IP-10 are specifically induced during early stages of COVID-19 infection and might constitute attractive targets for early diagnosis and treatment of this disease.


Subject(s)
COVID-19 , Biomarkers , Cross-Sectional Studies , Humans , SARS-CoV-2
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