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1.
J Heart Lung Transplant ; 41(11): 1547-1555, 2022 11.
Article in English | MEDLINE | ID: covidwho-2178981

ABSTRACT

The number of lung transplant procedures performed internationally is increasing but the donor organ pool is insufficient to meet demand and waiting list mortality is unacceptably high. As survival rates for patients with acute respiratory distress syndrome managed on extracorporeal life support (ECLS) have steadily improved, a potential role for ECLS to support critically ill patients awaiting a donor organ match has emerged. We explore the rapidly evolving landscape of ECLS as a bridge to lung transplantation with review of the patient selection criteria, predictors of survival, modes of pre and peri-transplant support, and the importance of a holistic multidisciplinary approach to care. Finally, we consider innovations that are envisaged to increase the accessibility, safety, and effectiveness of ECLS delivery for future lung transplant candidates.


Subject(s)
Extracorporeal Membrane Oxygenation , Lung Transplantation , Respiratory Distress Syndrome , Humans , Extracorporeal Membrane Oxygenation/methods , Retrospective Studies , Waiting Lists
2.
Clin Simul Nurs ; 2022 Mar 14.
Article in English | MEDLINE | ID: covidwho-2178143

ABSTRACT

Coronavirus disease (COVID-19) required innovative training strategies for emergent aerosol generating procedures (AGPs) in intensive care units (ICUs). This manuscript summarizes institutional operationalization of COVID-specific training, standardized across four ICUs. An interdisciplinary team collaborated with the Simulator Program and OpenPediatrics refining logistics using process maps, walkthroughs and simulation. A multimodal approach to information dissemination, high-volume team training in modified resuscitation practices and technical skill acquisition included instructional videos, training superusers, small-group simulation using a flipped classroom approach with rapid cycle deliberate practice, interactive webinars, and cognitive aids. Institutional data on application of this model are presented. Success was founded in interdisciplinary collaboration, resource availability and institutional buy in.

3.
Clin Chest Med ; 43(3): 519-528, 2022 09.
Article in English | MEDLINE | ID: covidwho-2177066

ABSTRACT

Extracorporeal life support (ECLS) has a role in different types of respiratory failure including acute respiratory distress syndrome (ARDS), decompensated pulmonary hypertension, bridge to lung transplantation, and primary graft dysfunction after lung transplantation. ECLS in ARDS allows for lung-protective ventilation with the goal to reduce the risk of ventilator-induced lung injury. ECLS use in severe ARDS should be considered when conventional management strategies are not sufficient to safely support gas exchange. More research is needed to identify optimal mechanical ventilation during ECLS, weaning ECLS support, strategies for mobilization, sedation and anticoagulation, and long-term outcomes post-ECLS.


Subject(s)
Extracorporeal Membrane Oxygenation , Respiratory Distress Syndrome , Respiratory Insufficiency , Anticoagulants , Humans , Respiration, Artificial/adverse effects , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy
4.
Nurs Open ; 2022.
Article in English | Web of Science | ID: covidwho-2170323

ABSTRACT

AIM: To develop a competency framework applicable to Chinese extracorporeal membrane oxygenation (ECMO) nurses. DESIGN: A qualitative study was performed following the consolidated criteria for reporting qualitative research. METHODS: Semi-structured interviews based on the critical incident technique were conducted among 21 ECMO care providers recruited from five well-known ECMO centres in Guangzhou, China. Interview transcripts were coded and analysed using the constant comparative method. The data collection period lasted from November 2021 to April 2022. RESULTS: A competency framework for ECMO nurses was identified. It included four domains: knowledge, skills, behaviours and attitudes, containing 33 subcompetencies and 66 items. RELEVANCE TO CLINICAL PRACTICE: This framework can be a reference for the assessment and training of ECMO nurses.

5.
Port J Card Thorac Vasc Surg ; 29(4):51-54, 2023.
Article in English | PubMed | ID: covidwho-2206930

ABSTRACT

COVID-19 infection manifests as a spectrum of respiratory and vascular complications, including acute respiratory distress syndrome (ARDS) and pulmonary embolism. Herein, we describe a case of a healthy young male who presented with ARDS refractory to mechanical ventilation and concomitant bilateral pulmonary emboli managed with extracorporeal membrane oxygenation (ECMO) and embolectomy. The embolectomy and initial veno-venous ECMO configuration failed to correct the patient's hypoxemia despite maximal flows. This was thought to be due to a high-output state secondary to vasodilatory shock preventing adequate drainage from the existing single drainage ECMO cannulation, following which a second venous cannula was placed to form a unique veno-veno-venous ECMO circuit that resolved the persistent hypoxemia. The case underscores the importance of identifying embolic events and vasodilatory shock in COVID-19 patients, both of which need to be addressed simultaneously to avoid worsening right ventricular failure (via both mechanical and hypoxia-driven pathways) and the resulting veno-arterial ECMO along with its associated complications.

