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Leng A, Shou B, Liu O, Bachina P, Kalra A, Bush EL, Whitman GJR, Cho SM. Machine Learning from Veno-Venous Extracorporeal Membrane Oxygenation Identifies Factors Associated with Neurological Outcomes. Lung 2024:10.1007/s00408-024-00708-z. [PMID: 38814448 DOI: 10.1007/s00408-024-00708-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Neurological complications are common in patients receiving veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We used machine learning (ML) algorithms to identify predictors for neurological outcomes for these patients. METHODS All demographic, clinical, and circuit-related variables were extracted for adults with VV-ECMO support at a tertiary care center from 2016 to 2022. The primary outcome was good neurological outcome (GNO) at discharge defined as a modified Rankin Scale of 0-3. RESULTS Of 99 total VV-ECMO patients (median age = 48 years; 65% male), 37% had a GNO. The best performing ML model achieved an area under the receiver operating characteristic curve of 0.87. Feature importance analysis identified down-trending gas/sweep/blender flow, FiO2, and pump speed as the most salient features for predicting GNO. CONCLUSION Utilizing pre- as well as post-initiation variables, ML identified on-ECMO physiologic and pulmonary conditions that best predicted neurological outcomes.
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Affiliation(s)
- Albert Leng
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
- Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Benjamin Shou
- Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Olivia Liu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Preetham Bachina
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Errol L Bush
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Glenn J R Whitman
- Division of Cardiac Surgery, Department of Surgery, Heart and Vascular Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sung-Min Cho
- Divisions of Neurosciences Critical Care and Cardiac Surgery, Departments of Neurology, Surgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 455, Baltimore, MD, 21287, USA.
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Sylvestre A, Forel JM, Textoris L, Gragueb-Chatti I, Daviet F, Salmi S, Adda M, Roch A, Papazian L, Hraiech S, Guervilly C. Outcomes of Severe ARDS COVID-19 Patients Denied for Venovenous ECMO Support: A Prospective Observational Comparative Study. J Clin Med 2024; 13:1493. [PMID: 38592410 PMCID: PMC10932228 DOI: 10.3390/jcm13051493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Few data are available concerning the outcome of patients denied venovenous extracorporeal membrane oxygenation (VV-ECMO) relative to severe acute respiratory distress syndrome (ARDS) due to COVID-19. Methods: We compared the 90-day survival rate of consecutive adult patients for whom our center was contacted to discuss VV-ECMO indication. Three groups of patients were created: patients for whom VV-ECMO was immediately indicated (ECMO-indicated group), patients for whom VV-ECMO was not indicated at the time of the call (ECMO-not-indicated group), and patients for whom ECMO was definitely contraindicated (ECMO-contraindicated group). Results: In total, 104 patients were referred for VV-ECMO support due to severe COVID-19 ARDS. Among them, 32 patients had immediate VV-ECMO implantation, 28 patients had no VV-ECMO indication, but 1 was assisted thereafter, and 44 patients were denied VV-ECMO for contraindication. Among the 44 patients denied, 30 were denied for advanced age, 24 for excessive prior duration of mechanical ventilation, and 16 for SOFA score >8. The 90-day survival rate was similar for the ECMO-indicated group and the ECMO-not-indicated group at 62.1 and 61.9%, respectively, whereas it was significantly lower (20.5%) for the ECMO-contraindicated group. Conclusions: Despite a low survival rate, 50% of patients were at home 3 months after being denied for VV-ECMO for severe ARDS due to COVID-19.
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Affiliation(s)
- Aude Sylvestre
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Jean-Marie Forel
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Laura Textoris
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Ines Gragueb-Chatti
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Florence Daviet
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Saida Salmi
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Mélanie Adda
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Antoine Roch
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Laurent Papazian
- Centre Hospitalier de Bastia, Service de Réanimation, 604 Chemin de Falconaja, 20600 Bastia, France;
- Unité des Virus Émergents (UVE: Aix-Marseille Univ, Università di Corsica, IRD 190, Inserm 1207, IRBA), 13284 Marseille, France
| | - Sami Hraiech
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
| | - Christophe Guervilly
- Assistance Publique—Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; (A.S.); (J.-M.F.); (L.T.); (I.G.-C.); (F.D.); (S.S.); (M.A.); (A.R.); (S.H.)
- Faculté de Médecine, Aix-Marseille Université, Centre d’Études et de Recherches sur les Services de Santé et Qualité de vie EA 3279, 13005 Marseille, France
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Tan Z, Su L, Chen X, He H, Long Y. Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:868. [PMID: 38337562 PMCID: PMC10856383 DOI: 10.3390/jcm13030868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is the etiology of acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) is used to support gas exchange in patients who have failed conventional mechanical ventilation. However, there is no clear consensus on the timing of ECMO use in severe COVID-19 patients. OBJECTIVE The aim of this study is to compare the differences in pre-ECMO time and ECMO duration between COVID-19 survivors and non-survivors and to explore the association between them. METHODS PubMed, the Cochrane Library, Embase, and other sources were searched until 21 October 2022. Studies reporting the relationship between ECMO-related time and COVID-19 survival were included. All available data were pooled using random-effects methods. Linear regression analysis was used to determine the correlation between pre-ECMO time and ECMO duration. The meta-analysis was registered with PROSPERO under registration number CRD42023403236. RESULTS Out of the initial 2473 citations, we analyzed 318 full-text articles, and 54 studies were included, involving 13,691 patients. There were significant differences between survivors and non-survivors in the time from COVID-19 diagnosis (standardized mean difference (SMD) = -0.41, 95% confidence interval (CI): [-0.53, -0.29], p < 0.00001), hospital (SMD = -0.53, 95% CI: [-0.97, -0.09], p = 0.02) and intensive care unit (ICU) admission (SMD = -0.28, 95% CI: [-0.49, -0.08], p = 0.007), intubation or mechanical ventilation to ECMO (SMD = -0.21, 95% CI: [-0.32, -0.09], p = 0.0003) and ECMO duration (SMD = -0.18, 95% CI: [-0.30, -0.06], p = 0.003). There was no statistical association between a longer time from symptom onset to ECMO (hazard ratio (HR) = 1.05, 95% CI: [0.99, 1.12], p = 0.11) or time from intubation or mechanical ventilation (MV) and the risk of mortality (highest vs. lowest time groups odds ratio (OR) = 1.18, 95% CI: [0.78, 1.78], p = 0.42; per one-day increase OR = 1.14, 95% CI: [0.86, 1.52], p = 0.36; HR = 0.99, 95% CI: [0.95, 1.02], p = 0.39). There was no linear relationship between pre-ECMO time and ECMO duration. CONCLUSION There are differences in pre-ECMO time between COVID-19 survivors and non-survivors, and there is insufficient evidence to conclude that longer pre-ECMO time is responsible for reduced survival in COVID-19 patients. ECMO duration differed between survivors and non-survivors, and the timing of pre-ECMO does not have an impact on ECMO duration. Further studies are needed to explore the association between pre-ECMO and ECMO time in the survival of COVID-19 patients.
