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1.
Respiratory Medicine Case Reports ; : 101663, 2022.
Article in English | ScienceDirect | ID: covidwho-1821470

ABSTRACT

As opposed to widely recognized Coronavirus Disease 2019 (COVID-19)-associated thrombotic events, the unusual but serious bleeding complications in COVID-19 patients are worth-mentioned. Here, we describe a 44-year-old man afflicted by COVID-19 pneumonia with acute respiratory distress syndrome (ARDS) and submassive pulmonary embolism. The patient's condition initially improved with the prescription of ECMO, tocilizumab, and hemoadsorption, however, he later developed spontaneous tension hemothorax, which is considered rare but devastating in the setting of COVID-19. While the exact pathogenesis of COVID-19-associated bleeding events remain poorly understood, we aim to highlight the other aspect of coagulation dysfunction potentially caused by COVID-19.

2.
Annals of Thoracic Surgery ; 113(5):1401-1404, 2022.
Article in English | EMBASE | ID: covidwho-1821141
3.
Annals of Medicine and Surgery ; : 103709, 2022.
Article in English | ScienceDirect | ID: covidwho-1821117

ABSTRACT

The impact on mortality associated with covid-19 today exceeds five million deaths worldwide, and the number of deaths continues to rise. The complications of the survivors, socio-economic implications at a global level, economic limitations in the health systems, and physical and emotional exhaustion of health personnel are detrimental. Therapeutic strategies are required to limit the evolution of the disease, improve the prognosis of critically ill patients, and, in countries with low purchasing power, create affordable alternatives that can help contain the evolution towards the severity of infected people with mild to moderate symptoms. The misinformation and myths that today are more frequent on social networks and the implementation of practices without scientific support is a problem that aggravates the general panorama. This review aims to concentrate on the best evidence for treating SARS-CoV-2 infection in a simple and summarized manner, addressing therapies from their bases to the most innovative alternatives available today.

4.
Artificial Organs ; n/a(n/a), 2022.
Article in English | Wiley | ID: covidwho-1819877

ABSTRACT

Background Severe COVID-19 can necessitate multiple organ support including veno-venous extracorporeal membrane oxygenation (vvECMO) and renal replacement therapy. The therapy can be complicated by venous thromboembolism due to COVID-19 related hypercoagulability, thus restricting vascular access beyond the vvECMO cannula. Although continuous renal replacement therapy can be performed via a vvECMO circuit, studies addressing sustained low-efficiency dialysis (SLED) integration into vvECMO circuits are scarce. Here we address the lack of evidence by evaluating feasibility of SLED integration into vvECMO circuits. Methods Retrospective cohort study on nine critically ill COVID-19 patients, treated with integrated ECMO-SLED on a single intensive care unit at a tertiary health care facility between 12/20 and 11/21. The SLED circuits were established between the accessory arterial oxygenator outlets of a double oxygenator vvECMO setup. Data on filter survival, quality of dialysis and volume management were collected and compared to an internal control group receiving single SLED. Results This study demonstrates general feasibility of SLED integration into existing vvECMO circuits. Filter lifespans of ECMO-SLED compared to single SLED are significantly prolonged (median 18.3 h vs 10.3 h, p <?0.01). ECMO-SLED treatment is furthermore able to sufficiently normalize creatinine, blood urea nitrogen and serum sodium, and allows for adequate ultrafiltration rates. Conclusions We can show that ECMO-SLED is practical, safe, results in adequate dialysis quality and enables sufficient electrolyte and volume management. Our data indicate that SLED devices can serve as potential alternative to continuous-veno-venous-hemodialysis for integration in vvECMO circuits.

5.
Journal of Cardiac Surgery ; : 2, 2022.
Article in English | Web of Science | ID: covidwho-1816600

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is a selectively available therapeutic option, generally available in a large-size referral healthcare system. In a single-center experience of the use of venovenous ECMO for COVID-19 ARDS in a medium-size healthcare system during the pandemic, West et al. in their study have convincingly demonstrated that ECMO can become a broadly available therapeutic option without compromising quality.

