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Dilawri A, Muir J, Brodie D, Abrams D, Agerstrand C, Madahar P, Dzierba AL. Practices surrounding antimicrobial use in patients managed with extracorporeal membrane oxygenation: An international survey. J Crit Care 2024; 81:154534. [PMID: 38367526 DOI: 10.1016/j.jcrc.2024.154534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
PURPOSE This study aimed to survey critical care clinicians and characterize their perception of antimicrobial dosing strategies in patients receiving extracorporeal membrane oxygenation (ECMO). METHODS International, cross-sectional survey distributed to members of the Society of Critical Care Medicine in October 2022. RESULTS Respondents were primarily physicians (45%), with 92% practicing in North America. Ninety-seven percent of respondents reported antimicrobial dosing in critically ill patients to be challenging, due to physiological derangements seen in the patient population. Eighty-seven percent reported consideration of physicochemical drug properties when dosing antimicrobials in ECMO-supported patients, with lipophilicity (83%) and degree of protein binding (74%) being the two most common. Respondents' approach to antimicrobial dosing strategies did not significantly differ in critically ill ECMO-supported patients, compared to patients with equal severity of illness not receiving ECMO support. CONCLUSION Approaches to antimicrobial dosing strategies do not significantly differ among respondents between critically ill patients on ECMO support, compared to patients with equal severity of illness not receiving ECMO support. These findings were unexpected considering the added physiologic complexity of the ECMO circuit to critically ill adult patients and the need for well designed and adequately powered studies to inform empiric dosing guidance for ECMO-supported patients.
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Affiliation(s)
- Atul Dilawri
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Justin Muir
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Daniel Brodie
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Darryl Abrams
- Division of Pulmonary and Critical Care Medicine, Columbia College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Cara Agerstrand
- Division of Pulmonary and Critical Care Medicine, Columbia College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Purnema Madahar
- Division of Pulmonary and Critical Care Medicine, Columbia College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, NY, United States of America
| | - Amy L Dzierba
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, NY, United States of America; Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, New York, NY, United States of America.
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Greendyk R, Kanade R, Parekh M, Abrams D, Lemaitre P, Agerstrand C. Respiratory extracorporeal membrane oxygenation : From rescue therapy to standard tool for treatment of acute respiratory distress syndrome? Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01118-y. [PMID: 38456999 DOI: 10.1007/s00063-024-01118-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECMO) for patients with acute respiratory distress syndrome (ARDS) has increased substantially. With modern trials supporting its efficacy, ECMO has become an important tool in the management of severe ARDS. OBJECTIVES The objectives of this paper are to discuss ECMO physiology and configurations used for patients with ARDS, review evidence supporting the use of ECMO for ARDS, and discuss aspects of management during ECMO. CONCLUSION Current evidence supports the use of ECMO, combined with an ultra-lung-protective approach to mechanical ventilation, in patients with ARDS who have refractory hypoxemia or hypercapnia with severe respiratory acidosis. Furthermore, data suggest that center volume and experience are important factors in the care of patients receiving ECMO. The use of extracorporeal technologies in expanded patient populations and the optimal management of patients during ECMO remain areas of investigation. This article is freely available.
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Affiliation(s)
- Richard Greendyk
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH 8E, 101, 10032, New York, NY, USA
| | - Rahul Kanade
- Division of Thoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Madhavi Parekh
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH 8E, 101, 10032, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH 8E, 101, 10032, New York, NY, USA
| | - Philippe Lemaitre
- Division of Thoracic Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Cara Agerstrand
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, 622 W 168th St, PH 8E, 101, 10032, New York, NY, USA.