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Affiliation(s)
| | | | | | | | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China; (Z.T.); (L.S.); (X.C.); (H.H.)
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Pans N, Vanherf J, Vandenbrande J, Lehaen J, Yilmaz A, Verwerft J, Van Tornout M, Geebelen L, Callebaut I, Herbots L, Dubois J, Stessel B. Predictors of poor outcome in critically ill patients with COVID-19 pneumonia treated with extracorporeal membrane oxygenation. Perfusion 2024; 39:151-161. [PMID: 36219740 PMCID: PMC9554572 DOI: 10.1177/02676591221131487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We aimed to identify risk factors associated with ICU mortality in critically ill patients with COVID-19 pneumonia treated with Extracorporeal membrane oxygenation (ECMO). We also aimed to assess protocol violations of the local eligibility criteria of ECMO initiation. METHODS All 31 consecutive adult patients with confirmed COVID-19 pneumonia admitted to ICU and treated with ECMO from March 13th 2020 to 8 December 2021 were enrolled. Eligibility criteria for ECMO initiation were: P/F-ratio<50 mmHg >3 hours, P/F-ratio<80 mmHg >6 hours or pH<7.25 + PaCO2>60 mmHg >6 hours, despite maximal protective invasive ventilation. Primary outcome was ICU mortality. Univariate logistic regression analyses were performed to identify predictors of ICU mortality. RESULTS 12 out of 31 patients (38.7%) did not survive ECMO treatment in ICU. Half of the non-survivors suffered from acute kidney failure compared to 3 out of 19 survivors (15.79%) (p = .04). Half of the non-survivors required CRRT treatment versus 1 patient in the survivor group (5.3%) (p < .01). Higher age (2.45 (0.97-6.18), p = .05), the development of AKI (5.33 (1.00-28.43), p = .05), need of CRRT during ICU stay (18.00 (1.79-181.31), p = .01) and major bleeding during ECMO therapy (0.51 (0.19-0.89), p < .01) were identified to be predictors of ICU mortality. CONCLUSION Almost 60% of patients could be treated successfully with ECMO with sustained results at 3 months. Predictors for ICU mortality were development of AKI and need of CRRT during ICU stay, higher age category and major bleeding. Inadvertent ECMO allocation was noted in almost one in five patients.
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Affiliation(s)
- Nick Pans
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Jul Vanherf
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Vandenbrande
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Lehaen
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Jan Verwerft
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Michiel Van Tornout
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Laurien Geebelen
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Ina Callebaut
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Belgium
| | - Lieven Herbots
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Jasperina Dubois
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Björn Stessel
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Belgium
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Murthy PR, Narendraprasad C, Karanth S, Gupta KVV, Kumar AKA, Padyana M. Extracorporeal membrane oxygenation in COVID-19- Associated acute respiratory distress syndrome - Outcome and experience in a tertiary care intensive care unit - A retrospective study. Indian J Anaesth 2023; 67:901-904. [PMID: 38044926 PMCID: PMC10691609 DOI: 10.4103/ija.ija_935_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 12/05/2023] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) has been used in patients with severe acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) who fail conventional treatment. Methods A retrospective observational study was designed in patients who underwent ECMO for severe COVID-19 ARDS in a tertiary care centre from September 2020 to July 2021. The primary outcome was to assess factors influencing clinical outcomes and survival to hospital discharge. Secondary outcomes were to assess the clinical profile and pre-ECMO features, ECMO characteristics and complications. Collected data were entered in Excel software and analysed using R software version 4.0.2 (R foundation for statistical computing, Vienna, Austria). Results A total of 19 patients underwent ECMO. Ten patients survived and discharge. Survivors had a longer median (interquartile range [IQR]) duration (days) on ECMO, that is, 25 (7-50), compared to non-survivors, that is, 12 (1-34) (P = 0.133). We also noted that patients who survived had a longer median (IQR) duration (days) of intensive care unit (ICU) stay, that is, 41.5 (30-70), compared to non-survivors, that is, 9 (2-40) (P = 0.001). Conclusion In our study, 52.3% of patients survived and discharge, and with ECMO outcomes for COVID-19 ARDS were at par with ECMO outcomes for non-COVID-19 ARDS despite requiring ECMO for longer duration and increased ICU length of stay.