6.
Intensive Care Medicine ; 48(3):270-280, 2022.
Article in English | EMBASE | ID: covidwho-1813641

ABSTRACT

Purpose: Previous studies support the potential efficacy of venovenous extracorporeal membrane oxygenation (vvECMO) for improving survival in severe acute respiratory distress syndrome (ARDS) cases. Prone positioning (PP) has been shown to improve the outcomes of moderate-to-severe ARDS patients. Few studies and no randomized controlled trials have evaluated the effect of PP performed in ECMO patients. Methods: We performed a systematic review and meta-analysis examining the effect of prone positioning for ARDS patients receiving vvECMO on survival. All authors were contacted to obtain complementary information not mentioned in the original articles. The main objective was to compare 28-day survival in vvECMO patients with PP to vvECMO patients without PP (controls). Results: Thirteen studies with a combined population of 1836 patients satisfied the inclusion criteria. PP was associated with a significant improvement in 28-day survival (503 survivors among 681 patients in the PP group [74%;95% CI 71–77] vs. 450 survivors among 770 patients in the control group [58%, 95% CI 55–62];RR 1.31 [95% CI 1.21–1.41];I2 22% [95% CI 0–62%];P < 0.0001). Survival was also improved in terms of other endpoints (60-day survival, 90-day survival, ICU survival, and hospital survival). In contrast, the duration of mechanical ventilation was increased in vvECMO patients with PP (mean difference 11.4 days [95% CI 9.2–13.5];0.64 [95% CI 0.50–0.78];I2 8%;P < 0.0001). Conclusion: According to this meta-analysis, survival was improved when prone positioning was used in ARDS patients receiving vvECMO. The impact of this combination on survival should be investigated in prospective randomized controlled trials.

7.
Rev Esp Quimioter ; 2022.
Article in English | PubMed | ID: covidwho-1812162

ABSTRACT

Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia.

9.
Journal of Heart and Lung Transplantation ; 41(4):S344, 2022.
Article in English | EMBASE | ID: covidwho-1796802

ABSTRACT

Introduction: Myocarditis is an inflammatory disease of cardiac muscle caused by a variety of infectious and non-infectious conditions. Viral infection is the most frequent cause of myocarditis;however, herpes simplex virus 1 (HSV-1) infection causing myocarditis has been rarely described. We present a case of a young woman with HSV-1 viremia and fulminant myocarditis presenting with cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO), complicated by hyperhemolysis. Case Report: A 35 year-old immunocompetent woman with moderate alcohol consumption presented to hospital with a 4-day history of fever and flu-like symptoms. She was fully vaccinated for COVID-19 two months prior to symptom onset. Her COVID-19 testing was negative and she was discharged home. She returned to hospital 4 days later in cardiogenic shock. Transthoracic echocardiogram demonstrated LVEF of 30% with a small pericardial effusion. Coronary angiogram revealed normal coronaries. She was placed on peripheral VA-ECMO for worsening cardiogenic shock. Due to inadequate LV unloading, she underwent atrial septostomy. Five days after VA-ECMO cannulation, HSV-1 was detected in the blood and she was started on intravenous acyclovir. Her ECMO course was complicated by acute kidney injury requiring dialysis, and hyperhemolysis with a peak LDH of 12,000 U/L. The mechanism of hemolysis was attributed to an intravascular process (plasma free hemoglobin 7487 mg/L, normal < 150 mg/L) likely from a combination cold agglutinins and the mechanical circuit. Interestingly the membrane pressure gradient was within normal. The patient received treatment with plasmapheresis (Table 1), and was eventually decannulated after 12 days following hemodynamic improvement. This case report highlights a rare viral cause of fulminant myocarditis and emphasizes the need for collaboration among various specialists in the management of complex cases.

