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Sprockel Díaz JJ, Torres Tobar LA, Rodríguez Acosta MJ. Aplicación de la calculadora de probabilidad fenotípica FEN-COVID en pacientes hospitalizados por COVID-19 en una población latinoamericana. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introducción: la variabilidad del comportamiento clínico del COVID-19 puede ser uno de los determinantes que limitan la toma de decisiones terapéuticas. Se busca clasificar a pacientes latinoamericanos hospitalizados mediante la herramienta FEN-COVID para la identificación de fenotipos clínicos y determinar su asociación con mortalidad e ingreso a la unidad de cuidado intensivo (UCI). Métodos: estudio observacional de cohorte retrospectivo, que incluyó adultos hospitalizados en dos centros de tercer nivel de atención con COVID-19 confirmado entre septiembre 2020 y marzo 2021. A cada paciente seleccionado se asignó un fenotipo aplicando la calculadora FEN-COVID. Se llevó a cabo un análisis multivariado para documentar las asociaciones entre el fenotipo, las complicaciones hospitalarias y los desenlaces clínicos. Resultados: se identificaron 126 pacientes hospitalizados por COVID-19, edad promedio de 58 años, 45 mujeres (35.7%), 23% diabéticos, 45% hipertensos y 20% obesos. 108 (85.7%) fueron del fenotipo B y 18 (14.2%) fenotipo C. Aunque en este último los desenlaces fueron peores (requerimiento de UCI 77.8% vs 45.4% y mortalidad 66% vs 22%, OR 1.408, IC95% 3.191-5.243, p <0.007), esta asociación no se mantuvo en el análisis multivariado con OR 1.110 (IC95% 0.780 - 1.581, p de 0.555) Conclusión: los fenotipos identificados a partir de FEN-COVID parecen discriminar un subgrupo de pacientes que ostenta el peor comportamiento clínico, aunque no tuvo representación del fenotipo más leve. El análisis bivariado documentó asociación con la muerte o ingreso a UCI que no se mantuvo en el modelo multivariado.
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2
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Zaidi S, Nguyen D, Harky A. COVID-19, ECMO, and respiratory infection: A new triad? J Card Surg 2022; 37:3619-3622. [PMID: 36073142 PMCID: PMC9538845 DOI: 10.1111/jocs.16910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Sara Zaidi
- School of Medicine, King's College London, London, UK
| | - Dang Nguyen
- Department of Biomedical Engineering, University of South Florida, Tampa, Florida, USA
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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3
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Ling RR, Ramanathan K, Sim JJL, Wong SN, Chen Y, Amin F, Fernando SM, Rochwerg B, Fan E, Barbaro RP, MacLaren G, Shekar K, Brodie D. Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis. Crit Care 2022; 26:147. [PMID: 35606884 PMCID: PMC9125014 DOI: 10.1186/s13054-022-04011-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) has been used extensively for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Reports early in the pandemic suggested that mortality in patients with COVID-19 receiving ECMO was comparable to non-COVID-19-related ARDS. However, subsequent reports suggested that mortality appeared to be increasing over time. Therefore, we conducted an updated systematic review and meta-analysis, to characterise changes in mortality over time and elucidate risk factors for poor outcomes.
Methods We conducted a meta-analysis (CRD42021271202), searching MEDLINE, Embase, Cochrane, and Scopus databases, from 1 December 2019 to 26 January 2022, for studies reporting on mortality among adults with COVID-19 receiving ECMO. We also captured hospital and intensive care unit lengths of stay, duration of mechanical ventilation and ECMO, as well as complications of ECMO. We conducted random-effects meta-analyses, assessed risk of bias of included studies using the Joanna Briggs Institute checklist and evaluated certainty of pooled estimates using GRADE methodology.