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3
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Patel B, Said AS, Justus A, Abrams D, Pham T, Antonini MV, Moore E, Shekar K, Zakhary B. An International Survey of Extracorporeal Membrane Oxygenation Education and Credentialing Practices. ATS Sch 2024; 5:71-83. [PMID: 38633517 PMCID: PMC11022670 DOI: 10.34197/ats-scholar.2022-0132oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 09/05/2023] [Indexed: 04/19/2024] Open
Abstract
Background The use of extracorporeal membrane oxygenation (ECMO) has grown rapidly over the past decades because of evolving indications, advances in circuit technology, and encouraging results from modern trials. Because ECMO is a complex and highly invasive therapy that requires a multidisciplinary team, optimal education, training, and credentialing remain a challenge. Objective The primary objectives of this study were to investigate the prevalence and application of ECMO education and ECMO practitioner credentialing at ECMO centers globally. In addition, we explored differences among education and credentialing practices in relation to various ECMO center characteristics. Methods We conducted an observational study of ECMO centers worldwide using a survey querying participants in two major domains: ECMO education and ECMO practitioner credentialing. Of note, the questionnaire included ECMO program characteristics, such as type and size of hospital and ECMO experience and volume, to explore the association with the two domains. Results A total of 241 (32%) of the 732 identified ECMO centers responded to the survey, representing 41 countries across the globe. ECMO education was offered at 221 (92%) of the 241 centers. ECMO education was offered at 105 (98.0%) high-ECMO volume centers compared with 136 (87.5%) low-ECMO volume centers (P = 0.005). Credentialing was established at 101 (42%) of the 241 centers. Credentialing processes existed at 52 (49.5%) high-ECMO volume centers compared with 51 (37.5%) low-ECMO volume centers (P = 0.08) and 101 (49.3%) Extracorporeal Life Support Organization centers compared with 1 (2.7%) non-Extracorporeal Life Support Organization center (P < 0.001). Conclusion We found significant variability in whether ECMO educational curricula are offered at ECMO centers. We also found fewer than half of the ECMO centers surveyed had established credentialing programs for ECMO practitioners. Future studies that assess variability in outcomes among centers with and without standardized educational and credentialing practices are needed.
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Affiliation(s)
- Bhoumesh Patel
- Division of Cardiac Anesthesiology,
Department of Anesthesiology, Yale School of Medicine, New Haven,
Connecticut
| | - Ahmed S. Said
- Division of Pediatric Critical Care,
Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Angelo Justus
- Adult Intensive Care, Sunshine Coast
University Hospital, Sunshine Coast, Queensland, Australia
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and
Critical Care, Columbia University Medical Center, New York, New York
| | - Tái Pham
- Service de Médecine
Intensive-Réanimation, Hôpitaux Universitaires Paris-Saclay, Le
Kremlin-Bicêtre, France
- Université Paris-Saclay, Villejuif,
France
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital,
Cesena, Italy
- Department of Biomedical, Metabolic, and
Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elizabeth Moore
- University of Iowa Heart and Vascular
Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kiran Shekar
- Adult Intensive Care Services, the
Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane,
Queensland, Australia
- University of Queensland, Brisbane,
Queensland, Australia
- Institute of Health and Biomedical
Innovation, Queensland University of Technology, Brisbane and Faculty of
Medicine, Bond University, Gold Coast, Queensland, Australia; and
| | - Bishoy Zakhary
- Pulmonary and Critical Care Medicine,
Oregon Health and Science University, Portland, Oregon
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4