10.
Journal of Heart and Lung Transplantation ; 41(4):S378, 2022.
Article in English | EMBASE | ID: covidwho-1796800

ABSTRACT

Introduction: Dual-lumen cannula is used for extracorporeal membrane perfusion (ECMO) to support patients with ARDS due to COVID-19 as a bridge to lung recovery. It tends to be a longer support and there are several factors that can degrade the physical structure of the ECMO cannula and put the cannula at risk for breakage. Case Report: A 63-year-old woman was admitted to the hospital with COVID-19 pneumonia. Two days later, she was intubated and VV-ECMO was initiated due to treatment-resistant acute respiratory failure;a 28Fr CrescentTM dual-lumen cannula (Medtronic, MN) was inserted through the left subclavian vein and connected to a centrifugal oxygen pump with a centrifugal oxygenator. Within six weeks after onset, the patient was unable to be weaned from the ventilator and was transferred to our center with ECMO connected for consideration of lung transplantation. Two days after transfer, the patient developed acute aphasia, altered mental status, disturbed consciousness, and left arm seizures. A suction sound was heard from the left subclavian cannula insertion site and the ECMO bubble detector alarmed, but local inspection, chest X-rays, and CT scans of the brain and chest showed no obvious abnormalities. The patient was reintubated for encephalopathy and subsequently underwent a tracheostomy. The patient regained normal neurological function over the next 7 days. However, the air bubble sensor alarmed and suction sound was heard at the cannulation site again, and air bubbles were seen in the oxygenator. Due to concerns about air entrapment and cannula failure, we changed to a dual-canal VV-ECMO configuration using a right internal cervical and a left femoral cannula. The removed cannula had a 2 cm fracture distal to the skin insertion site. After resumption of ECMO, no new neurological episodes occurred. While awaiting lung transplantation, the patient died due to sepsis and multiple organ failure. An autopsy revealed a possible cause of cerebrovascular disease patent foramen ovale and air embolism to the brain. If a patient has been on ECMO for a long time and the bubble sensor warns of air detection, cannula breakage and impending air embolism should be suspected clinically, even if the defect is not found on examination and is not evident on imaging. If the COVID-19 epidemic continues, increased transport events may increase ECMO cannula breakage.

11.
J Thorac Cardiovasc Surg ; 2022.
Article in English | PubMed | ID: covidwho-1796408

ABSTRACT

OBJECTIVE: We sought to determine the influence of venovenous extracorporeal membrane oxygenation (ECMO) on outcomes of mechanically ventilated patients with COVID-19 during the first 120 days after hospital discharge. METHODS: Five academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 admitted during March through May 2020. Survivors had access to a multidisciplinary postintensive care recovery clinic. Physical, psychological, and cognitive deficits were measured using validated instruments and compared based on ECMO status. RESULTS: Two hundred sixty two mechanically ventilated patients were compared with 46 patients cannulated for venovenous ECMO. Patients receiving ECMO were younger and traveled farther but there was no significant difference in gender, race, or body mass index. ECMO patients were mechanically ventilated for longer durations (median, 26 days [interquartile range, 19.5-41 days] vs 13 days [interquartile range, 7-20 days]) and were more likely to receive inhaled pulmonary vasodilators, neuromuscular blockade, investigational COVID-19 therapies, blood transfusions, and inotropes. Patients receiving ECMO experienced greater bleeding and clotting events (P < .01). However, survival at discharge was similar (69.6% vs 70.6%). Of the 217 survivors, 65.0% had documented follow-up within 120 days. Overall, 95.5% were residing at home, 25.7% had returned to work or usual activity, and 23.1% were still using supplemental oxygen;these rates did not differ significantly based on ECMO status. Rates of physical, psychological, and cognitive deficits were similar. CONCLUSIONS: Our data suggest that COVID-19 survivors experience significant physical, psychological, and cognitive deficits following intensive care unit admission. Despite a more complex critical illness course, longer average duration of mechanical ventilation, and longer average length of stay, patients treated with venovenous ECMO had similar survival at discharge and outcomes within 120 days of discharge.

12.
Arch Gynecol Obstet ; 305(5): 1135-1142, 2022 May.
Article in English | MEDLINE | ID: covidwho-1797645

ABSTRACT

PURPOSE: Pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have a higher risk of hospitalization, admission to intensive care unit (ICU) and invasive ventilation, and of acute respiratory distress syndrome (ARDS). In case of ARDS and critical severe coronavirus disease 2019 (COVID-19), the use of extracorporeal membrane oxygenation (ECMO) is recommended when other respiratory support strategies (oxygen insufflation, non-invasive ventilation [NIV], invasive ventilation through an endotracheal tube) are insufficient. However, available data on ECMO in pregnant and postpartum women with critical COVID-19 are very limited. METHODS: A case series of three critically ill pregnant women who required ECMO support for COVID-19 in pregnancy and/or in the postpartum period. RESULTS: The first patient tested positive for COVID-19 during the second trimester, she developed ARDS and required ECMO for 38 days. She was discharged in good general conditions and a cesarean-section [CS] at term was performed for obstetric indication. The second patient developed COVID-19-related ARDS at 28 weeks of gestation. During ECMO, she experienced a precipitous vaginal delivery at 31 weeks and 6 days of gestation. She was discharged 1 month later in good general conditions. The third patient, an obese 43-year-old woman, tested positive at 38 weeks and 2 days of gestation. Because of the worsening of clinical condition, a CS was performed, and she underwent ECMO. 143 days after the CS, she died because of sepsis and multiple organ failure (MOF). Thrombosis, hemorrhage and infections were the main complications among our patients. Neonatal outcomes have been positive. CONCLUSION: ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19.

