Extracorporeal membrane oxygenation in patients with SARS-CoV-2

Coronaviruses are single-stranded RNA viruses that cause respiratory and intestinal infections in humans. The coronaviruses (HCoVNL63, HCoV-229E, HCoV-OC43 and HKU1), were known to cause mild infections in immunocompromised persons. However, at the beginning of the XXI century, two new coronaviruses with high pathogenicity were described; the severe acute respiratory syndrome coronavirus (SARS-CoV) and the middle east respiratory syndrome coronavirus (MERS-CoV). In the Wuhan city, the capital of China's Hubei province in December 2019 a new coronavirus (2019-nCoV) was identified.1,2 Provisionally named 2019-nCoV, the International Committee on Taxonomy of Viruses (ICTV) was renamed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) named the pathology as coronavirus disease 2019 (COVID-19).3 The infection by SARS-CoV-2 occurs for respiratory droplets and aerosols released from coughing and sneezing. The viral particles can fall on surfaces and objects, causing the virus to remain on them for several hours. Transmission can occur through direct contact of the hands-on mucous membranes of the mouth, nose and eyes.4,5 Fever, muscle pain, cough and dyspnea are symptoms frequently reported in patients infected with SARS-CoV-2.6 A lot of people have a positive prognosis; however, in the elderly population and individuals with underlying chronic diseases (diabetes, hypertension and cardiovascular diseases) the infection causes more serious manifestations, with a high mortality rate. Although the most of patients affected by COVID-19 have mild symptoms, some may develop acute respiratory distress syndrome (ARDS), requiring admission to the intensive care unit (ICU).7 ARDS is a state of severe acute hypoxia, caused by increased capillary permeability and consequent damage to alveolar cells.5 Histopathological examinations of lung samples from patients with SARS-CoV-2, are similar to those seen in SARS-CoV and MERS-CoV infections, demonstrating diffuse alveolar damage, fibrinous exudates, pulmonary edema and interstitial inflammatory infiltrates consisting of lymphocytes.8 The World Health Organization recommends the use of extracorporeal membrane oxygenation (ECMO) in patients affected by COVID-19 with refractory hypoxemia who do not respond to conventional treatment on mechanical ventilation.9 The ECMO can serve as a rescue therapy for these patients and the venous venous type is the choice. However, the SARSCov-2 can causes cardiovascular complications and, in these cases, can be considered the configuration venoarterial...

Benefits of Continuous Monitoring of PCO2 Obtained from a System Applied to Membrane Oxygenator Exhaustion of the Cardiopulmonary Bypass Circuit.

OBJECTIVE: To observe the impact of the use of capnography system adapted to cardiopulmonary bypass (CPB). To measure the concordance between values obtained from continuous monitoring of partial pressure of carbon dioxide in membrane oxygenator exhaustion (PeCO2) and the results observed on arterial blood gas test. METHODS: Participated in this study 40 patients submitted to elective cardiovascular surgery with CPB. They were divided into two groups: Group 1, with 20 patients submitted to the surgical procedure using blood gas analysis at intermittent intervals (20 - 30 minutes); Group 2, with 20 patients operated with a capnography system adapted applied to membrane oxygenator exhaustion and blood gas test. A test was used to compare arterial partial pressure of carbon dioxide (PaCO2) from group 1 and group 2. In group 2, the strength of the correlation between PeCO2 and PaCO2 was evaluated by a linear regression test. The Bland-Altman method was used to determine the degree of agreement between the two variables. RESULTS: Average and standard deviation of Group 1's PaCO2 (34.6 ± 7.44) and Group 2's PaCO2 / PeCO2 (36.5 ± 4.42) / (39.9 ± 3.98). There was no statistically significant difference in PaCO2 between the groups (P = 0.21). In group 2, PeCO2 and PaCO2 analyzed corrected for esophageal temperature obtained a positive linear correlation (r = 0.79, P < 0.001), the degree of agreement presented an average 3.47 ± 2.70 mmHg. CONCLUSION: The continuous PeCO2 monitoring from cardiopulmonary bypass circuit has a positive impact on the result of PaCO2. This instrument confirms and maintains the carbon dioxide (CO2) values into reference parameters.

Benefits of continuous monitoring of PCO2 obtained from a system applied to membrane oxygenator exhaustion of the cardiopulmonary bypass circuit

OBJECTIVE: To observe the impact of the use of capnography system adapted to cardiopulmonary bypass (CPB). To measure the concordance between values obtained from continuous monitoring of partial pressure of carbon dioxide in membrane oxygenator exhaustion (PeCO2) and the results observed on arterial blood gas test. METHODS: Participated in this study 40 patients submitted to elective cardiovascular surgery with CPB. They were divided into two groups: Group 1, with 20 patients submitted to the surgical procedure using blood gas analysis at intermittent intervals (20 - 30 minutes); Group 2, with 20 patients operated with a capnography system adapted applied to membrane oxygenator exhaustion and blood gas test. A test was used to compare arterial partial pressure of carbon dioxide (PaCO2 ) from group 1 and group 2. In group 2, the strength of the correlation between PeCO2 and PaCO2 was evaluated by a linear regression test. The Bland-Altman method was used to determine the degree of agreement between the two variables. RESULTS: Average and standard deviation of Group 1's PaCO2 (34.6 ± 7.44) and Group 2's PaCO2 / PeCO2 (36.5 ± 4.42) / (39.9 ± 3.98). There was no statistically significant difference in PaCO2 between the groups (P = 0.21). In group 2, PeCO2 and PaCO2 analyzed corrected for esophageal temperature obtained a positive linear correlation (r = 0.79, P < 0.001), the degree of agreement presented an average 3.47 ± 2.70 mmHg. CONCLUSION: The continuous PeCO2 monitoring from cardiopulmonary bypass circuit has a positive impact on the result of PaCO2. This instrument confirms and maintains the carbon dioxide (CO2) values into reference parameters.