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Simons J, Di Mauro M, Mariani S, Ravaux J, van der Horst ICC, Driessen RGH, Sels JW, Delnoij T, Brodie D, Abrams D, Mueller T, Taccone FS, Belliato M, Broman ML, Malfertheiner MV, Boeken U, Fraser J, Wiedemann D, Belohlavek J, Barrett NA, Tonna JE, Pappalardo F, Barbaro RP, Ramanathan K, MacLaren G, van Mook WNKA, Mees B, Lorusso R. Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry. Crit Care Med 2024; 52:80-91. [PMID: 37678211 DOI: 10.1097/ccm.0000000000006040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVES Peripheral venoarterial extracorporeal membrane oxygenation (ECMO) with femoral access is obtained through unilateral or bilateral groin cannulation. Whether one cannulation strategy is associated with a lower risk for limb ischemia remains unknown. We aim to assess if one strategy is preferable. DESIGN A retrospective cohort study based on the Extracorporeal Life Support Organization registry. SETTING ECMO centers worldwide included in the Extracorporeal Life Support Organization registry. PATIENTS All adult patients (≥ 18 yr) who received peripheral venoarterial ECMO with femoral access and were included from 2014 to 2020. INTERVENTIONS Unilateral or bilateral femoral cannulation. MEASUREMENTS AND MAIN RESULTS The primary outcome was the occurrence of limb ischemia defined as a composite endpoint including the need for a distal perfusion cannula (DPC) after 6 hours from implantation, compartment syndrome/fasciotomy, amputation, revascularization, and thrombectomy. Secondary endpoints included bleeding at the peripheral cannulation site, need for vessel repair, vessel repair after decannulation, and in-hospital death. Propensity score matching was performed to account for confounders. Overall, 19,093 patients underwent peripheral venoarterial ECMO through unilateral ( n = 11,965) or bilateral ( n = 7,128) femoral cannulation. Limb ischemia requiring any intervention was not different between both groups (bilateral vs unilateral: odds ratio [OR], 0.92; 95% CI, 0.82-1.02). However, there was a lower rate of compartment syndrome/fasciotomy in the bilateral group (bilateral vs unilateral: OR, 0.80; 95% CI, 0.66-0.97). Bilateral cannulation was also associated with lower odds of cannulation site bleeding (bilateral vs unilateral: OR, 0.87; 95% CI, 0.76-0.99), vessel repair (bilateral vs unilateral: OR, 0.55; 95% CI, 0.38-0.79), and in-hospital mortality (bilateral vs unilateral: OR, 0.85; 95% CI, 0.81-0.91) compared with unilateral cannulation. These findings were unchanged after propensity matching. CONCLUSIONS This study showed no risk reduction for overall limb ischemia-related events requiring DPC after 6 hours when comparing bilateral to unilateral femoral cannulation in peripheral venoarterial ECMO. However, bilateral cannulation was associated with a reduced risk for compartment syndrome/fasciotomy, lower rates of bleeding and vessel repair during ECMO, and lower in-hospital mortality.
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Affiliation(s)
- Jorik Simons
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY
- Department of Intensive Care Medicine and Pneumology, University Hospital Regensburg, Regensburg, Germany
- Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of UOC Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
- Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
- 2nd Department of Medicine-Department of Cardiovascular Medicine, General University Hospital in Prague, Prague, Czech Republic
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
- Cardiothoracic Intensive Care, National University Health System, Singapore
- Department of School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Vascular Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Silvia Mariani
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Justine Ravaux
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Rob G H Driessen
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY
- Department of Intensive Care Medicine and Pneumology, University Hospital Regensburg, Regensburg, Germany
- Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of UOC Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
- Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
- 2nd Department of Medicine-Department of Cardiovascular Medicine, General University Hospital in Prague, Prague, Czech Republic
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
- Cardiothoracic Intensive Care, National University Health System, Singapore
- Department of School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Vascular Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Jan Willem Sels
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY
- Department of Intensive Care Medicine and Pneumology, University Hospital Regensburg, Regensburg, Germany
- Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of UOC Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
- Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
- 2nd Department of Medicine-Department of Cardiovascular Medicine, General University Hospital in Prague, Prague, Czech Republic
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
- Cardiothoracic Intensive Care, National University Health System, Singapore
- Department of School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Vascular Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Thijs Delnoij