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Affiliation(s)
- Pooja R. Murthy
- Department of Critical Care Medicine, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - C Narendraprasad
- Department of Critical Care Medicine, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - Sunil Karanth
- Department of Critical Care Medicine, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - K V Venkatesha Gupta
- Department of Critical Care Medicine, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - A K Ajith Kumar
- Department of Critical Care Medicine, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
| | - Mahesha Padyana
- Department of Critical Care Medicine, Manipal Hospitals, Old Airport Road, Bangalore, Karnataka, India
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Rottmann FA, Noe C, Bemtgen X, Maier S, Supady A, Wengenmayer T, Staudacher DL. Survival outcomes and mobilization during venovenous extracorporeal membrane oxygenation: a retrospective cohort study. Front Med (Lausanne) 2023; 10:1271540. [PMID: 37841002 PMCID: PMC10569171 DOI: 10.3389/fmed.2023.1271540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Venovenous extracorporeal membrane oxygenation (V-V ECMO) can be considered in critically ill patient in severe pulmonary failure. However, the mobilization of patients on V-V ECMO can be challenging due to logistic and safety concerns. This study aimed to investigate whether 30 days survival was improved in patients who were mobilized during V-V ECMO support. Methods We conducted a retrospective cohort all-comer study that included all patients cannulated for V-V ECMO at a single center. Patients with a V-V ECMO duration below 24 h were excluded from the analysis. The patients were grouped based on the ICU mobility scale documented during V-V ECMO support. The primary endpoint was 30 days survival, and secondary endpoints included weaning from ECMO and mechanical ventilation, as well as hospital survival. Results A total of 343 patients were included in the study, with a median age of 56 years and 32% were female. Among them, 28% had chronic lung disease. The ICU mobilization scale ≥2 during ECMO was documented in 62/343 (18%) patients. There were no significant differences in age, gender and preexisting lung disease. Duration of ICU stay (13.1 vs. 15.6 days), time on ECMO (186 vs. 190 h) and mechanical ventilation (11.2 vs. 13.6 days) were slightly shorter in patients with ICU mobility scale <2 compared to those with ≥2 (all p = 0.0001). However, patients with ICU mobilization scale ≥2 showed significantly better 30 days survival (71.0 vs. 48.0%, OR 2.6 (1.5 to 4.8), p = 0.0012) compared to those with <2. In the ≥2 mobility scale group, a significantly higher number of patients were successfully weaned from the ventilator (61.3 vs. 46.6%, OR 1.8 (1.0 to 3.2), p = 0.049). A stronger correlation was observed between more intense mobilizations, such as being in a standing position (OR 5.0 (1.7 to 14.0), p = 0.0038), and higher 30 days survival. Conclusion The findings of this study suggest that active mobilization during V-V ECMO support is associated with improved 30 days survival and successful weaning from the respirator. Incorporating mobilization as part of the therapeutic approach during ECMO support may offer potential benefits for critically ill patients.
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Affiliation(s)
- Felix A. Rottmann
- Department of Medicine IV – Nephrology and Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Christian Noe
- Interdisciplinary Medical Intensive Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Xavier Bemtgen
- Department of Cardiology and Angiology I, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexander Supady
- Interdisciplinary Medical Intensive Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Tobias Wengenmayer
- Interdisciplinary Medical Intensive Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dawid L. Staudacher
- Interdisciplinary Medical Intensive Care, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
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Zhai K, Xu X, Zhang P, Wei S, Li J, Wu X, Gao B, Zhang Y, Li Y. Venovenous extracorporeal membrane oxygenation for coronavirus disease 2019 patients: A systematic review and meta-analysis. Perfusion 2023; 38:1107-1122. [PMID: 35608047 DOI: 10.1177/02676591221104302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Although the application of venovenous extracorporeal membrane oxygenation (VV-ECMO) in coronavirus disease 2019 (COVID-19) patients with acute respiratory distress syndrome (ARDS) is accumulating, the feasibility and safety of this therapy remain controversial. We aimed to evaluate the effect of VV-ECMO in the treatment of these patients. METHODS A comprehensive literature search was performed using PubMed, Embase, the Cochrane Library, and International Clinical Trials Registry Platform databases through November 2021. According to the inclusion and exclusion criteria, the included studies were screened, and meta-analysis was performed by R software (version 4.0.2). RESULTS Forty-two studies including 2037 COVID-19 patients supported with VV-ECMO due to ARDS were identified. The pooled analysis revealed that 30-, 60-, and 90-day mortality among patients were respectively 46% (95% CI 37%-57%, I2 = 66%), 46% (95% CI 30%-70%, I2 = 93%), and 49% (95% CI 43%-58%, I2 = 52%), and the pooled incidence rate of in-hospital mortality, major bleeding, hemorrhagic stroke, thrombosis, pulmonary embolism, deep venous thrombosis, and renal replacement therapy were respectively 35%, 39%, 11%, 40%, 15%, 21%, and 44%. CONCLUSION Although COVID-19 patients may have a higher risk of bleeding, hemorrhagic stroke, and acute kidney injury during ECMO therapy, the survival rate was more than half of the cases. Our data may support the application of VV-ECMO in COVID-19 patients.