13.
J Card Surg ; 2022.
Article in English | PubMed | ID: covidwho-1794629

ABSTRACT

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is implemented as rescue therapy in COVID-19 related acute distress respiratory syndrome (ARDS) and refractory hypoxemia. Google Trends (GT) is an ongoing-developing web kit providing feedback on specific population's interests. This study uses GT to analyze the United States (US) general population interest in ECMO as COVD-19/ARDS salvage therapy. METHODS: GT was used to access data searched for the term ECMO and COVID-19. The gathered information included data from March 2020 to July 2021 within US territories. Search frequency, time intervals, sub-regions, frequent topics of interest, and related searches were analyzed. Data were reported as search frequency on means, and a value of 100 represented overall peak popularity. RESULTS: The number of Google searches related to the terms ECMO and COVID-19 has surged and sustained interest over time ever since the initial reports of COVID-19 in the US, from an initial mean of 34% in March 2020 to a 100% interest by April 2020, resulting in an up-to-date overall average of 40% interest. Over time West Virginia, Gainesville, and Houston, lead the frequency of searches in sub-region, metro and city areas, respectively. Top search terms by frequency include: ECMO machine, COVID ECMO, what is ECMO, ECMO treatment and VV ECMO. Parallel to this, the related rising terms are: COVID ECMO, ECMO machine COVID, ECMO for COVID, ECMO machine coronavirus, and ECMO vs ventilator. Seemingly, medical-relevant websites fail to adequately address these for patient therapeutic education (PTE) purposes. CONCLUSIONS: GT complements the understanding of interest in ECMO for COVID-19. When properly interpreted, the use of these trends can potentially improve on PTE and therapy awareness via specific medical relevant websites.

14.
J Card Surg ; 2022.
Article in English | PubMed | ID: covidwho-1794628

ABSTRACT

BACKGROUND: The role of extracorporeal membrane oxygenation (ECMO) for patients with refractory respiratory failure due to coronavirus 2019 (COVID-19) is still unclear even now over a year into the pandemic. ECMO is becoming more commonplace even at smaller community hospitals. While the advantages of venovenous (VV) ECMO in acute respiratory distress syndrome (ARDS) from COVID-19 have not been fully determined, we believe the benefits outweighed the risks in our patient population. Here we describe all patients who underwent VV ECMO at our center. METHODS: All patients placed on ECMO at our center since the beginning of the pandemic, May 5, 2020, until February 20, 2021 were included in our study. All patients placed on ECMO during the time period described above were followed until discharge or death. The primary endpoint was in-hospital death. Secondary outcomes included discharge disposition, that is, whether patients were sent to a long-term acute care center (LTAC), inpatient rehabilitation, or went directly home. RESULTS: A total of 41 patients were placed on VV ECMO for refractory acute respiratory failure. Survival to discharge, the primary end point, was 63.4% (26/41). Inpatient mortality was 36.6% (15/41). CONCLUSIONS: We show here that a successful high-volume VV ECMO program for ARDS is achievable at even a medium-size community hospital. We think our success can be replicated by most small- and medium-size community hospitals with cardiothoracic surgery programs and intensivist teams.

15.
Int J Artif Organs ; : 3913988221092041, 2022.
Article in English | PubMed | ID: covidwho-1794151

ABSTRACT

At the beginning of the COVID 19 pandemic, the outcome of patients treated with ECMO was discouraging. Subsequently, it became clear that a certain group of patients may benefit from ECMO treatment. The primary objective of this study was to compare the outcome of ECMO treatment in COVID-19 and influenza patients referred to a tertiary care center. A total of 119 adult patients required ECMO treatment following ARDS secondary to H1N1 (49) and SARS-CoV-2 (70) in the referral ECMO Center based in Zagreb between October 2009 and October 2021. Our study revealed a significantly higher mortality in COVID-19 patients compared to H1N1 influenza when the onset of ARDS was severe enough to require ECMO support. Based on these results and current knowledge, we argue that ECMO treatment for ARDS in COVID-19 patients is more challenging compared to H1N1 influenza patients. Therefore, referral to the most experienced ECMO centers should be considered. Additionally, patient selection and timing for ECMO treatment play a key role in relation to outcome. Mortality rate in COVID-19 patients requiring ECMO treatment may be used as a reference frame for ECMO centers to ensure best possible care and outcome.