6.
Messenger of Anesthesiology and Resuscitation ; 19(4):15-21, 2022.
Article in Russian | Scopus | ID: covidwho-2204890

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is a method that makes it possible to compensate for critical changes caused by acute respiratory failure, with the ineffectiveness of treatment with rigid modes of artificial lung ventilation (ventilator) in patients with acute respiratory distress syndrome in intensive care units. The search for the optimal state of the hemostasis system is one of the main tasks in the treatment of critical patients in ECMO conditions. The objective: to study changes in hemostatic parameters in patients with COVID-19 undergoing ECMO and determine the need for their correction. Subjects and Methods. According to the inclusion and exclusion criteria, 100 patients were included in the study: 72 men and 28 women aged 26 to 75 years old, the median age made 55 years [47;60]. VV-ECMO was performed in all observations. In 100% of cases, the cause of respiratory failure which required VV-ECMO was COVID-19-associated pneumonia. Results. 49 episodes of hemorrhagic complications and 76 episodes of thrombotic complications were recorded from the 1st to the 7th day from the moment of ECMO initiation. We found that the chance of developing thrombosis decreased by an average of 0.3% with an increase in the activity of antithrombin-3 by 1%. A statistically significant association of thrombosis risk was also found for prothrombin and prothrombin time. Conclusion. During the first 7 days of ECMO, patients with COVID-19 demonstrate the increase in APTT, prothrombin time and a decrease in the number of platelets, prothrombin activity, and fibrinogen concentration. The risk of thrombosis in this group of patients significantly decreases with the increasing activity of antithrombin-3 and prothrombin and increases with rising need of the higher dose of unfractionated heparin. The tactics of restrictive anticoagulant therapy when using unfractionated heparin can be taken into account as a way to reduce the risk of thrombosis and requires further research. © 2022 The authors.

7.
Indian Journal of Respiratory Care ; 11(3):270-273, 2022.
Article in English | Web of Science | ID: covidwho-2201838

ABSTRACT

The utility of extracorporeal membrane oxygenation (ECMO) has gained significant attention over the past 25 years. ECMO has revolutionized the management of patients with refractory cardiac and respiratory complications in critically ill patients. We herewith present a case of a 26-year-old pregnant female patient with coronavirus disease-2019 and refractory hypoxemia, who was managed successfully on ECMO.

8.
Bali Journal of Anesthesiology ; 6(4):235-238, 2022.
Article in English | Scopus | ID: covidwho-2201683

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) has been shown to be effective as a form of a life-sustaining modality in previous outbreaks such as Middle East respiratory syndromes covariant and H1N1. A 28-year-old woman was referred from a military hospital after experiencing prolonged dyspnea and a loss of consciousness. At the time of admission, the patient was pregnant with a gestational age of 24-25 weeks and has a history of hypertension and a caesarian section. Respiratory failure forced a caesarean section, which was followed by an intensive care unit admission. Five days after admission, the patient was placed on ECMO with a heparin drip. The patient suffered coinfections identified in the patient's sputum, blood, and urine samples. Significant clinical improvement observed after the second ECMO weaning and was followed by successful discharge. The successful treatment of a critically ill COVID-19 pregnant patient with ECMO as a life-sustaining critical-care modality is uncommon. However, potential coinfections must be considered, and physicians must prepare for waves of clinical worsening and improvement. © 2022 National Journal of Clinical Anatomy ;Published by Wolters Kluwer - Medknow.

9.
Yonsei Medical Journal ; 64(1):66-70, 2023.
Article in English | MEDLINE | ID: covidwho-2198649

ABSTRACT

Pregnancy has been shown to be associated with an adverse clinical course and symptomatic patients with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Extracorporeal membrane oxygenation (ECMO) is rarely used in pregnant or postpartum women with severe coronavirus disease 2019 (COVID-19). Here, we report the rare case of a pregnant woman diagnosed with SARS-CoV-2 infection placed on ECMO postpartum who subsequently received treatment for active rectal ulcer bleeding. Despite being placed on ECMO for 38 days and receiving a massive transfusion of 95 packs of red blood cells, she recovered and was discharged on hospital day 112. ECMO can be used in most patients with severe COVID-19, including pregnant patients, although potential coagulopathy complications must be considered.