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Affiliation(s)
- Kerong Zhai
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xu Xu
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Pengbin Zhang
- Department of Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shilin Wei
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Jian Li
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiangyang Wu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Bingren Gao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yanhua Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
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Grouls A, Dobbie K, Neuendorf K, Nakagawa S, Young A, Rosa WE, Akkanti B. Top Ten Tips Palliative Care Clinicians Should Know About Working With Adults Receiving Extracorporeal Membrane Oxygenation. J Palliat Med 2023; 26:1270-1276. [PMID: 36791329 PMCID: PMC10701507 DOI: 10.1089/jpm.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 02/17/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is an invasive intervention that is both resource- and labor-intensive. It can also be emotionally challenging for all involved. Palliative care (PC) clinicians can support adult patients, families, surrogate decision makers, and the interdisciplinary team (IDT) throughout ECMO, starting at the time of ECMO initiation through discontinuation and to bereavement in the event of a patient's death. In addition to knowing the basics of ECMO circuitry, indications to start ECMO, and the complex decision points throughout treatment, PC clinicians must understand the critical need for specialist and IDT coordination when discussing prognosis and resuscitation, clarifying goals of care, and identifying future treatment options. Not only are PC clinicians' skills needed to manage symptoms and psychosocial needs but also during end-of-life care, which can often be rapid and requires team consensus to ensure a smooth clinical process with continuous family support. While using their expert communication skills to conduct frequent family meetings, ideally starting within one week of ECMO initiation and weekly thereafter, PC clinicians offer a consistent presence and "big picture" perspective for patients and families, while other members of the IDT may rotate regularly. PC clinicians will also be called on to assist members of the IDT to debrief about the understandable moral and emotional distress they may experience while providing care for patients receiving ECMO and their families.
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Affiliation(s)
- Astrid Grouls
- Department of Medicine, Section of Geriatrics and Palliative Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Krista Dobbie
- Department of Palliative and Supportive Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kathleen Neuendorf
- Department of Palliative and Supportive Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shunichi Nakagawa
- Adult Palliative Care Service, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Alisha Young
- Division of Pulmonary and Critical Care Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Division of Geriatric and Palliative Care Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bindu Akkanti
- Division of Pulmonary and Critical Care Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA
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9
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Rabie AA, Elhazmi A, Azzam MH, Abdelbary A, Labib A, Combes A, Zakhary B, MacLaren G, Barbaro RP, Peek GJ, Antonini MV, Shekar K, Al-Fares A, Oza P, Mehta Y, Alfoudri H, Ramanathan K, Ogino M, Raman L, Paden M, Brodie D, Bartlett R. Expert consensus statement on venovenous extracorporeal membrane oxygenation ECMO for COVID-19 severe ARDS: an international Delphi study. Ann Intensive Care 2023; 13:36. [PMID: 37129771 PMCID: PMC10152433 DOI: 10.1186/s13613-023-01126-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/05/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The high-quality evidence on managing COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO) support is insufficient. Furthermore, there is little consensus on allocating ECMO resources when scarce. The paucity of evidence and the need for guidance on controversial topics required an international expert consensus statement to understand the role of ECMO in COVID-19 better. Twenty-two international ECMO experts worldwide work together to interpret the most recent findings of the evolving published research, statement formulation, and voting to achieve consensus. OBJECTIVES To guide the next generation of ECMO practitioners during future pandemics on tackling controversial topics pertaining to using ECMO for patients with COVID-19-related severe ARDS. METHODS The scientific committee was assembled of five chairpersons with more than 5 years of ECMO experience and a critical care background. Their roles were modifying and restructuring the panel's questions and, assisting with statement formulation in addition to expert composition and literature review. Experts are identified based on their clinical experience with ECMO (minimum of 5 years) and previous academic activity on a global scale, with a focus on diversity in gender, geography, area of expertise, and level of seniority. We used the modified Delphi technique rounds and the nominal group technique (NGT) through three face-to-face meetings and the voting on the statement was conducted anonymously. The entire process was planned to be carried out in five phases: identifying the gap of knowledge, validation, statement formulation, voting, and drafting, respectively. RESULTS In phase I, the scientific committee obtained 52 questions on controversial topics in ECMO for COVID-19, further reviewed for duplication and redundancy in phase II, resulting in nine domains with 32 questions with a validation rate exceeding 75% (Fig. 1). In phase III, 25 questions were used to formulate 14 statements, and six questions achieved no consensus on the statements. In phase IV, two voting rounds resulted in 14 statements that reached a consensus are included in four domains which are: patient selection, ECMO clinical management, operational and logistics management, and ethics. CONCLUSION Three years after the onset of COVID-19, our understanding of the role of ECMO has evolved. However, it is incomplete. Tota14 statements achieved consensus; included in four domains discussing patient selection, clinical ECMO management, operational and logistic ECMO management and ethics to guide next-generation ECMO providers during future pandemic situations.