16.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793904

ABSTRACT

Introduction: Invasive ventilation initiation after a prolonged period of non-invasive ventilation (NIV) trial can be associated with poor outcome in coronavirus disease 2019 (COVID-19) ARDS patients. This study aimed to document our center's experience with COVID-19 ARDS patients treated with veno-venous ECMO (VVECMO) after a prolonged NIV trial period to avoid intubation. We speculated that VV-ECMO support is not associated with a worse outcome than invasive ventilation in these patients. Methods: We retrospectively reviewed 6 patients with COVID-19 ARDS who presented severe hypoxemia and pneumomediastinum after NIV (ECMO group). Twenty patients with COVID - 19 and age less than 70 years old were treated in the first wave of the national outbreak and underwent NIV trials for more than 24 h before intubation (Control group). The primary outcome was intensive care unit (ICU) survival and secondary ECMO or mechanical ventilation weaning at 28 days. Results: The age of the patients in the ECMO group was 59 years (IQR: 46 - 65) and SAPS II score 47 (IQR: 46 - 52), compared to 60 years (IQR: 51 - 66) (p = 0.71) and 48 (IQR: 45 - 54) (p = 0.63) in the control group. NIV duration before ECMO or invasive ventilation initiation was 5 days (IQR: 2 - 8) and 3 days (IQR: 1 - 5), respectively (p = 0.13). Drainage multistage femoral cannula 25 F and internal jugular infusion cannula 21 F were placed percutaneously. After cannulation, the patients received light sedation that permitted communication, active physiotherapy and oral feeding. None of the patients in the ECMO group died within 28 days after ECMO initiation (Fig. 1, Panel A) or received invasive ventilation. VV-ECMO was not associated with longer mechanical support than invasive ventilation (HR: 1.26 95%CI: 0.24 - 6.55, p = 0.77) (Fig. 1, Panel B). Conclusions: VV-ECMO can be a not inferior strategy to invasive ventilation for treating patients with COVID-19 ARDS and severe hypoxemia not responding to long trials of NIV. (Table Presented).

17.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793865

ABSTRACT

Introduction: Purpose of the study: to analyze the effectiveness of the use of intravenous ECMO as part of the complex therapy of patients with confirmed SARS-Cov-2 infection. Methods: VV-ECMO was used in 19 patients (11 men, 8 women) over 18 years old (50 ± 12.5) with body mass index 32 ± 3.4 and severity of organ dysfunctions SOFA 3 points. Previously, all patients underwent therapy with interleukin-6 receptor inhibitors and glucocorticoids, non-invasive ventilation. The duration of mechanical ventilation before the start of ECMO was 1 ± 0.75 days, PaO2/FiO2 index-68 ± 12 mmHg, pHa were 7.25 ± 0.06, lactate 2.5 ± 0.6 mmol/l. ECMO was connected according to the femoral vena-jugular vein scheme, volumetric flow rate 3-4 l/min, oxygen 3 l/min. Results: Disconnected from ECMO 37% (7), discharged 26% (5), 60- day survival-26%. Patients with an unfavorable outcome, compared with those who were discharged, had pronounced leukocytosis 14(10- 17) versus 8 (4-8) × 109/ l, p = 0.009) and lymphocytopenia 7 ± 4% versus 12 ± 2%, p = 0.007). After initiation of the procedure, by day 3 in the lethal group: SOFA scores increased from 3 to 9 (in the group of survivors from 3 to 4 (p = 0.027));the level of procalcitonin from 0.2 to 1.45 ng/ml;the number of platelets decreased by 48% (in the group of survivors it increased by 42% (p = 0.011);PaO2/FiO2 index did not change significantly (an increase of 200% in the group of survivors up to 206 mmHg (p = 0.011). The following complications developed in the group of patients with an adverse outcome: bleeding from cannulation sites (26.3%, n = 5), nosebleeds (26.3%, n = 5), circuit thrombosis (10.5%, n = 2) and pneumothorax (5.2%, n = 1). Conclusions: VV-ECMO is an effective method of supporting lung function in patients with confirmed SARS-Cov-2 infection. The presence and progression of a bacterial infection is a predictor of an adverse outcome.