Results Of 4522 citations, we included 52 studies comprising 18,211 patients in the meta-analysis. The pooled mortality rate among patients with COVID-19 requiring ECMO was 48.8% (95% confidence interval 44.8–52.9%, high certainty). Mortality was higher among studies which enrolled patients later in the pandemic as opposed to earlier (1st half 2020: 41.2%, 2nd half 2020: 46.4%, 1st half 2021: 62.0%, 2nd half 2021: 46.5%, interaction p value = 0.0014). Predictors of increased mortality included age, the time of final patient enrolment from 1 January 2020, and the proportion of patients receiving corticosteroids, and reduced duration of ECMO run. Conclusions The mortality rate for patients receiving ECMO for COVID-19-related ARDS has increased as the pandemic has progressed. The reasons for this are likely multifactorial; however, as outcomes for these patients evolve, the decision to initiate ECMO should include the best contextual estimate of mortality at the time of ECMO initiation. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04011-2.
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Affiliation(s)
- Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore. .,Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, Singapore, 119228.
| | - Jackie Jia Lin Sim
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Suei Nee Wong
- Medical Resource Team, National University of Singapore Libraries, Singapore, Singapore
| | - Ying Chen
- Agency for Science, Technology and Research, Singapore, Singapore
| | - Faizan Amin
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ryan P Barbaro
- Division of Paediatrics Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, Singapore, 119228
| | - Kiran Shekar
- Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, Australia.,University of Queensland, Brisbane and Bond University, Gold Coast, QLD, Australia
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
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4
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Bohman JJKK, Seelhammer TG, Mazzeffi M, Gutsche J, Ramakrishna H. The Year in Extracorporeal Membrane Oxygenation: Selected Highlights From 2021. J Cardiothorac Vasc Anesth 2022; 36:1832-1843. [PMID: 35367120 DOI: 10.1053/j.jvca.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/11/2022]
Abstract
This review summarizes the extracorporeal membrane oxygenation (ECMO) or extracorporeal life support literature published in 2021. This Selected Highlights article is not intended to be an exhaustive review of the literature, but rather a summarizing of key themes that developed in the ECMO literature during 2021. The primary topics presented include the following: ECMO for coronavirus disease 2019, extracorporeal cardiopulmonary resuscitation, periprocedural cardiopulmonary support with ECMO, and anticoagulation for ECMO.
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Affiliation(s)
- John J Kyle K Bohman
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Troy G Seelhammer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Michael Mazzeffi
- Department of Anesthesiology and Critical Care Medicine, The George Washington University, Washington, DC
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care Medicine, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Bringing biological ARDS phenotypes to the bedside with machine-learning-based classifiers. THE LANCET RESPIRATORY MEDICINE 2022; 10:319-320. [DOI: 10.1016/s2213-2600(21)00492-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022]
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6
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Whebell S, Zhang J, Lewis R, Berry M, Ledot S, Retter A, Camporota L. Survival benefit of extracorporeal membrane oxygenation in severe COVID-19: a multi-centre-matched cohort study. Intensive Care Med 2022; 48:467-478. [PMID: 35238946 PMCID: PMC8892395 DOI: 10.1007/s00134-022-06645-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Abstract
Purpose Extracorporeal membrane oxygenation (ECMO) has become an established therapy for severe respiratory failure in coronavirus disease 2019 (COVID-19). The added benefit of receiving ECMO in COVID-19 remains uncertain. The aim of this study is to analyse the impact of receiving ECMO at specialist centres on hospital mortality. Methods A multi-centre retrospective study was conducted in COVID-19 patients from 111 hospitals, referred to two specialist ECMO centres in the United Kingdom (UK) (March 2020 to February 2021). Detailed covariate data were contemporaneously curated from electronic referral systems. We analysed added benefit of ECMO treatment in specialist centres using propensity score matching techniques. Results 1363 patients, 243 receiving ECMO, were analysed. The best matching technique generated 209 matches, with a marginal odds ratio (OR) for mortality of 0.44 (95% CI 0.29–0.68, p < 0.001) and absolute mortality reduction of 18.2% (44% vs 25.8%, p < 0.001) for treatment with ECMO in a specialist centre. Conclusion We found ECMO provided at specialist centres conferred significant survival benefit. Where resources and specialism allow, ECMO should be widely offered. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06645-w.