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Affiliation(s)
- Ahmed A Rabie
- Critical Care Department-ECMO care Unit (ECU), Riyadh Region Cluster1, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Alyaa Elhazmi
- Internal Medicine Department, King Faisal University, Riyadh, Saudi Arabia
| | - Mohamed H Azzam
- Adult Critical Care Department, Dr. Sulaiman Alhabib Medical Group, Jeddah, Saudi Arabia
| | | | - Ahmed Labib
- Hamad Medical Corporation, Weill Cornell Medical College, Doha, Qatar
| | - Alain Combes
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Sorbonne Université, 75013, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | | | - Graeme MacLaren
- Cardiothoracic ICU, National University Hospital, Singapore, Singapore
| | - Ryan P Barbaro
- Division of Pediatric Critical Care and Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Giles J Peek
- Congenital Heart Center, University of Florida, Gainesville, FL, USA
| | | | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Abdulrahman Al-Fares
- Department of Anesthesia, Critical Care Medicine and Pain Medicine, Ministry of Health, Kuwait City, Kuwait
- Al-Amiri Hospital Center for Respiratory and Cardiac Failure, Kuwait Extracorporeal Life Support Program, Ministry of Health, Kuwait City, Kuwait
| | - Pranay Oza
- Riddhi Vinayak Multispecialty Hospital, Mumbai, India
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Sector-38, Gurgaon, 122001, Haryana, India
| | - Huda Alfoudri
- Department of Anaesthesia, Critical Care, and Pain Management, Al-Adan Hospital Ministry of Health, Hadiya, Kuwait
| | | | - Mark Ogino
- Chief Partnership Officer, Nemours Children's Health, Delaware Valley, USA
| | - Lakshmi Raman
- Division of Paediatric Critical Care, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Matthew Paden
- Division of Paediatric Critical Care, Emory University, Atlanta, GA, USA
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians & Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian/Columbia University Medical Center, New York, USA
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10
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Ray P, Chakraborty R, Banik O, Banoth E, Kumar P. Surface Engineering of a Bioartificial Membrane for Its Application in Bioengineering Devices. ACS OMEGA 2023; 8:3606-3629. [PMID: 36743049 PMCID: PMC9893455 DOI: 10.1021/acsomega.2c05983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/04/2023] [Indexed: 06/18/2023]
Abstract
Membrane technology is playing a crucial role in cutting-edge innovations in the biomedical field. One such innovation is the surface engineering of a membrane for enhanced longevity, efficient separation, and better throughput. Hence, surface engineering is widely used while developing membranes for its use in bioartificial organ development, separation processes, extracorporeal devices, etc. Chemical-based surface modifications are usually performed by functional group/biomolecule grafting, surface moiety modification, and altercation of hydrophilic and hydrophobic properties. Further, creation of micro/nanogrooves, pillars, channel networks, and other topologies is achieved to modify physio-mechanical processes. These surface modifications facilitate improved cellular attachment, directional migration, and communication among the neighboring cells and enhanced diffusional transport of nutrients, gases, and waste across the membrane. These modifications, apart from improving functional efficiency, also help in overcoming fouling issues, biofilm formation, and infection incidences. Multiple strategies are adopted, like lysozyme enzymatic action, topographical modifications, nanomaterial coating, and antibiotic/antibacterial agent doping in the membrane to counter the challenges of biofilm formation, fouling challenges, and microbial invasion. Therefore, in the current review, we have comprehensibly discussed different types of membranes, their fabrication and surface modifications, antifouling/antibacterial strategies, and their applications in bioengineering. Thus, this review would benefit bioengineers and membrane scientists who aim to improve membranes for applications in tissue engineering, bioseparation, extra corporeal membrane devices, wound healing, and others.
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Affiliation(s)
- Pragyan Ray
- BioDesign
and Medical Devices Laboratory, Department of Biotechnology and Medical
Engineering, National Institute of Technology,
Rourkela, Sector-1, Rourkela 769008, Odisha, India
| | - Ruchira Chakraborty
- BioDesign
and Medical Devices Laboratory, Department of Biotechnology and Medical
Engineering, National Institute of Technology,
Rourkela, Sector-1, Rourkela 769008, Odisha, India
| | - Oindrila Banik
- BioDesign
and Medical Devices Laboratory, Department of Biotechnology and Medical
Engineering, National Institute of Technology,
Rourkela, Sector-1, Rourkela 769008, Odisha, India
- Opto-Biomedical
Microsystem Laboratory, Department of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, Sector-1, Rourkela 769008, Odisha, India
| | - Earu Banoth
- Opto-Biomedical
Microsystem Laboratory, Department of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, Sector-1, Rourkela 769008, Odisha, India
| | - Prasoon Kumar
- BioDesign
and Medical Devices Laboratory, Department of Biotechnology and Medical
Engineering, National Institute of Technology,
Rourkela, Sector-1, Rourkela 769008, Odisha, India
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11
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Huespe IA, Lockhart C, Kashyap R, Palizas F, Colombo M, Romero MDP, Prado E, Casabella García CA, Las Heras M, Carboni Bisso I. Evaluation of the discrimination and calibration of predictive scores of mortality in ECMO for patients with COVID-19. Artif Organs 2023:10.1111/aor.14493. [PMID: 36582133 PMCID: PMC9880702 DOI: 10.1111/aor.14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/28/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND The criteria for the selection of COVID-19 patients that could benefit most from ECMO organ support are yet to be defined. In this study, we evaluated the predictive performance of ECMO mortality predictive models in patients with COVID-19. We also performed a cost-benefit analysis depending on the mortality predicted probability. We conducted a retrospective cohort study in COVID-19 patients who received ECMO at two tertiary care hospitals between March 2020 to July 2021. MATERIALS AND METHODS We evaluated the discrimination (C-statistic), calibration (Cox calibration), and accuracy of the prediction of death due to severe ARDS in V-V ECMO score (PRESERVE), the Respiratory Extracorporeal Membrane Oxygenation Survival Score (RESP) score, and the PREdiction of Survival on ECMO Therapy-Score (PRESET) score. In addition, we compared the RESP score with Plateau pressure instead of Peak pressure. RESULTS We included a total of 36 patients, 29 (80%) of them male and with a median (IQR) APACHE of 10 (8-15). The PRESET score had the highest discrimination (AUROCs 0.81 [95%CI 0.67-0.94]) and calibration (calibration-in-the-large 0.5 [95%CI -1.4 to 0.3]; calibration slope 2.2 [95%CI 0.7/3.7]). The RESP score with Plateau pressure had higher discrimination than the conventional RESP score. The cost per QALY in the USA, adjusted to life expectancy, was higher than USD 100 000 in patients older than 45 years with a PRESET > 10. CONCLUSION The PRESET score had the highest predictive performance and could help in the selection of patients that benefit most from this resource-demanding and highly invasive organ support.