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY
- Department of Intensive Care Medicine and Pneumology, University Hospital Regensburg, Regensburg, Germany
- Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of UOC Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
- Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
- 2nd Department of Medicine-Department of Cardiovascular Medicine, General University Hospital in Prague, Prague, Czech Republic
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
- Cardiothoracic Intensive Care, National University Health System, Singapore
- Department of School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Vascular Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Daniel Brodie
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY
| | - Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY
| | - Thomas Mueller
- Department of Intensive Care Medicine and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Fabio Silvio Taccone
- Department of Intensive Care, Hopital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mirko Belliato
- Department of UOC Anestesia e Rianimazione 2, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mike Lars Broman
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Maximilian V Malfertheiner
- Department of Intensive Care Medicine and Pneumology, University Hospital Regensburg, Regensburg, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, QLD, Australia
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
| | - Jan Belohlavek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, General University Hospital in Prague, Prague, Czech Republic
| | - Nicholas A Barrett
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joseph E Tonna
- Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
- Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Federico Pappalardo
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Ryan P Barbaro
- Department of Pediatric Critical Care Medicine and Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI
| | | | - Graeme MacLaren
- Cardiothoracic Intensive Care, National University Health System, Singapore
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Academy for Postgraduate Medical Training, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Barend Mees
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
- Department of Vascular Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, CARIM School for Cardiovascular Diseases, Heart and Vascular Center, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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5
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Qadir N, Sahetya S, Munshi L, Summers C, Abrams D, Beitler J, Bellani G, Brower RG, Burry L, Chen JT, Hodgson C, Hough CL, Lamontagne F, Law A, Papazian L, Pham T, Rubin E, Siuba M, Telias I, Patolia S, Chaudhuri D, Walkey A, Rochwerg B, Fan E. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2024; 209:24-36. [PMID: 38032683 PMCID: PMC10870893 DOI: 10.1164/rccm.202311-2011st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background: This document updates previously published Clinical Practice Guidelines for the management of patients with acute respiratory distress syndrome (ARDS), incorporating new evidence addressing the use of corticosteroids, venovenous extracorporeal membrane oxygenation, neuromuscular blocking agents, and positive end-expiratory pressure (PEEP). Methods: We summarized evidence addressing four "PICO questions" (patient, intervention, comparison, and outcome). A multidisciplinary panel with expertise in ARDS used the Grading of Recommendations, Assessment, Development, and Evaluation framework to develop clinical recommendations. Results: We suggest the use of: 1) corticosteroids for patients with ARDS (conditional recommendation, moderate certainty of evidence), 2) venovenous extracorporeal membrane oxygenation in selected patients with severe ARDS (conditional recommendation, low certainty of evidence), 3) neuromuscular blockers in patients with early severe ARDS (conditional recommendation, low certainty of evidence), and 4) higher PEEP without lung recruitment maneuvers as opposed to lower PEEP in patients with moderate to severe ARDS (conditional recommendation, low to moderate certainty), and 5) we recommend against using prolonged lung recruitment maneuvers in patients with moderate to severe ARDS (strong recommendation, moderate certainty). Conclusions: We provide updated evidence-based recommendations for the management of ARDS. Individual patient and illness characteristics should be factored into clinical decision making and implementation of these recommendations while additional evidence is generated from much-needed clinical trials.
