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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):S313-S313, 2022.
Article in English | Web of Science | ID: covidwho-1849103
4.
Journal of Heart and Lung Transplantation ; 41(4):S309-S310, 2022.
Article in English | Web of Science | ID: covidwho-1848283
5.
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.

6.
The Journal of Heart and Lung Transplantation ; 41(4):S313-S313, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783361

ABSTRACT

The use of mesenchymal stromal cells (MSC) was recently proposed as a promising intervention for COVID-19 related respiratory failure (RF). Prior studies have suggested that its larger size might lead to entrapment in extracorporeal membrane oxygenation (ECMO), affect circuit function, and attenuate its efficacy. We present a successful case of a severe COVID-19 patient treated with MSC-derived exosomes while receiving veno-venous (VV) ECMO support. 41-year-old unvaccinated obese White male with no past medical history presenting with shortness of breath and a +COVID-19 nasopharyngeal test was admitted receiving high-flow nasal cannula (HFNC), remdesivir, and dexamethasone (Day 1), followed by intubation (day 5), and a peripheral VV ECMO insertion (day 10) due to worsening RF. We used bivalirudin for post-ECMO anticoagulation. Subsequently, he received the first cycle of MSC-derived exosomes on alternative days (day 1, 3, & 5) between days 13-17, followed by the second cycle between days 34-38. After administration of exosomes, the plasma concentration of inflammatory markers reduced, including a decrease of 77% for ferritin, 74% for CRP, and 62% for procalcitonin in approximately one week, along with consistent improvement of PaO 2 /FiO 2 ratio. ECMO membrane oxygenator was exchanged on day 23 at the time of tracheostomy. After successful weaning, ECMO decannulation was performed on day 47, and the patient was discharged home on day 61. ECMO has emerged as a supportive strategy for patients with severe COVID-19 related RF. The patient's inflammatory response has been implicated in the pathophysiology of lung failure. Multiple pharmacological methods are employed to control the severity of this inflammatory response, thus preventing progression to the fibrotic stage of the disease. In our experience, MSC-derived exosomes neither resulted in any side effects nor impaired the function of ECMO and might have enhanced the recovery of the patient. [ 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.)

7.
Journal of Heart & Lung Transplantation ; 41(4):S309-S310, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783360

ABSTRACT

Lung transplant is considered a last resource surgical therapy for non-resolving COVID-19-associated acute distress respiratory syndrome (ARDS) and refractory hypoxemia. Google trends (GT) is an ongoing-developing web-kit providing feedback on specific general population's interests. This study uses GT to analyze the United States (US) general population interest in LT as COVD-19/ARDS salvage therapy. GT was used to access data searched for the term lung transplant. The gathered information included data from January 2016 through October 2021 within US territories. Search frequency, time intervals, sub-regions, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, and a value of 100 represented overall peak popularity. The number of Google searches related to the term lung transplant has remained steady interest over time and surged in congruence with the appearance of COVID-19 in the US. From January 2016 until February 2019, interest has ranged from 29 to 58% (average 40%). Following the COVID-19 surge, average interest shifted up to 49%, with an all-time increase in November 2019, February 2020, and June 2020, of 90, 65 and 100%. Over time, the lead frequency of searches in sub-regions, metro areas, and cities, were Pennsylvania, Gainesville, FL, and Philadelphia, PA, respectively. Top related topic and top related query in search frequency, over time are electronic cigarette and lung transplant covid. At a glance, medical-relevant websites fail to provide adequate information for LT patient therapeutic education (PTE). GT complements the understanding of interest in LT, especially in consideration of the COVID-19 pandemic's perspective. When properly interpreted, the use of these trends can potentially improve on PTE and therapy awareness via specific medical relevant websites. [ 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.)

8.
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.

9.
ASAIO Journal ; 67(SUPPL 3):45, 2021.
Article in English | EMBASE | ID: covidwho-1481481

ABSTRACT

Objective: ECMO is implemented as rescue therapy in patients with ARDS secondary to COVID-19 and refractory hypoxemia. Google Trends(GT) is a consistent development web-tool of data feedback providing information on the specific population's interests. This study aims to use GT to analyze the United States(US) general population interest on ECMO as COVID-19 ARDS salvage therapy. Methods: GT was used to access data searched for the term ECMO and COVID-19. Gathered information included data from March2020 through July2021 within the US. Search frequency, time intervals, locations, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, with a value of 100 representing overall peak popularity. Results: The number of Google searches related to the terms ECMO and COVID-19 surged and sustained interest over time since the initial reports of COVID-19 in the US, from an initial mean of 34% in March2020 to a 100% interest by April, resulting in an up-to-date overall average of 40.6%. Over time, WV, MN, and IA lead frequency of searches in subregion and metro areas. Conversely, Houston leads the city with the highest interest. Top searches terms by frequency include: ECMO-machine, COVID-ECMO, what-is-ECMO, ECMO-medical and ECMO-ventilator. Parallel to this, the related rising terms are: COVID-ECMO, ECMOmachine-COVID, ECMO-for-COVID, and ECMO-treatment-COVID. Websites seemingly fail to properly address these. Conclusions: GT complements the understanding of interest in ECMO for COVID-19. Interpreted properly, the use of GT can potentially improve on patient therapeutic education and therapy awareness via specific official websites.

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

ABSTRACT

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.

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