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Affiliation(s)
- Ivan Alfredo Huespe
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina,Área de investigación en medicina InternaHospital Italiano de Buenos AiresBuenos AiresArgentina,Universidad de Buenos AiresBuenos AiresArgentina,Global Clinical Scholars Research TraineeHarvard Medical SchoolBostonMassachusettsUSA
| | - Carolina Lockhart
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Rahul Kashyap
- Global Clinical Scholars Research TraineeHarvard Medical SchoolBostonMassachusettsUSA,Department of Anesthesiology and Perioperative MedicineMayo ClinicRochesterMinnesotaUSA,Department of ResearchWellSpan HealthYorkPennsylvaniaUSA
| | - Fernando Palizas
- Unidad de Terapia Intensiva Adultos, Clínica BazterricaBuenos AiresArgentina
| | - Malena Colombo
- Instituto Universitario del Hospital ItalianoBuenos AiresArgentina
| | | | - Eduardo Prado
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Marcos Las Heras
- Unidad de Terapia Intensiva Adultos, Hospital Italiano de Buenos AiresBuenos AiresArgentina
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12
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Consequences of COVID-19 on the cardiovascular and renal systems. Sleep Med 2022; 100:31-38. [PMID: 35994936 PMCID: PMC9345655 DOI: 10.1016/j.sleep.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 01/11/2023]
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13
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Takada R, Takazawa T, Takahashi Y, Fujizuka K, Akieda K, Saito S. Risk factors for mechanical ventilation and ECMO in COVID-19 patients admitted to the ICU: A multicenter retrospective observational study. PLoS One 2022; 17:e0277641. [PMID: 36374929 PMCID: PMC9662741 DOI: 10.1371/journal.pone.0277641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The primary purpose of this study was to investigate risk factors associated with the need for mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) in COVID-19 patients admitted to the intensive care unit (ICU). METHODS We retrospectively enrolled 66 consecutive COVID-19 patients admitted to the ICUs of three Japanese institutions from February 2020 to January 2021. We performed logistic regression analyses to identify risk factors associated with subsequent MV and ECMO requirements. Further, multivariate analyses were performed following adjustment for Acute Physiology and Chronic Health Evaluation (APACHE) II scores. RESULTS At ICU admission, the risk factors for subsequent MV identified were: higher age (Odds Ratio (OR) 1.04, 95% Confidence Interval (CI) 1.00-1.08, P = 0.03), higher values of APACHE II score (OR 1.20, 95% CI 1.08-1.33, P < 0.001), Sequential Organ Failure Assessment score (OR 1.53, 95% CI 1.18-1.97, P < 0.001), lactate dehydrogenase (LDH) (OR 1.01, 95% CI 1.00-1.02, p<0.001) and C-reactive protein (OR 1.09, 95% CI 1.00-1.19, P = 0.04), and lower values of lymphocytes (OR 1.00, 95% CI 1.00-1.00, P = 0.02) and antithrombin (OR 0.95, 95% CI 0.91-0.95, P < 0.01). Patients who subsequently required ECMO showed lower values of estimated glomerular filtration rate (OR 0.98, 95% CI 0.96-1.00, P = 0.04) and antithrombin (OR 0.94, 95% CI 0.88-1.00, P = 0.03) at ICU admission. Multivariate analysis showed that higher body mass index (OR 1.19, 95% CI 1.00-1.40, P = 0.04) and higher levels of LDH (OR 1.01, 95% CI 1.01-1.02, P < 0.01) were independent risk factors for the need for MV. Lower level of antithrombin (OR 0.94, 95% CI 0.88-1.00, P = 0.03) was a risk factor for the need for ECMO. CONCLUSION We showed that low antithrombin level at ICU admission might be a risk factor for subsequent ECMO requirements, in addition to other previously reported factors.
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Affiliation(s)
- Ryo Takada
- Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Tomonori Takazawa
- Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan
- * E-mail:
| | - Yoshihiko Takahashi
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kazuki Akieda
- Department of Emergency Medicine, Subaru Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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14
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Identification of bronchoalveolar and blood immune-inflammatory biomarker signature associated with poor 28-day outcome in critically ill COVID-19 patients. Sci Rep 2022; 12:9502. [PMID: 35681070 PMCID: PMC9178326 DOI: 10.1038/s41598-022-13179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/20/2022] [Indexed: 11/09/2022] Open
Abstract
The local immune-inflammatory response elicited by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is still poorly described, as well as the extent to which its characteristics may be associated with the outcome of critical Coronavirus disease 2019 (COVID-19). In this prospective monocenter study, all consecutive COVID-19 critically ill patients admitted from February to December 2020 and explored by fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) were included. Biological assays, including digital ELISA cytokine profiling and targeted eicosanoid metabolomic analysis, were performed on paired blood and BAL fluid (BALF). Clinical outcome was assessed through the World Health Organization 10-point Clinical Progression Scale (WHO-CPS) at the 28th day (D28) following the admission to intensive care unit. A D28-WHO-CPS value higher than 5 defined a poor outcome. Seventy-six patients were included, 45 (59%) had a poor day-28 outcome. As compared to their counterparts, patients with D28-WHO-CPS > 5 exhibited a neutrophil-predominant bronchoalveolar phenotype, with a higher BALF neutrophil/lymphocyte ratio, a blunted local type I interferon response, a decompartimentalized immune-inflammatory response illustrated by lower BALF/blood ratio of concentrations of IL-6 (1.68 [0.30-4.41] vs. 9.53 [2.56-19.1]; p = 0.001), IL-10, IL-5, IL-22 and IFN-γ, and a biological profile of vascular endothelial injury illustrated by a higher blood concentration of VEGF and higher blood and/or BALF concentrations of several vasoactive eicosanoids. In critically ill COVID-19 patients, we identified bronchoalveolar and blood immune-inflammatory biomarker signature associated with poor 28-day outcome.