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Affiliation(s)
- Stephen Whebell
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.
- Department of Adult Critical Care, St Thomas' Hospital, London, SE1 7EH, UK.
| | - Joe Zhang
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Rebecca Lewis
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Berry
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Stephane Ledot
- Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Andrew Retter
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
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7
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Ali HS, Elshafei MS, Saad MO, Mitwally HA, Al Wraidat M, Aroos A, Shaikh N, Ananthegowda DC, Abdelaty MA, George S, Nashwan AJ, Mohamed AS, Khatib MY. Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study. BMC Pulm Med 2021; 21:354. [PMID: 34743710 PMCID: PMC8572690 DOI: 10.1186/s12890-021-01717-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background Intravenous immunoglobulin (IVIG) has been used as an immunomodulatory therapy to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). But its use in COVID-19 related acute respiratory distress syndrome (ARDS) is not well established. Methods We conducted a retrospective analysis of electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020 and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy or not. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28, and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis. Results Among 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98–6.19; P < 0.001). Ventilator-free days and ICU-free days at day-28 were lower (P < 0.001 for both), and incidence of AKI was significantly higher (85.6% vs. 67.8%; P = 0.001) in the IVIG group. Conclusion IVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized clinical trial is needed to confirm this observation further. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01717-x.
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Affiliation(s)
- Husain S Ali
- Department of Medical ICU/Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar.
| | | | - Mohamed O Saad
- Department of Pharmacy, Al Wakra Hospital, Al Wakrah, Qatar
| | | | | | - Asra Aroos
- Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar
| | - Nissar Shaikh
- Department of Surgical ICU, Hamad General Hospital, Doha, Qatar
| | | | - Mohamed A Abdelaty
- Department of Medical ICU/Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Saibu George
- Department of Medical ICU/Medicine, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | | | - Ahmed S Mohamed
- Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar
| | - Mohamad Y Khatib
- Intensive Care Unit, Hazm Mebaireek General Hospital, Doha, Qatar
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8
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Su C, Xu Z, Hoffman K, Goyal P, Safford MM, Lee J, Alvarez-Mulett S, Gomez-Escobar L, Price DR, Harrington JS, Torres LK, Martinez FJ, Campion TR, Wang F, Schenck EJ. Identifying organ dysfunction trajectory-based subphenotypes in critically ill patients with COVID-19. Sci Rep 2021; 11:15872. [PMID: 34354174 PMCID: PMC8342520 DOI: 10.1038/s41598-021-95431-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Abstract
COVID-19-associated respiratory failure offers the unprecedented opportunity to evaluate the differential host response to a uniform pathogenic insult. Understanding whether there are distinct subphenotypes of severe COVID-19 may offer insight into its pathophysiology. Sequential Organ Failure Assessment (SOFA) score is an objective and comprehensive measurement that measures dysfunction severity of six organ systems, i.e., cardiovascular, central nervous system, coagulation, liver, renal, and respiration. Our aim was to identify and characterize distinct subphenotypes of COVID-19 critical illness defined by the post-intubation trajectory of SOFA score. Intubated COVID-19 patients at two hospitals in New York city were leveraged as development and validation cohorts. Patients were grouped into mild, intermediate, and severe strata by their baseline post-intubation SOFA. Hierarchical agglomerative clustering was performed within each stratum to detect subphenotypes based on similarities amongst SOFA score trajectories evaluated by Dynamic Time Warping. Distinct worsening and recovering subphenotypes were identified within each stratum, which had distinct 7-day post-intubation SOFA progression trends. Patients in the worsening suphenotypes had a higher mortality than those in the recovering subphenotypes within each stratum (mild stratum, 29.7% vs. 10.3%, p = 0.033; intermediate stratum, 29.3% vs. 8.0%, p = 0.002; severe stratum, 53.7% vs. 22.2%, p < 0.001). Pathophysiologic biomarkers associated with progression were distinct at each stratum, including findings suggestive of inflammation in low baseline severity of illness versus hemophagocytic lymphohistiocytosis in higher baseline severity of illness. The findings suggest that there are clear worsening and recovering subphenotypes of COVID-19 respiratory failure after intubation, which are more predictive of outcomes than baseline severity of illness. Distinct progression biomarkers at differential baseline severity of illness suggests a heterogeneous pathobiology in the progression of COVID-19 respiratory failure.
