Extracorporeal membrane oxygenation during the coronavirus disease 2019 pandemic-Continued observations from a retrospective single-center registry

Microbiological findings in a cohort of patients with coronavirus disease 2019 and venovenous extracorporeal membrane oxygenation

BACKGROUND

Venovenous extracorporeal membrane oxygenation (VV ECMO) is an established support option for patients with very severe respiratory failure and played an important role during the coronavirus disease 2019 (COVID-19) pandemic. Bacteria and fungi can lead to severe infectious complications in critically ill patients. The aim of this study was to describe the microbiological spectrum of bacteria and fungi detected in patients with COVID-19-associated respiratory failure supported with VV ECMO in our center.

METHODS

This retrospective single-center analysis included all patients with COVID-19-associated respiratory failure supported with VV ECMO in our center between March 2020 and May 2022. All findings from microbiological samples, taken as part of clinical routine assessment from initiation of VV ECMO until day 30 were included. Samples were described by site and time of detection and microbiological characteristics.

RESULTS

From March 2020 through May 2022, 88 patients with COVID-19-associated respiratory failure received VV ECMO support at our center. In 83/88 patients (94.3%), one or more pathogens were found in microbiological samples. Most pathogens were isolated from samples from the respiratory tract (88.6%). Earliest detection occurred in samples from the respiratory tract with a median time of 5 days to first detection. The most frequently detected pathogens were Staphylococcus spp., Candida spp., Klebsiella spp., Escherichia coli and Enterococcus spp.

CONCLUSION

In this cohort of severely ill COVID-19 patients receiving VV ECMO support, pathogens were frequently detected.

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2022

This special article is the 15th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief Dr. Kaplan and the editorial board for the opportunity to continue this series, namely the research highlights of the past year in the specialties of cardiothoracic and vascular anesthesiology. The major themes selected for 2022 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights, in the specialties for 2022, begin with an update on COVID-19 therapies, with a focus on the temporal updates in a wide range of therapies, progressing from medical to the use of extracorporeal membrane oxygenation and, ultimately, with lung transplantation in this high-risk group. The second major theme is focused on medical cardiology, with the authors discussing new insights into the life cycle of coronary disease, heart failure treatments, and outcomes related to novel statin therapy. The third theme is focused on mechanical circulatory support, with discussions focusing on both right-sided and left-sided temporary support outcomes and the optimal timing of deployment. The fourth and final theme is an update on cardiac surgery, with a discussion of the diverse aspects of concomitant valvular surgery and the optimal approach to procedural treatment for coronary artery disease. The themes selected for this 15th special article are only a few of the diverse advances in the specialties during 2022. These highlights will inform the reader of key updates on a variety of topics, leading to the improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.

Acute respiratory distress syndrome following coronary artery bypass grafting successfully treated with venovenous extracorporeal membrane oxygenation

Introduction. Acute respiratory distress syndrome (ARDS) is one of the most serious complications during the postoperative period in cardiac surgery. Venovenous extracorporeal membrane oxygenation (VV-ECMO) has proven to be a valuable therapy in ARDS when standard therapy is insufficient. Our aim is to present a case of severe ARDS which was succesfully treated by VV-ECMO. Case outline. A 54-year-old male patient was urgently admitted to our hospital due to anterior wall myocardal infarction. Urgent coronarography was performed, which found severe three-vessel coronary disease. Triple coronary artery bypass grafting (CABG) was performed. After surgery, due to prolonged respiratory insufficiency, the patient was diagnosed with ARDS and VV-ECMO was placed. Nine days later, normal values of gase exchange were achieved and the patient was succesfully weaned from VV-ECMO. Conclusion. We showed that when conventional therapy for ARDS is not effective, use of ECMO should be considered.