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15
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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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16
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Sreenivasan J, Ranka S, Lahan S, Abu-Haniyeh A, Li H, Kaul R, Malik A, Aronow WS, Frishman WH, Lansman S. Extracorporeal Membrane Oxygenation in Patients With COVID-19. Cardiol Rev 2022; 30:129-133. [PMID: 34292184 PMCID: PMC8983617 DOI: 10.1097/crd.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by a clinical spectrum of diseases ranging from asymptomatic or mild cases to severe pneumonia with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. Extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy in appropriate patients with COVID-19 complicated by ARDS refractory to mechanical ventilation. In this study, we review the indications, challenges, complications, and clinical outcomes of ECMO utilization in critically ill patients with COVID-19-related ARDS. Most of these patients required venovenous ECMO. Although the risk of mortality and complications is very high among patients with COVID-19 requiring ECMO, it is similar to that of non-COVID-19 patients with ARDS requiring ECMO. ECMO is a resource-intensive therapy, with an inherent risk of complications, which makes its availability limited and its use challenging in the midst of a pandemic. Well-maintained data registries, with timely reporting of outcomes and evidence-based clinical guidelines, are necessary for the careful allocation of resources and for the development of standardized utilization protocols.
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Affiliation(s)
- Jayakumar Sreenivasan
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Ahmed Abu-Haniyeh
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Heyi Li
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Risheek Kaul
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Aaqib Malik
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Wilbert S. Aronow
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - William H. Frishman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Steven Lansman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
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17
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Daviet F, Guilloux P, Hraiech S, Tonon D, Velly L, Bourenne J, Porto A, Gragueb-Chatti I, Bobot M, Baumstarck K, Papazian L, Collart F, Forel JM, Guervilly C. Impact of obesity on survival in COVID-19 ARDS patients receiving ECMO: results from an ambispective observational cohort. Ann Intensive Care 2021; 11:157. [PMID: 34779944 PMCID: PMC8591429 DOI: 10.1186/s13613-021-00943-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Since March 2020, health care systems were importantly affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, with some patients presenting severe acute respiratory distress syndrome (ARDS), requiring extra-corporeal membrane oxygenation (ECMO). We designed an ambispective observational cohort study including all consecutive adult patients admitted to 5 different ICUs from a university hospital. The main objective was to identify the risk factors of severe COVID-19 ARDS patients supported by ECMO associated with 90-day survival. RESULTS Between March 1st and November 30th 2020, 76 patients with severe COVID-19 ARDS were supported by ECMO. Median (interquartile range IQR) duration of mechanical ventilation (MV) prior to ECMO was of 6 (3-10) days. At ECMO initiation, patients had a median PaO2:FiO2 of 71 mmHg (IQR 62-81), median PaCO2 of 58 mmHg (IQR 51-66) and a median arterial pH of 7.33 (IQR 7.25-7.38). Forty-five patients (59%) were weaned from ECMO. Twenty-eight day, 60-day and 90-day survival rates were, respectively, 92, 62 and 51%. In multivariate logistic regression analysis, with 2 models, one with the RESP score and one with the PRESERVE score, we found that higher BMI was associated with higher 90-day survival [odds ratio (OR): 0.775 (0.644-0.934), p = 0.007) and 0.631 (0.462-0.862), respectively]. Younger age was also associated with 90-day survival in both models [OR: 1.1354 (1.004-1.285), p = 0.044 and 1.187 (1.035-1.362), p = 0.014 respectively]. Obese patients were ventilated with higher PEEP than non-obese patients and presented slightly higher respiratory system compliance. CONCLUSION In this ambispective observational cohort of COVID-19 severe ARDS supported by ECMO, obesity was an independent factor associated with improved survival at 90-day.
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Affiliation(s)
- Florence Daviet
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France.
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France.
| | - Philippe Guilloux
- Département d'Anesthésie-réanimation, Centre hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, 13005, Marseille, France
| | - Sami Hraiech
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - David Tonon
- Département d'Anesthésie-réanimation, Centre hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, 13005, Marseille, France
| | - Lionel Velly
- Département d'Anesthésie-réanimation, Centre hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, 13005, Marseille, France
| | - Jeremy Bourenne
- Médecine intensive Réanimation, Réanimation des Urgences, Centre hospitalier Universitaire La Timone 2, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Alizée Porto
- Département de chirurgie cardiaque, Centre Hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Inès Gragueb-Chatti
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
| | - Mickael Bobot
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
| | - Karine Baumstarck
- Faculté de Médecine, Centre d'Etudes et de Recherches sur les Services de Santé et Qualité de Vie EA 3279, Aix-Marseille Université, Marseille, France
| | - Laurent Papazian
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Frédéric Collart
- Département de chirurgie cardiaque, Centre Hospitalier Universitaire La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Jean-Marie Forel
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
| | - Christophe Guervilly
- Medecine Intensive Réanimation, Centre hospitalier Universitaire L'Hôpital Nord, Assistance Publique hôpitaux de Marseille, chemin des Bourrely, 13015, Marseille, France
- Faculté de Médecine Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, Aix-Marseille Université, 13005, Marseille, France
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Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature. MEMBRANES 2021; 11:membranes11080584. [PMID: 34436348 PMCID: PMC8400963 DOI: 10.3390/membranes11080584] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/21/2022]
Abstract
(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute-refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative-advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ -2 points, PRESET score ≥ 6 points, and "do not attempt resuscitation" order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.
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Shah N, Said AS. Extracorporeal Support Prognostication-Time to Move the Goal Posts? MEMBRANES 2021; 11:537. [PMID: 34357187 PMCID: PMC8304743 DOI: 10.3390/membranes11070537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/12/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
Advances in extracorporeal membrane oxygenation (ECMO) technology are associated with expanded indications, increased utilization and improved outcome. There is growing interest in developing ECMO prognostication scores to aid in bedside decision making. To date, the majority of available scores have been limited to mostly registry-based data and with mortality as the main outcome of interest. There continues to be a gap in clinically applicable decision support tools to aid in the timing of ECMO cannulation to improve patients' long-term outcomes. We present a brief review of the commonly available adult and pediatric ECMO prognostication tools, their limitations, and future directions.
