RESUMO
Objectives: More than 200 patients have benefited from lung transplantation who failed to recover from COVID-19-induced acute respiratory distress (ARDS) with conventional ventilatory support and/ or extracorporeal membrane oxygenation support (ECMO) in USA. We aim to share our experience and lessons learned at our institute through this case series. Method(s): After IRB approval, we performed a retrospective chart review and identified 37 patients who received ECMO for COVID-19 induced ARDS between May 2020 through January 2022. Out of these, 12 received a formal consultation from the transplant team. We studied patient characteristics, interventions during ECMO support, and evaluation outcomes. Result(s): Most of our patients had single organ failure i.e., lung, except for two who required dialysis after ECMO initiation. Six out of the 12 patients received bilateral lung transplant. One patient received the transplant before ECMO initiation. However, the patient required two runs of ECMO after the transplant due to postop complications from suspected COVID19 reinfection and deceased on postoperative day 101. All the patients after transplant had an expedited recovery except one who required prolonged hospitalization before starting physical therapy. The median length of hospital stay for the transplant group was 148 (89- 194) days and for the non-transplant group was 114 (58-178) days. The 30-day survival rate was 100% for the transplant group. At a median follow-up of 207 (0- 456) days after discharge, 5(83.3%) patients in the transplant group and 3(50%) patients in the nontransplant group were alive. In the non-transplant group, 4 patients received ECMO support for more than 75 days and at last follow-up 2 were alive and functioning well without needing new lungs. This asks for an objective prospective study to define the timeline of irreversibility of the lung injury. Conclusion(s): Lung transplantation is a viable salvage option in patients with COVI-19 induced irreversible lung injury. However, the irreversibility of the lung injury and the timing of lung transplant remains to be determined case-by-case. (Figure Presented).
RESUMO
Accidents and emergency situations have been on a constant rise, especially during the COVID-19 pandemic. Typically, the emergency vehicle dispatch and routing problems involve various dynamic factors which make them very different from conventional vehicle routing problems. This paper presents a metaheuristic approach to emergency vehicle dispatch and routing. Dispatching aims at allotting and sending the nearby available vehicle to the location of emergency and routing deals with selecting the ideal route to reach the destination. The objective is to minimize incident response time and the total time travel for the vehicle from the dispatch point to the destination. This usually depends on the emergency service vehicle availability and other dynamic factors such as traffic, number of turns in the route, etc. Three different bio-inspired algorithms, namely, ant colony optimization, adaptive ACO and firefly algorithm are investigated. Performance evaluation shows that firefly algorithm outperforms the other algorithms in terms of cost, number of turns, and run time for the given data set. However, in case of larger datasets and multiple variables if involved, adaptive ACO gives better results but takes longer time.