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6
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Huang F, Ammirati E, Ponnaiah M, Montero S, Raimbault V, Abrams D, Lebreton G, Pellegrino V, Ihle J, Bottiroli M, Persichini R, Barrionuevo-Sánchez MI, Ariza-Solé A, Ng PY, Sin SWC, Ayer R, Buscher H, Belaid S, Delmas C, Ferreira R, Roncon-Albuquerque R, Lόpez-Sobrino T, Bunge JJH, Fisser C, Franchineau G, McCanny J, Ohshimo S, Sionis A, Hernández-Pérez FJ, Barge-Caballero E, Balik M, Muglia H, Park S, Donker DW, Porral B, Aïssaoui N, Mekontso Dessap A, Burgos V, Lesouhaitier M, Fried J, Jung JS, Rosillo S, Scherrer V, Nseir S, Winszewski H, Jorge-Pérez P, Kimmoun A, Diaz R, Combes A, Schmidt M. Fulminant myocarditis proven by early biopsy and outcomes. Eur Heart J 2023; 44:5110-5124. [PMID: 37941449 DOI: 10.1093/eurheartj/ehad707] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND AIMS While endomyocardial biopsy (EMB) is recommended in adult patients with fulminant myocarditis, the clinical impact of its timing is still unclear. METHODS Data were collected from 419 adult patients with clinically suspected fulminant myocarditis admitted to intensive care units across 36 tertiary centres in 15 countries worldwide. The diagnosis of myocarditis was histologically proven in 210 (50%) patients, either by EMB (n = 183, 44%) or by autopsy/explanted heart examination (n = 27, 6%), and clinically suspected cardiac magnetic resonance imaging confirmed in 96 (23%) patients. The primary outcome of survival free of heart transplantation (HTx) or left ventricular assist device (LVAD) at 1 year was specifically compared between patients with early EMB (within 2 days after intensive care unit admission, n = 103) and delayed EMB (n = 80). A propensity score-weighted analysis was done to control for confounders. RESULTS Median age on admission was 40 (29-52) years, and 322 (77%) patients received temporary mechanical circulatory support. A total of 273 (65%) patients survived without HTx/LVAD. The primary outcome was significantly different between patients with early and delayed EMB (70% vs. 49%, P = .004). After propensity score weighting, the early EMB group still significantly differed from the delayed EMB group in terms of survival free of HTx/LVAD (63% vs. 40%, P = .021). Moreover, early EMB was independently associated with a lower rate of death or HTx/LVAD at 1 year (odds ratio of 0.44; 95% confidence interval: 0.22-0.86; P = .016). CONCLUSIONS Endomyocardial biopsy should be broadly and promptly used in patients admitted to the intensive care unit for clinically suspected fulminant myocarditis.
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Affiliation(s)
- Florent Huang
- Department of Cardiology, Foch Hospital, Suresnes, France
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Enrico Ammirati
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Maharajah Ponnaiah
- ICAN Intelligence and Omics, Institute of Cardiometabolism and Nutrition, Pitié-Salpêtrière Hospital, Paris, France
| | - Santiago Montero
- Acute Cardiovascular Care Unit, Cardiology, Departament de Medicina, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain
| | - Victor Raimbault
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
| | - Darryl Abrams
- Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital and Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Guillaume Lebreton
- Service de Chirurgie Cardiaque, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris Cedex 13, France
| | | | - Joshua Ihle
- Intensive Care Unit, Alfred Hospital, Melbourne, Australia
| | - Maurizio Bottiroli
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy
| | - Romain Persichini
- Medical-Surgical Intensive Care Unit, Félix Guyon Hospital, CHU de La Réunion, France
| | - Marisa Isabel Barrionuevo-Sánchez
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit, Cardiology Department, Bioheart, Grup de Malalties Cardiovasculars, Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pauline Yeung Ng
- Adult Intensive Care Unit, Queen Mary Hospital, Hong-Kong, China
| | - Simon Wai Ching Sin
- Department of Anaesthesiology, The University of Hong Kong, Hong-Kong, China
| | - Raj Ayer
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Hergen Buscher
- Intensive Care Unit, St Vincent Hospital, Sydney, Australia
| | - Slimane Belaid
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Clément Delmas
- Department of Cardiology, Rangueil University Hospital, Toulouse, France
| | - Rita Ferreira
- Intensive Care Unit, Saint João Hospital, Porto, Portugal
| | | | | | - Jeroen J H Bunge