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Affiliation(s)
- Neel Shah
- Division of Pediatric Critical Care, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, MO 63130, USA;
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20
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Gresser E, Reich J, Sabel BO, Kunz WG, Fabritius MP, Rübenthaler J, Ingrisch M, Wassilowsky D, Irlbeck M, Ricke J, Puhr-Westerheide D. Risk Stratification for ECMO Requirement in COVID-19 ICU Patients Using Quantitative Imaging Features in CT Scans on Admission. Diagnostics (Basel) 2021; 11:diagnostics11061029. [PMID: 34205176 PMCID: PMC8228774 DOI: 10.3390/diagnostics11061029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 01/28/2023] Open
Abstract
(1) Background: Extracorporeal membrane oxygenation (ECMO) therapy in intensive care units (ICUs) remains the last treatment option for Coronavirus disease 2019 (COVID-19) patients with severely affected lungs but is highly resource demanding. Early risk stratification for the need of ECMO therapy upon admission to the hospital using artificial intelligence (AI)-based computed tomography (CT) assessment and clinical scores is beneficial for patient assessment and resource management; (2) Methods: Retrospective single-center study with 95 confirmed COVID-19 patients admitted to the participating ICUs. Patients requiring ECMO therapy (n = 14) during ICU stay versus patients without ECMO treatment (n = 81) were evaluated for discriminative clinical prediction parameters and AI-based CT imaging features and their diagnostic potential to predict ECMO therapy. Reported patient data include clinical scores, AI-based CT findings and patient outcomes; (3) Results: Patients subsequently allocated to ECMO therapy had significantly higher sequential organ failure (SOFA) scores (p < 0.001) and significantly lower oxygenation indices on admission (p = 0.009) than patients with standard ICU therapy. The median time from hospital admission to ECMO placement was 1.4 days (IQR 0.2-4.0). The percentage of lung involvement on AI-based CT assessment on admission to the hospital was significantly higher in ECMO patients (p < 0.001). In binary logistic regression analyses for ECMO prediction including age, sex, body mass index (BMI), SOFA score on admission, lactate on admission and percentage of lung involvement on admission CTs, only SOFA score (OR 1.32, 95% CI 1.08-1.62) and lung involvement (OR 1.06, 95% CI 1.01-1.11) were significantly associated with subsequent ECMO allocation. Receiver operating characteristic (ROC) curves showed an area under the curve (AUC) of 0.83 (95% CI 0.73-0.94) for lung involvement on admission CT and 0.82 (95% CI 0.72-0.91) for SOFA scores on ICU admission. A combined parameter of SOFA on ICU admission and lung involvement on admission CT yielded an AUC of 0.91 (0.84-0.97) with a sensitivity of 0.93 and a specificity of 0.84 for ECMO prediction; (4) Conclusions: AI-based assessment of lung involvement on CT scans on admission to the hospital and SOFA scoring, especially if combined, can be used as risk stratification tools for subsequent requirement for ECMO therapy in patients with severe COVID-19 disease to improve resource management in ICU settings.
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Affiliation(s)
- Eva Gresser
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
- Correspondence: ; Tel.: +49-89-4400-73620
| | - Jakob Reich
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Bastian O. Sabel
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Matthias P. Fabritius
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Dietmar Wassilowsky
- Department of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (D.W.); (M.I.)
| | - Michael Irlbeck
- Department of Anesthesiology, University Hospital, LMU Munich, 81377 Munich, Germany; (D.W.); (M.I.)
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
| | - Daniel Puhr-Westerheide
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (J.R.); (B.O.S.); (W.G.K.); (M.P.F.); (J.R.); (M.I.); (J.R.); (D.P.-W.)
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21
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Duy Nguyen BT, Nguyen Thi HY, Nguyen Thi BP, Kang DK, Kim JF. The Roles of Membrane Technology in Artificial Organs: Current Challenges and Perspectives. MEMBRANES 2021; 11:239. [PMID: 33800659 PMCID: PMC8065507 DOI: 10.3390/membranes11040239] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/20/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023]
Abstract
The recent outbreak of the COVID-19 pandemic in 2020 reasserted the necessity of artificial lung membrane technology to treat patients with acute lung failure. In addition, the aging world population inevitably leads to higher demand for better artificial organ (AO) devices. Membrane technology is the central component in many of the AO devices including lung, kidney, liver and pancreas. Although AO technology has improved significantly in the past few decades, the quality of life of organ failure patients is still poor and the technology must be improved further. Most of the current AO literature focuses on the treatment and the clinical use of AO, while the research on the membrane development aspect of AO is relatively scarce. One of the speculated reasons is the wide interdisciplinary spectrum of AO technology, ranging from biotechnology to polymer chemistry and process engineering. In this review, in order to facilitate the membrane aspects of the AO research, the roles of membrane technology in the AO devices, along with the current challenges, are summarized. This review shows that there is a clear need for better membranes in terms of biocompatibility, permselectivity, module design, and process configuration.
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Affiliation(s)
- Bao Tran Duy Nguyen
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
| | - Hai Yen Nguyen Thi
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
| | - Bich Phuong Nguyen Thi
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
| | - Dong-Ku Kang
- Department of Chemistry, Incheon National University, Incheon 22012, Korea
| | - Jeong F. Kim
- Department of Energy and Chemical Engineering, Incheon National University, Incheon 22012, Korea; (B.T.D.N.); (H.Y.N.T.); (B.P.N.T.)
- Innovation Center for Chemical Engineering, Incheon National University, Incheon 22012, Korea
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