10.
Journal of Intensive Care ; 10(1) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2196496

ABSTRACT

Background: Extracorporeal membrane oxygenation (ECMO) is an integral method of life support in critically ill patients with severe cardiopulmonary failure;however, such patients generally require prolonged mechanical ventilation and exhibit high mortality rates. Tracheostomy is commonly performed in patients on mechanical ventilation, and its early implementation has potential advantages for favorable patient outcomes. This study aimed to investigate the association between tracheostomy timing and patient outcomes, including mortality, in patients requiring ECMO. Method(s): We conducted a single-center retrospective observational study of consecutively admitted patients who were supported by ECMO and underwent tracheostomy during intensive care unit (ICU) admission at a tertiary care center from April 2014 until December 2021. The primary outcome was hospital mortality. Using the quartiles of tracheostomy timing, the patients were classified into four groups for comparison. The association between the quartiles of tracheostomy timing and mortality was explored using multivariable logistic regression models. Result(s): Of the 293 patients treated with ECMO, 98 eligible patients were divided into quartiles 1 (<= 15 days), quartile 2:16-19 days, quartile 3:20-26 days, and 4 (> 26 days). All patients underwent surgical tracheostomy and 35 patients underwent tracheostomy during ECMO. The complications of tracheostomy were comparable between the groups, whereas the duration of ECMO and ICU length of stay increased significantly as the quartiles of tracheostomy timing increased. Patients in quartile 1 had the lowest hospital mortality rate (19.2%), whereas those in quartile 4 had the highest mortality rate (50.0%). Multivariate logistic regression analysis showed a significant association between the increment of the quartiles of tracheostomy timing and hospital mortality (adjusted odds ratio for quartile increment:1.55, 95% confidence interval 1.03-2.35, p for trend = 0.037). Conclusion(s): The timing of tracheostomy in patients requiring ECMO was significantly associated with patient outcomes in a time-dependent manner. Further investigation is warranted to determine the optimal timing of tracheostomy in terms of mortality. Copyright © 2022, The Author(s).

11.
Clinical & Applied Thrombosis/Hemostasis ; 28:10760296221148162, 2022.
Article in English | MEDLINE | ID: covidwho-2195099

ABSTRACT

Support with VV-ECMO requires anticoagulation with unfractionated heparin to prevent thrombotic complications. This must be monitored due to bleeding risk. A point-of-care (POC) method of testing aPTT and APR was evaluated for agreement with laboratory methods. In a prospective observational study, patients supported on VV-ECMO as a result of severe respiratory failure secondary to Covid-19 infection were given heparin as part of standard therapy. The aPTT was measured (i) at the bedside using the Hemochron Signature Elite device and (ii) at the hospital laboratory. Duplicate results were compared. Agreement between the POC and laboratory tests was poor, as assessed using the Bland-Altman method. The maximum difference between POC and laboratory methods was 133% and the minimum was 0%. Overall bias was 7.3% and limits of agreement were between -43.8% and 58.5%. Correlation increased when results were normalised to platelet count and creatinine. This POC test is insufficiently accurate for use as the primary method of heparin monitoring in patients requiring VV-ECMO for Covid-19. Platelets and renal function may influence the result of this whole blood POC test.

12.
Critical Care Medicine ; 51(1):143-145, 2023.
Article in English | Web of Science | ID: covidwho-2190853
13.
Medicina Intensiva ; 46(8):465-471, 2022.
Article in Spanish | Web of Science | ID: covidwho-2181543
14.
The Journal of Thoracic and Cardiovascular Surgery ; 2023.
Article in English | ScienceDirect | ID: covidwho-2181031
15.
Inflamm Res ; 2023.
Article in English | PubMed | ID: covidwho-2173971