- Department of Intensive Care Adults, and Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christoph Fisser
- Intensive Care Unit, University Medical Centre Regensburg, Regensburg, Germany
| | - Guillaume Franchineau
- Department of Intensive Care Medicine and Infectious Diseases, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Sorbonne Université, Paris Cedex 18, France
| | - Jamie McCanny
- Intensive Care Unit, Guy's and St Thomas' NHS Foundation Trust Hospital, London, UK
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francisco José Hernández-Pérez
- Advanced Heart Failure and Transplant Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Eduardo Barge-Caballero
- Cardiology Department, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, A Coruña, Spain
| | - Martin Balik
- Department of Anaesthesiology and Intensive Care, General University Hospital, Prague, Czech Republic
| | | | - Sunghoon Park
- Intensive Care Unit, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands
| | - Beatriz Porral
- Intensive Care Department, Hospital Alvaro Cunqueiro, Vigo, Spain
| | - Nadia Aïssaoui
- Intensive Care Unit, Cochin Hospital, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris Cedex 5, France
| | - Armand Mekontso Dessap
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Mondor Hospital, Créteil, France
| | - Virginia Burgos
- Acute Cardiac Care Unit, Department of Cardiology, Hospital Marqués de Valdecilla, Santander, Spain
| | - Mathieu Lesouhaitier
- Departement of Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, Rennes 35200, France
| | - Justin Fried
- Department of Cardiology, Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Sandra Rosillo
- Department of Cardiology, Hospital Universitario La Paz, IDIPAZ, Madrid, Spain
| | - Vincent Scherrer
- Department of Anesthesiology and Critical Care, CHU Rouen, Rouen F-76000, France
| | - Saad Nseir
- Médecine Intensive-Réanimation, Inserm U1285, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, CHU de Lille, University Lille, Lille, France
| | | | - Pablo Jorge-Pérez
- Department of Cardiology, Hospital Universitario de Canarias Nuestra Señora de Candelaria, Canary Islands, Tenerife, Spain
| | - Antoine Kimmoun
- CHRU de NANCY, Service de Médecine Intensive et Réanimation, Inserm U1116, Université de Lorraine, Nancy, France
| | - Rodrigo Diaz
- Department of Cardiology, Clínica Las Condes, Las Condes, Chile
| | - Alain Combes
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris Cedex 13, France
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France
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Tonna JE, Bailey M, Abrams D, Brodie D, Hodgson CL. Predictors of early mobilization in patients requiring VV ECMO for greater than 7 days: An international cohort study. Heart Lung 2023; 62:57-63. [PMID: 37311360 PMCID: PMC10592536 DOI: 10.1016/j.hrtlng.2023.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the demonstrated benefits of rehabilitation, active physical therapy and early mobilization are not universally performed during critical illness, especially among patients receiving extracorporeal membrane oxygenation (ECMO), with variation among sites. OBJECTIVE What factors are predictive of physical mobility during venovenous (VV) ECMO support? METHODS We performed an observational analysis of an international cohort using data from the Extracorporeal Life Support Organization (ELSO) Registry. We analyzed adults (≥18 years) supported with VV ECMO who survived for at least 7 days. Our primary outcome was early mobilization (ICU Mobility Scale score >0) at day 7 of ECMO support. Hierarchical multivariable logistic regression models were utilized to identify factors independently associated with early mobilization at day 7 of ECMO. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). RESULTS Among 8,160 unique VV ECMO patients, factors independently associated with early mobilization included cannulation for transplantation (aOR 2.86 [95% CI 2.08-3.92]; p<0.001), avoidance of mechanical ventilation (aOR 0.51 [95% CI 0.41-0.64]; p<0.0001), higher center level patient volume (6-20 patients annually: aOR 1.49 [95% CI 1 to 2.23] and >20 patients annually: aOR 2 [95% CI: 1.37 to 2.93]; p<0.0001 for group), and cannulation with a dual-lumen cannula (aOR 1.25 [95% CI 1.08-1.42]; p = 0.0018). Early mobilization was associated with a lower probability of death (29 vs 48%; p<0.0001). CONCLUSIONS Higher levels of early mobilization on ECMO were associated modifiable and non-modifiable patient characteristics, including cannulation with a dual-lumen cannula, and with high center level patient volume.
