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USE OF CRESCENT JUGULAR CATHETER IN PATIENTS WITH SEVERE COVID-19 REQUIRING EXTENDED ECMO SUPPORT
Chest ; 160(4):A742, 2021.
Article in English | EMBASE | ID: covidwho-1457657
ABSTRACT
TOPIC Critical Care TYPE Medical Student/Resident Case Reports

INTRODUCTION:

ECMO has long been used in the ICU as a salvage or bridge therapy for selected ICU patients. There had been a variety of cannulas available in the market. We report 2 cases with positive outcomes associated with the use of jugular dual lumen cannula. CASE PRESENTATION An obese 42-year-old obese female, with PMH of hypothyroidism and ulcerative colitis, was admitted for acute hypoxic respiratory failure due to COVID-19. Patient underwent conventional treatment at the time (dexamethasone, remdesivir, convalescent plasma and antibiotics) for COVID-19 but was ultimately intubated on day 8 due to profound hypoxia requiring VV ECMO on day 10. She remained on full ECMO support until day 56. Her FiO2 was eventually weaned down to 21% but she continued to require a sweep of 3L secondary to profound muscular weakness and obesity. After transitioning to the jugular dual lumen cannula on day 75 for long-term ECMO, her sedation was weaned down, that allowed participation of physical therapy. She was decannulated on day 94 and was discharged to LTAC on day 100. A 48-year-old female was tested positive for COVID-19 after being exposed 12 days before. Due to worsening symptoms, she eventually sought care at the hospital. Despite the standard treatment, her respiratory status continued to worsen. She was intubated on Day 2 before receiving full support on VV ECMO on day 6. Despite effort to wean down to FiO2 of 21%, she still required a sweep of 1L. After being transitioned to a jugular dual lumen cannula on day 71, she was weaned off of sedation and able to participate in therapy. She was eventually decannulated on day 79, and discharged to a rehab facility on day 85 to continue her recovery.

DISCUSSION:

Transition from a dual cannula ECMO system to a single cannula ECMO system allowed increased mobility and participation of physical therapy while in the ICU for patients requiring extended time on ECMO. Study has suggested a reduction of up to 35% in muscle mass among ECMO patients by day 20 of their cannulation. In an economic study performing on transplant patients, a 73% reduction in post-transplant ICU cost was reported for those who underwent rehabilitation while being supported on ECMO. Both studies demonstrated the potential benefits with promoting early rehabilitation for ECMO patients. Regarding the technique involved, there was a recent report of a similar transition without any ECMO interruption, allowing the patient uninterrupted time on ECMO while benefiting from early rehab.

CONCLUSIONS:

We present two cases of severe COVID-19 patients with an extended period of time on VV ECMO became severely debilitated. They were transitioned to a jugular dual lumen cannula, allowing early participation in rehab, resulting in their eventual discharge. These cases demonstrated these cannulas were valuable tool to reduce patients' reliance on support, before being transitioned off of ECMO. REFERENCE #1 Hayes K, Holland AE, Pellegrino VA, Mathur S, Hodgson CL. Acute skeletal muscle wasting and relation to physical function in patients requiring extracorporeal membrane oxygenation (ECMO). J Crit Care. 2018;481-8. doi10.1016/j.jcrc.2018.08.002 REFERENCE #2 Bain JC, Turner DA, Rehder KJ, et al. Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation. Respir Care. 2016;61(1)1-7. doi10.4187/respcare.03729 REFERENCE #3 Chan EG, Chan PG, Harano T, Sanchez PG. Transition of femoral-jugular to dual-stage left subclavian without discontinuation of extracorporeal membrane oxygenation. J Card Surg. 2020;35(10)2794-2797. doi10.1111/jocs.14881 DISCLOSURES No relevant relationships by Vernon Chan, source=Web Response No relevant relationships by Marina Dolina, source=Web Response

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Chest Year: 2021 Document Type: Article