ABSTRACT

BACKGROUND: Cysteinyl leukotrienes (CysLT) are potent inflammation-promoting mediators, but remain scarcely explored in COVID-19. We evaluated urinary CysLT (U-CysLT) relationship with disease severity and their usefulness for prognostication in hospitalized COVID-19 patients. The impact on U-CysLT of veno-venous extracorporeal membrane oxygenation (VV-ECMO) and of comorbidities such as hypertension and obesity was also assessed. METHODS: Blood and spot urine were collected in "severe" (n = 26), "critically ill" (n = 17) and "critically ill on VV-ECMO" (n = 17) patients with COVID-19 at days 1-2 (admission), 3-4, 5-8 and weekly thereafter, and in controls (n = 23) at a single time point. U-CysLT were measured by ELISA. Routine markers, prognostic scores and outcomes were also evaluated. RESULTS: U-CysLT did not differ between groups at admission, but significantly increased along hospitalization only in critical groups, being markedly higher in VV-ECMO patients, especially in hypertensives. U-CysLT values during the first week were positively associated with ICU and total hospital length of stay in critical groups and showed acceptable area under curve (AUC) for prediction of 30-day mortality (AUC: 0.734, p = 0.001) among all patients. CONCLUSIONS: U-CysLT increase during hospitalization in critical COVID-19 patients, especially in hypertensives on VV-ECMO. U-CysLT association with severe outcomes suggests their usefulness for prognostication and as therapeutic targets.

16.
Macromolecular bioscience ; : e2200479, 2023.
Article in English | EMBASE | ID: covidwho-2173286

ABSTRACT

The artificial lung has provided life-saving support for pulmonary disease patients, and recently afforded patients with severe cases of COVID-19 better prognostic outcomes. While it addresses a critical medical need, reducing the risk of clotting inside the device remains challenging. Here, a two-step surface coating process of the lung circuit using Zwitterionic polysulfobetaine methacrylate was evaluated for its non-specific protein antifouling activity. It was hypothesized that similarly applied coatings on materials integrated (IT) or nonintegrated (NIT) into the circuit will yield similar antifouling activity. The effects of human plasma pre-conditioned with nitric oxide-loaded liposome on platelet (plt) fouling was also evaluated. Fibrinogen antifouling activities in coated fibers were similar in the IT and NIT groups. It however decreased in coated polycarbonate (PC) in the IT group. Also, plt antifouling activity in coated fibers was similar in the IT and NIT groups and was lower in coated PC and Tygon in the IT group compared to the NIT group. Coating process optimization in the IT lung circuit may help address difference in the coating appearance of outer and inner fiber bundle fibers, and the NO-liposome significantly reduced (86%) plt fouling on fibers indicating its potential use for blood anticoagulation. This article is protected by copyright. All rights reserved.

17.
Am J Respir Crit Care Med ; 2022 Sep 23.
Article in English | MEDLINE | ID: covidwho-2194459

ABSTRACT

RATIONAL: Long-term outcomes of patients with COVID-19-related acute respiratory distress syndrome (ARDS) treated with extracorporeal membrane oxygenation (ECMO) are unknown. METHODS: Multicenter, prospective study in patients who received ECMO for COVID-19 ARDS from March to June 2020 and survived hospital discharge. Physical examination, pulmonary function tests, anxiety, depression, post-traumatic stress disorders (PTSD), and quality of life (QoL) were assessed at 6 and 12 months after ECMO onset. RESULTS: Of 80 eligible patients, 62 were enrolled in 7 French Intensive Care Units (ICU). ECMO and invasive mechanical ventilation duration were 18 (11-25) and 36 (27-62) days, respectively. All were alive but only 19/50 (38%) returned to work and 13/42 (31%) had recovered a normal sex drive at one year. Pulmonary function tests were almost normal at 6 months except for diffusing capacity for carbon monoxide which was still impaired at 12 months. Mental health, role-emotional, and role-physical were the most impaired domain compared to non-COVID ECMO patients. One year after ICU admission, 19/43 (44%) patients had significant anxiety, 18/43 (42%) had depression symptoms and 21/50 (42%) were at risk for PTSD. CONCLUSIONS: Despite the partial recovery of the lung function tests at one year, the physical and psychological function of this population remains impaired. Based on the comparison with long-term follow-up of non-COVID ECMO patients, poor mental and physical health may be more related to COVID-19 than to ECMO in itself, although this needs confirmation This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).

