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Early mobilization in coronavirus-19 patients treated with extracorporeal membrane oxygenation.
George, Timothy J; Sheasby, Jenelle; Taylor, Jeff E; Vaquera, Key A; Curry, Matthew W; Harness-Brumley, Cayce L; Myers, David P; Erwin, Gary E; Lilly, Jeffrey C; Michael DiMaio, J.
  • George TJ; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Sheasby J; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Taylor JE; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Vaquera KA; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Curry MW; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Harness-Brumley CL; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Myers DP; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Erwin GE; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Lilly JC; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
  • Michael DiMaio J; Baylor Scott and White, The Heart Hospital, Plano, Texas, USA.
J Card Surg ; 2022 Oct 31.
Article in English | MEDLINE | ID: covidwho-2097825
ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) pneumonia can be associated with refractory respiratory failure requiring extracorporeal membrane oxygenation(ECMO). Although ECMO has helped many COVID patients, optimal management strategies for these patients remain unknown.

METHODS:

We conducted a retrospective review of all COVID patients requiring ECMO at our hospital. Six months into the pandemic, we changed our management strategy to focus on early mobilization. The early mobilization effort included tracheostomy within 48 h of cannulation, decreasing sedation, and an aggressive physical and occupational therapy program progressing toward early ambulation while on ECMO. The primary outcome measured was survival to discharge. The primary stratification was based on the mobilization strategy.

RESULTS:

From 2020 to 2021, 47 COVID patients have been supported with ECMO at our institution. Five are still in the hospital on ECMO. 39 (83%) were supported with venovenous ECMO while 8 (17%) were supported with venoarterial or a right ventricular assist device type configuration. All 47 (100%) were cannulated at bedside with transesophageal echocardiographic guidance. The average age was 47 ± 9 years; 36(77%) were male; and 20 (43%) were Hispanic. The median duration of support was 22 (11-44) days. Excluding those who remain in the hospital and on support, overall survival to discharge was 24/42 (57%). When stratified by mobilization strategy, early tracheostomy and mobilization were associated with significantly improved survival (74% [17/23] vs. 37% [7/19], p = .02). There were no changes in patient acuity or duration of support throughout the study period.

CONCLUSION:

In conclusion, early tracheostomy, decreased sedation, and aggressive mobilization of COVID-19 ECMO patients is associated with improved survival.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal subject: Cardiology Year: 2022 Document Type: Article Affiliation country: Jocs.17079

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Journal subject: Cardiology Year: 2022 Document Type: Article Affiliation country: Jocs.17079