18.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793864

ABSTRACT

Introduction: Current literature regarding sedative dosing in venovenous extracorporeal membrane oxygenation (VV-ECMO) is sparse, with information pertaining to those with SARS-CoV-2 (COVID) requiring VV-ECMO being even rarer. The purpose of this quality improvement project was to examine the sedation practices and requirements of patients who received VV-ECMO in the year prior to and the first year of the COVID epidemic. Methods: This was a single-center, observational study. Adults who received VV-ECMO from January 1, 2019 through December 31, 2020 were included. Those who received VV-ECMO in 2019 were considered the pre-COVID cohort, while those who received VVECMO during 2020 were the COVID cohort. Demographics, clinical and lab parameters, and doses of oral and intravenous (IV) opioids, benzodiazepines (BZD), and other sedatives were recorded. Results: Twelve pre-COVID and 13 COVID patients were included with a mean duration of VV-ECMO of 10 and 27 days, respectively. Mean medication doses during the first week of VV-ECMO and mean duration of use are described in Table 1. Patients who received IV opioids (11 vs. 13), IV BZD (12 vs. 13), and propofol (10 each) were similar between groups. Median number of IV sedation agents used was similar between groups (3.5 vs. 4), while the number of oral agents (opioids, BZD, phenobarbital) was higher in the COVID group (0 vs. 2). Conclusions: There were a similar number of IV agents used between the two cohorts. Oral medications were used more often to augment sedation in the COVID cohort of this study. (Table Presented).

19.
New Microbiol ; 45(1):35-39, 2022.
Article in English | PubMed | ID: covidwho-1782188

ABSTRACT

SARS-CoV-2 and flu may lead to severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO). The aim of the present study is to compare the incidence of bloodstream infections (BSIs) and outcome in patients with flu and SARS-CoV-2 infection hospitalized in ICU and undergoing ECMO. This study is a retrospective analysis of the San Matteo COVID-19 Registry (SMACORE) cohort. The study was conducted from January 2018 to April 2020. Demographic data and microbiological data were recorded during hospitalization. BSIs occurring during ECMO were analyzed. Eighteen patients treated with ECMO, 22 subjects with SARS-CoV-2 infection and 7 with flu, median age 61years for SARS-CoV-2 and 50 for flu (p=NS). Median ECMO duration was similar in the two pathologies. Median time to bloodstream infection from ECMO initiation was similar. Bloodstream infection incidence rate was 2.65 per 100 patients/days for flu and 2.2 per 100 patients/days for SARS-CoV-2. Global infection rate was 5 per 100 patients/days for SARS-CoV-2 patients and 5.3 per 100 patients/days for flu. Mortality during ECMO was 40.9% (5 out of 22 patients) for SARS-CoV-2 infection while none died among flu patients. ECMO-associated mortality was higher in SARS-CoV-2 infection compared with flu infection.

20.
J Card Surg ; 2022 Apr 11.
Article in English | MEDLINE | ID: covidwho-1784691

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has significantly burdened the global healthcare system since December 2019. Minority populations are found to have a higher incidence of hospitalization and higher mortality when compared to Caucasians. Extracorporeal membrane oxygenation (ECMO) is reserved for COVID-19 patients who develop respiratory failure refractory to conventional management. To our knowledge, no data has been reported on outcome differences between Minority COVID-19 patients and Caucasian COVID-19 patients managed with ECMO. We aimed to investigate the outcome differences between these two groups. METHODS: Our retrospective cohort study had 23 adults (aged 18 and older) diagnosed with COVID-19 by polymerase chain reaction. All patients developed acute respiratory distress syndrome (ARDS), refractory to conventional treatment, and were managed on ECMO support. The primary outcome of interest was mortality; the secondary outcome was the rate of ECMO-related complications. RESULTS: The overall mortality rate of our study was higher (70%) than other reports of the COVID-19 population on ECMO. Caucasians in our study had more severe respiratory acidosis with carbon dioxide retention and appeared to have a higher mortality rate of 85.7% compared to Minorities (62.5%). No differences in complication rates between these two groups were identified. CONCLUSIONS: Our cohort revealed a high overall mortality rate of COVID-19 patients on ECMO support. The Caucasian group was observed to have higher mortality than the Minority group. The high overall mortality was likely attributed to the Caucasian group, which had more severe respiratory acidosis before ECMO initiation, a known predictor of poor prognosis in ARDS patients. Our cohort's ethnic composition may also partially explain the high mortality rate since COVID-19 Minorities are reported to have worse outcomes than Caucasians. Larger and randomized studies are needed to investigate further the mortality and complication differences between Minority and Caucasian patients diagnosed with COVID-19 and managed by ECMO.

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