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Affiliation(s)
- Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, United States of America; Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, United States of America.
| | - Michael Bailey
- Australian and New Zealand Intensive Care-Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darryl Abrams
- Department of Medicine, Columbia University College of Physicians & Surgeons, United States of America; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians & Surgeons, United States of America; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care-Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, The Alfred, Melbourne, Australia; The George Institute for Global Health, Sydney, Australia; Department of Critical Care, The University of Melbourne, Melbourne, Australia
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8
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Madahar P, Capaccione KM, Salvatore MM, Short B, Wahab R, Abrams D, Parekh M, Geleris JD, Furfaro D, Anderson MR, Zucker J, Brodie D, Cummings MJ, O’Donnell M, McGroder CF, Wei Y, Garcia CK, Baldwin MR. Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness. Crit Care Med 2023; 51:e209-e220. [PMID: 37294143 PMCID: PMC10615871 DOI: 10.1097/ccm.0000000000005954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness. DESIGN Single-center prospective cohort study. SETTING We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns. PATIENTS Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival. CONCLUSIONS Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.
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Affiliation(s)
- Purnema Madahar
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Kathleen M. Capaccione
- Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Mary M. Salvatore
- Division of Cardiothoracic Imaging, Department of Radiology, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Briana Short
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Romina Wahab
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Madhavi Parekh
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Joshua D. Geleris
- Division of General Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - David Furfaro
- Division of Pulmonary, Allergy, and Critical Care, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michaela R Anderson
- Division of Pulmonary and Critical Care, University of Pennsylvania Medical School, Philadelphia, PA, USA
| | - Jason Zucker
- Division of Infectious Diseases, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Matthew J. Cummings
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Max O’Donnell
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Claire F. McGroder
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Christine K. Garcia
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
| | - Matthew R. Baldwin
- Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY, USA
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Asija R, Fried JA, Siddall EC, Mullin DA, Agerstrand CL, Brodie D, Sonett JR, Lemaitre PH, Abrams D. How I manage differential gas exchange in peripheral venoarterial extracorporeal membrane oxygenation. Crit Care 2023; 27:408. [PMID: 37891688 PMCID: PMC10612193 DOI: 10.1186/s13054-023-04703-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/22/2023] [Indexed: 10/29/2023] Open
Abstract
Dual circulation is a common but underrecognized physiological occurrence associated with peripheral venoarterial extracorporeal membrane oxygenation (ECMO). Competitive flow will develop between blood ejected from the heart and blood travelling retrograde within the aorta from the ECMO reinfusion cannula. The intersection of these two competitive flows is referred to as the "mixing point". The location of this mixing point, which depends upon the relative strengths of the native and extracorporeal pumps, will determine which regions of the body are perfused with blood ejected from the left ventricle and which regions are perfused by reinfused blood from the ECMO circuit, effectively establishing dual circulations. Because gas exchange within these circulations is dictated by the native lungs and membrane lung, respectively, oxygenation and carbon dioxide removal may differ between regions-depending on how well gas exchange is preserved within each circulation-potentially leading to differential oxygenation or differential carbon dioxide, each of which may have important clinical implications. In this perspective, we address the identification and management of dual circulation and differential gas exchange through various clinical scenarios of venoarterial ECMO. Recognition of dual circulation, proper monitoring for differential gas exchange, and understanding the various strategies to resolve differential oxygenation and carbon dioxide may allow for more optimal patient management and improved clinical outcomes.
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Affiliation(s)
- Richa Asija
- Division of Thoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
- Department of Surgery, Community Memorial Health Systems, Ventura, CA, USA
| | - Justin A Fried
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Eric C Siddall
- Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Dana A Mullin
- Clinical Perfusion, Columbia University Irving Medical Center, New York, NY, USA
| | - Cara L Agerstrand
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, 177 Ft. Washington Avenue, New York, NY, 10032, USA
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua R Sonett
- Division of Thoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Philippe H Lemaitre
- Division of Thoracic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, 177 Ft. Washington Avenue, New York, NY, 10032, USA.