18.
The Journal of Thoracic and Cardiovascular Surgery ; 2022.
Article in English | ScienceDirect | ID: covidwho-2165644

ABSTRACT

Objective We sought to determine the impact of right ventricular dysfunction (RVD) on outcomes of mechanically ventilated patients with coronavirus-19 (COVID-19) requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO). Methods Six academic centers conducted a retrospective analysis of mechanically ventilated patients with COVID-19 stratified by support with VV-ECMO during the first wave of the pandemic (March – August 2020). Echocardiograms performed for clinical indications were reviewed for right and left ventricular function. Baseline characteristics, hospitalization characteristics, and survival were compared. Results The cohort included 424 mechanically ventilated patients with COVID-19, 126 of whom were cannulated for VV-ECMO. RVD was observed in 38.1% of ECMO patients and 27.4% of non-ECMO patients with an echocardiogram. Biventricular dysfunction was observed in 5.5% of ECMO patients. Baseline patient characteristics were similar in both the ECMO and non-ECMO cohorts stratified by presence of RVD. In the ECMO cohort, RVD was associated with increased inotrope use (66.7% versus 24.4%, p<0.001), bleeding complications (77.1% versus 53.8%, p=0.015), and worse survival independent of left ventricular dysfunction (39.6% versus 64.1%, p=0.012). There was no significant difference in days ventilated prior to ECMO, length of hospital stay, hours on ECMO, duration of mechanical ventilation, vasopressor use, inhaled pulmonary vasodilator use, infectious complications, clotting complications or stroke. The non-ECMO cohort demonstrated no statistically significant differences in in-hospital outcomes. Conclusion The presence of RVD in patients with COVID-19 related ARDS supported with VV-ECMO was associated with increased in-hospital mortality. Additional studies are required to determine if mitigating RVD in patients requiring VV-ECMO improves mortality.

19.
International Journal of Obstetric Anesthesia ; : 103625, 2023.
Article in English | ScienceDirect | ID: covidwho-2165404

ABSTRACT

Background Available data identify pregnancy as a strong determinant of a severe course of COVID-19 with increased mortality. Extracorporeal membrane oxygenation (ECMO) remains the last resort treatment in the critical course of COVID-19 yet may increase the risk of excessive bleeding, especially in the direct post-cesarean section period. One in five of all patients receiving ECMO during the COVID-19 pandemic were women who were pregnant or postpartum. While the risk of critical respiratory failure in the peripartum period is high, in an early survey only 52% of pregnant patients intended to receive the COVID-19 vaccine. Methods Our study aimed to evaluate clinical characteristics and treatment modalities in a series of five pregnant and peripartum women supported with ECMO and anticoagulated with anti-Xa guided nadroparin therapy in our center. We reviewed the full treatment courses;inflammatory, hemodynamic, and coagulation variables;and maternal and neonatal outcomes. We identified adverse events during the therapy. Results All five patients developed acute respiratory distress syndrome due to COVID-19 in the third trimester of pregnancy. Termination of pregnancy occurred between 28 and 36 gestational weeks. While four of five newborns survived to hospital discharge, only two of the five mothers survived to leave hospital. Conclusions ECMO is feasible in the third trimester but not devoid of complications. The severity of respiratory failure during COVID-19 and extracorporeal support may not adversely impact neonatal outcomes.

20.
Adv Exp Med Biol ; 1353: 173-195, 2021.
Article in English | MEDLINE | ID: covidwho-2157941

ABSTRACT

INTRODUCTION: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention. METHODS: This review summarizes the evidence gathered until June 12, 2020; electronic databases were screened for pertinent reports on coronavirus and V-V ECMO. Search was conducted by two independent investigators; keywords used were SARS-CoV-2, COVID-19, ECMO, and extracorporeal life support (ECLS). RESULTS: Many patients with COVID-19 experience moderate symptoms and a relatively quick recovery, but others must be admitted into the intensive care unit due to severe respiratory failure and often must be mechanically ventilated. Further deterioration may require institution of extracorporeal oxygenation. Infection mechanisms may trigger "cytokine storm," an inflammatory disorder notable for multi-organ system failure; together with other metabolic and hematological changes, these amplify the changes pertinent to ECMO therapy, often exaggerating blood coagulation disorders. Thirty-two studies were found describing experiences with ECMO in the treatment of COVID-19. Of 4,912 COVID-19 patients, 2,119 (43%) developed ARDS and 2,086 (42%) were transferred to the ICU; 1,015 patients (21%) were treated with ECMO. While in an overall cohort, observed mortality was 640 (13%), the mortality within ECMO subgroups reached up to 34.6% (range 0-100%). CONCLUSION: The efficacy of ECMO treatment for COVID-19 is largely dependent on the expertise of the center in ECLS due to the interplay between the changes in hematological and inflammatory modulators associated with both COVID-19 and ECMO. In order to support gas exchange during early infection with SARS-CoV-2, ECMO has a strong rationale for the treatment of the most critically ill patients. Due to the limited resources during a global pandemic, ECMO should be reserved for only the most severe cases of COVID-19.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Respiratory Insufficiency , Humans , Pandemics , Respiratory Insufficiency/therapy , SARS-CoV-2
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