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Affiliation(s)
- Chang Su
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 St., New York, NY, 10065, USA
| | - Zhenxing Xu
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 St., New York, NY, 10065, USA
| | - Katherine Hoffman
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 St., New York, NY, 10065, USA
| | - Parag Goyal
- Division of General Internal Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
| | - Monika M Safford
- Division of General Internal Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
| | - Jerry Lee
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - Sergio Alvarez-Mulett
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Luis Gomez-Escobar
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David R Price
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - John S Harrington
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lisa K Torres
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Fernando J Martinez
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Thomas R Campion
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 St., New York, NY, 10065, USA
| | - Fei Wang
- Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61 St., New York, NY, 10065, USA.
| | - Edward J Schenck
- New York-Presbyterian Hospital, Weill Cornell Medicine, 1300 York Ave., Box 96, New York, NY, 10065, USA.
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
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Cook TM, Camporota L. Critical care outcomes from COVID-19: patients, interventions, healthcare systems and the need for core datasets. Anaesthesia 2021; 76:1155-1158. [PMID: 34318495 PMCID: PMC8444852 DOI: 10.1111/anae.15545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2021] [Indexed: 01/08/2023]
Affiliation(s)
- T M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,School of Medicine, University of Bristol, UK
| | - L Camporota
- Department of Intensive Care, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre of Human Applied Physiological Sciences, King's College London, London, UK
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10
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Ramanathan K, Shekar K, Ling RR, Barbaro RP, Wong SN, Tan CS, Rochwerg B, Fernando SM, Takeda S, MacLaren G, Fan E, Brodie D. Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis. Crit Care 2021; 25:211. [PMID: 34127027 PMCID: PMC8201440 DOI: 10.1186/s13054-021-03634-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research. METHODS We searched MEDLINE, Embase, Cochrane and Scopus databases from 1 December 2019 to 10 January 2021 for observational studies or randomised clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and meta-regression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO. RESULTS We included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI 32.3-42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI 30.7-40.7%, high certainty). Meta-regression found that age and ECMO duration were associated with increased mortality. Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI 13.4-18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI 50.5-82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common. CONCLUSION The majority of patients received venovenous ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1% during the first year of the pandemic, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS. PROSPERO CRD42020192627.
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Affiliation(s)
- Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, 119228, Singapore.
| | - Kiran Shekar
- Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ryan P Barbaro
- Division of Paediatric Critical Care Medicine, University of Michigan, Ann Arbor, USA
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Suei Nee Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chuen Seng Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shinhiro Takeda
- Japan ECMOnet for COVID-19 & President, Kawaguchi Cardiovascular and Respiratory Hospital, Saitama, Japan
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, 119228, Singapore
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
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11
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Isgro G, Yusuff HO, Zochios V. The Right Ventricle in COVID-19 Lung Injury: Proposed Mechanisms, Management, and Research Gaps. J Cardiothorac Vasc Anesth 2021; 35:1568-1572. [PMID: 33546967 PMCID: PMC7810029 DOI: 10.1053/j.jvca.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Graziella Isgro
- Department of Anesthesia and Intensive Care Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK
| | - Hakeem O Yusuff
- Department of Anesthesia and Intensive Care Medicine, Glenfield Hospital, University Hospitals of Leicester National Health Service Trust, Leicester, UK; University of Leicester, Leicester, UK
| | - Vasileios Zochios
- Department of Critical Care Medicine, University Hospitals Birmingham National Health Service Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Birmingham Acute Care Research, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK
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