Interhospital ECMO transport during Covid-19 pandemic: A clinical experince

Objectives: During COVID pandemic, ECMO support for the patients with ARDS have saved many lives. Although its an important and effective treatment modality, management of ECMO could be done in a few specialized centers. In this study, we share our in- and out-of-city ECMO transport experience of the patients with COVID-ARDS. Method(s): A total of 75 patients (57% male- 43 %female) were included in this study. The decision ECMO support, initiation at referral hospital, and transport process of all of the patients to our centre were performed by our mobile ECMO team. All transports were done by land ambulance Results: Mean age of the patients was 43.4+/-11.5 years. Mean intubation period before ECMO support was 8.5 +/-8.3 days. We transferred 14 patients from the centers within the city and 12 patients from the centers outside the city to our hospital. Mean distance between our center and the referral center was 36,2 kms (max 269- min 1). We did not experience any major complication during transport. A total of 30 patients (38,6 %) were weaned from ECMO and discharged from hospital. Conclusion(s): ECMO support is an advanced treatment modality for pulmonary failure patients. The decision of initiation, cannulation, transport and management should be performed by experienced centers to achive acceptable results.

Prolonged oxygenator usage for VV ECMO for COVID ARDS: A clinical experience

Objectives: Its known that with the prolonged use of ECMO, because of the thrombogenic activations -minor/majorclot formations may ocur at the oxygenator and eventually it fails to function properly. Physicians take some precautions to prevent or postpone this process but usually exchange the circuit. In this study we share our follow up strategy and prolonged oxygenator use for the COVID-ARDS patients. Method(s): A total of 68 patients who were followed more than 7 days were included in this study. Sorin/LivaNova oxygenators and VV-ECMO circuit were used for all of the patients. Bivaluridin infusion was used for routine anticoagulation protocol. Result(s): Mean age of the patients was 44.1 +/-12.2 years. The patients were followed for a total of 2705 days with a total of 103 oxygenators [mean 26.2 +/-18.3(104-7) days for per oxygenator] Mean duration of ECMO support was 40.3 +/-24.4 days . The oxygenator use per patient was 1.5 +/-0.89. There was no major hypoxic period experience for the patients. Survival rate was 43.2 %. Conclusion(s): With using bivaluridin for anticoagulation, daily washing of oxygenators and close follow up methods we can protect the oxygenators and use them for longer periods safely like in our experience which can save us from serious additional costs and interventions.

SARS-CoV2 infection after vaccination in patients requiring extracorporeal life support: An analysis from the EuroECMO-COVID study group

Objectives: At the beginning of the pandemic, it was believed that severe SARS-CoV2 infection would induce lifelong immunity and that reinfections would be unlikely. However, several cases of reinfection were documented in previously infected patient and the waning humoral immunity has raised significant concerns. Accordingly, long-term and durable vaccineinduce antibody protection against infection have also become a challenge, as several breakthroughs of COVID-19 have been identified in individuals partially or fully vaccinated. This study describes the incidence, the characteristics of severe COVID-19 infections requiring ECMO occurred after vaccination and the presence of side effects related to the vaccine. Method(s): EuroECMO COVID is a prospective, multicenter, observational study, developed by the EuroELSO, based on data from patients aged >=16 years who received ECMO support for refractory COVID-19 during the pandemic in 204 centers. The analysis investigates the survival of vaccinated patient, the associations between management-related variables, the incidence of vaccination during the different pandemic phases, the type of vaccines and the possible side effects. Result(s): Immunosuppressed patients are susceptible to reinfection even after being naturally infected or receiving a full vaccination. Ineffective antibody production, due to relatively ineffective vaccines, inadequate number of doses or the time after vaccination are involved in the pathogenesis of postvaccination infections. This population was found to have a partial immunity due to an inadequate number of doses and an overlapped time from vaccination and SARS-CoV2 incubation with PCR results after being vaccinated. Several manifestations of SARS-CoV2 infection are similar to vaccine-induce side effects and mild symptoms can be presented both as an adverse reaction after vaccination and a result of infection. In this subgroup no side effects were attributable to the vaccine. Conclusion(s): Vaccination does not entirely prevent SARS-CoV2 but will lead to less morbidity and mortality, as demonstrated by less need of ICU and ECMO care. In addition, the partial immunity for inadequate doses of vaccine or through the evolution of new variants demonstrated the importance of further analysis to differentiate the possible causes of waning humoral immunity.

Cardiopulmonary Bypass: Advances in Extracorporeal Life Support

Cardiopulmonary Bypass: Advancements in Extracorporeal Life Support provides comprehensive coverage on the technological developments and clinical applications of extracorporeal technologies, including the underlying basic science and the latest clinical advances in the field. Written by experts around the world, this book comprises all characteristics of cardiopulmonary bypass as well as chapters regarding equipment, physiology and pathology, pediatric aspects and clinical applications. Important highlights include the latest updates regarding minimal invasive cardiopulmonary bypass (MICPB), extracorporeal circulatory and respiratory support (ECCRS) in cardiac and non-cardiac patients, ECMO support in COVID-19, and updated guidelines of extracorporeal technologies. This book is an invaluable resource to clinicians, researchers and medical students in the fields of cardiothoracic surgery, cardiac anesthesiology, intensive care, and perfusion technology. © 2023 Elsevier Inc. All rights reserved.

ECMO in COVID–ARDS

Acute respiratory distress syndrome (ARDS) is a complex pathologic manifesto of acute lung injury that causes noncardiogenic pulmonary edema in different clinical presentations and increases the mortality rate up to 40%. The main physiologic changes are alveolar collapse/de-recruitment, decreased lung compliance, higher pulmonary vascular resistance, and gas-exchange disturbance, which may be combined with the patient's own respiratory response or assisted ventilatory support due to regional heterogeneity of the underlying lung injury. Since the main clinical features of COVID-19 (coronavirus disease 2019) pneumonia are hypoxemia and dyspnea, noninvasive oxygen therapy or mechanical ventilation remains the cornerstone of managing more severe cases. The aim of this chapter is to summarize the current state of knowledge on the worst pulmonary manifestation of the long COVID-19 syndrome, namely, COVID–ARDS, including parenchymal and functional abnormalities, follow-up strategies for early identification, and timely therapeutic interventions including veno-venous extracorporeal membrane oxygenation (vv-ECMO) management. Although only a limited proportion of COVID-19 patients develop severe respiratory failure refractory to advanced conventional treatments, it is of utmost importance to clearly define criteria for the use of vv-ECMO in this steadily growing patient population. The use of vv-ECMO in COVID–ARDS is a rescue treatment, if mechanical ventilation cannot guarantee appropriate gas exchange anymore, resulting in life-threatening or organ-damaging hypoxia and/or hypercapnia, whereas the vv-ECMO treatment modality still has a high all mortality rate in COVID–ARDS (> 50%). © 2023 Elsevier Inc. All rights reserved.

Management of COVID-19-Associated Pleural Empyema

The highly contagious and rapidly spreading coronavirus 2 (SARS-CoV 2) has been associated with the development of severe acute respiratory syndrome, a potentially fatal disease. A patient who underwent coronary artery bypass surgery for an acute myocardial infarction developed acute respiratory failure due to coronavirus 2 (SARS-CoV-2) pneumonia in the early postoperative period. The patient was placed on mechanical ventilation (MV) and V-V (veno-venous) ECMO (Extracorporeal Membrane Oxygenation) support. Here we discuss the application of decortication in the patient due to the development of pneumothorax and prolonged air leak empyema in the follow-up, and the subsequent development of pleural thickening. Copyright © 2022 LookUs Scientific. All rights reserved.