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An outbreak of a respiratory sickness started in Wuhan, China in December 2019 and the causative agent was found be a novel betacoronovirus of the same subgenus as SARSCoV and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronavirus disease 2019 (COVID-19) quickly spread around the world, with clinical signs ranging from mild respiratory symptoms to severe pneumonia and a fatality rate estimated around 2%. Lower respiratory tract infections can occur in immunocompromised subjects and the elderly persons. Respiratory droplets are the causative agent for the person-to-person spread of the disease resembling the spread of influenza. Individual to individual spread turned into the primary mode of transmission. The transmission of the disease might be more likely in the earlier stage of infection as the viral RNA levels appear to be higher. Accurate diagnosis in the early stages of the epidemic helps control the spread of the disease. [ FROM AUTHOR] Copyright of Indian Drugs is the property of Indian Drug Manufacturers' Association (IDMA) 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.)
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Objectives: To present an unusual complication related to prolonged ECMO support in a patient with COVID19 induced acute respiratory syndrome (ARDS). Method(s): Clinical chart review of the care process after obtaining the informed consent from the patient. Result(s): A 48-year-old female with COVID-19 infection during second wave of pandemic in August 2021 progressed to severe ARDS. She was put on VV-ECMO support after failing conventional therapy for refractory hypoxemia. Her cannulation configuration included a 25 F venous drainage cannula in the right femoral vein and a 21 F venous return cannula in the right Internal Jugular (IJ) vein. Cannulations were performed using the ;Seldinger technique;under USG guidance, and no difficulties or complications were reported. Her hospital course was notable for delirium, and intermittent bleeding from the cannula sites. After 80 days of support, she showed adequate respiratory improvement which allowed ECMO decannulation. She continued to show improvement, and was eventually discharged after 102 days of total hospital stay. During her 6 weeks follow-up clinic visit a palpable thrill was noted at the jugular ECMO cannula site. A CT angiogram of the neck demonstrated a large venous varix connecting the right IJ and the left common carotid artery with filling from the left common carotid artery. ECMO cannulation site complications such as aneurysm, clots, infections and stenosis are well known. What was unusual in this case is the nature of the aneurysm given that there were no arterial procedures performed on the left side of the neck. She was managed by an ;Amplatzer plug;to the carotid artery at the level of the connection to the varix without any complications. Conclusion(s): Longer duration of ECMO support needs careful follow-up for timely recognition and management of vascular complications. (Figure Presented).
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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).
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Objectives: Extracorporeal membrane oxygenation (ECMO) is well established in cardiorespiratory failure. Here we report the use of ECMO in an airway emergency to provide respiratory support. Method(s): Informed consent was obtained from patient at the time of admission. Result(s): A 48-year-old with COVID-19 requiring venovenous ECMO (VVECMO) for 32 days and tracheostomy for 47 days had developed tracheal stenosis three months after tracheostomy removal, and undergone tracheal resection and reconstruction. He presented two weeks later with acute dyspnea, bloody drainage and a bulge in his neck with coughing. A computerized tomography (CT) of the cervical spine and chest showed dehiscence of the tracheal wound and a gap in the trachea. He was managed with High Flow Nasal Canula and supported on VVECMO support using 25 Fr. right femoral drainage cannula and 23 Fr. left IJ return cannula. A covered stent was placed, neck wound was irrigated and debrided. Patient was decannulated after 10 days on ECMO. Future therapeutic considerations include mediastinal tracheostomy, aortic homograft interposition of the disrupted segment of trachea with stent placement and permanent self-expandable stent with internal silicone stent. Conclusion(s): ECMO is increasingly used in complex thoracic surgery as well as in the perioperative period as salvage support. One of the areas where it has shown promising results is traumatic main bronchial rupture, airway tumor leading to severe airway stenosis, and other complex airway problems. The ease of cannulation, the technological advances and growing confidence in the management of ECMO patients are the main reasons for the expansion of ECMO use beyond conventional indications. The case described above is an example of the use of ECMO in the perioperative management of impending respiratory failure due to airway obstruction or disconnection. (Figure Presented).
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INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) has been utilized as a rescue therapy for patients with severe ARDS. Multiple case series have suggested that the duration of veno-venous ECMO support in patients with COVID-19 pneumonia may be longer than patients with ARDS secondary to alternative etiology. However, the impact of longer run of ECMO on patient outcomes are not clear. METHOD(S): This was a retrospective study performed at Mayo Clinic Florida and Mayo Clinic Rochester, tertiary ECMO centers in USA. Analysis includes all consecutive patients who were placed on VV ECMO for COVID-19- induced ARDS between January 2019 to March 2022. The study population was classified into two groups: short term ECMO duration (< 4 weeks) and prolonged ECMO support (>4 weeks). Demographic data, baseline clinical characteristics, treatments administered, mechanical ventilator data, lab data, ECMO data and outcome related data were collected and analyzed. RESULT(S): A total of 63 COVID-19 patients were included. For the entire cohort, the 30 day mortality was 6%, the 90 day mortality was 30% and the median duration of ECMO support was 35 days (IQR 38). A total of 6 (10%) patients went on to receive lung transplant. Among these, 25(40%) patients required ECMO for < 4 weeks and 38(60%) patients for >4 weeks. The median SOFA values (13 vs 11, 0.016) for the <=4 weeks cohort was higher. Both groups received similar COVID-19 therapies: glucocorticoids (96 vs 100%, p=0.397), tocilizumab (52 vs 50%, p=1.000), antivirals (88 vs 87%, p=1.000), and convalescent plasma (48 vs 45%, p=1.000). The cumulative mortality rates for the 2 groups were 8% vs 5% at 30 days (p=1.0), 12% vs 42% at 60 days (p=0.013), 12% vs 50% at 90 days (p=0.002) and 12% vs 50%(p=0.002) at 180 days. CONCLUSION(S): The study demonstrated that a substantial number of COVID19 patients require ECMO for > 4 weeks. In this cohort, the mortality rate in the first 4 weeks of ECMO support was low, at 6%. The patients who required ECMO for >4 weeks were more likely to have higher mortality compared to the patients treated with ECMO for shorter duration.
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On account of the national closedown, the economy has suffered a severe slump. The reduced purchase of goods and services has lead to slow down of domestic manufacturing and agricultural sectors, leading to severe unemployment in urban industrial areas and contraction of the rural economy. This lockdown has influenced economy and business circumstance in India as it has occurred in other nations. The ongoing lockdown due to COVID-19 outbreak affects the Indian economy in many ways, including sharp declines in domestic demand, lower tourism and business travel, trade and production linkages, supply disruptions, and health effects. There are certain sectors that have been affected due to the outbreak of corona virus. This research paper, anticipates indicative measures that may be taken to revive the economy as well as affected sectors to some extent. First, this paper provides an overview of effect of this lockdown on Indian economy. With no manufacturing activity, it is likely that growth of gross domestic product (GDP) will be slowed down. This will be followed listing of the sectors affected due to COVID-19, which carries the risk of global supply chain disruptions. This includes five import items that are heavily dependent on China - electrical machinery, mechanical appliances, organic chemicals, plastics and surgical instruments - that make up about 28% of India's import basket could be the mostly affected ones due to this potential shutdown. Next, the paper will present some of the indicative measures to revive the economy and rejuvenate the affected sectors. Protection of workers at the workplace must be given utmost priority followed by adapting to new work arrangements such as work-from-home (WFH). This will be followed by measures to stimulate the economy and labour demand by making and implementing active fiscal policy. Making expenditure on purchasing domestic goods and services will be the best way to push the economy. As a matter of fact, it is now may be required to evaluate on what can be produced here (in India) and give a deliberate thought to it towards implanting the same. Further, India will be at advantage by having domestically based and well established 'pharma industry'. This sector may act as 'catalyst sector' towards economic growth of the country.