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Rudym D, Pham T, Rackley CR, Grasselli G, Anderson M, Baldwin MR, Beitler J, Agerstrand C, Serra A, Winston LA, Bonadonna D, Yip N, Emerson LJ, Dzierba A, Sonett J, Abrams D, Ferguson ND, Bacchetta M, Schmidt M, Brodie D. Mortality in Patients with Obesity and Acute Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation: The Multicenter ECMObesity Study. Am J Respir Crit Care Med 2023; 208:685-694. [PMID: 37638735 PMCID: PMC10515561 DOI: 10.1164/rccm.202212-2293oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/19/2023] [Indexed: 08/29/2023] Open
Abstract
Rationale: Patients with obesity are at increased risk for developing acute respiratory distress syndrome (ARDS). Some centers consider obesity a relative contraindication to receiving extracorporeal membrane oxygenation (ECMO) support, despite growing implementation of ECMO for ARDS in the general population. Objectives: To investigate the association between obesity and mortality in patients with ARDS receiving ECMO. Methods: In this large, international, multicenter, retrospective cohort study, we evaluated the association of obesity, defined as body mass index ⩾ 30 kg/m2, with ICU mortality in patients receiving ECMO for ARDS by performing adjusted multivariable logistic regression and propensity score matching. Measurements and Main Results: Of 790 patients with ARDS receiving ECMO in our study, 320 had obesity. Of those, 24.1% died in the ICU, compared with 35.3% of patients without obesity (P < 0.001). In adjusted models, obesity was associated with lower ICU mortality (odds ratio, 0.63 [95% confidence interval, 0.43-0.93]; P = 0.018). Examined as a continuous variable, higher body mass index was associated with decreased ICU mortality in multivariable regression (odds ratio, 0.97 [95% confidence interval, 0.95-1.00]; P = 0.023). In propensity score matching of 199 patients with obesity to 199 patients without, patients with obesity had a lower probability of ICU death than those without (22.6% vs. 35.2%; P = 0.007). Conclusions: Among patients receiving ECMO for ARDS, those with obesity had lower ICU mortality than patients without obesity in multivariable and propensity score matching analyses. Our findings support the notion that obesity should not be considered a general contraindication to ECMO.
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Affiliation(s)
- Darya Rudym
- Department of Medicine, New York University Langone Health, New York, New York
| | - Tài Pham
- Service de Médecine Intensive-Réanimation, Assistance Publique–Hôpitaux de Paris, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche CARMAS, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, Université de Versailles Saint-Quentin-en-Yvelines, Université Paris-Sud, Inserm U1018, Equipe d’Epidémiologie Respiratoire Intégrative, Centre d’Épidémiologie et de Santé des Populations, Villejuif, France
| | | | - Giacomo Grasselli
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italia
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Michaela Anderson
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew R. Baldwin
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jeremy Beitler
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Center for Acute Respiratory Failure and
| | - Cara Agerstrand
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Center for Acute Respiratory Failure and
| | - Alexis Serra
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Desiree Bonadonna
- Perfusion Services, Duke University Health System, Durham, North Carolina
| | - Natalie Yip
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Center for Acute Respiratory Failure and
| | - Logan J. Emerson
- Duke Respiratory Care Services, Duke University Hospital, Durham, North Carolina
| | - Amy Dzierba
- Center for Acute Respiratory Failure and
- Department of Pharmacy, NewYork-Presbyterian Hospital, New York, New York
| | | | - Darryl Abrams
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Center for Acute Respiratory Failure and
| | - Niall D. Ferguson
- Interdepartmental Division of Critical Care Medicine
- Department of Medicine
- Department of Physiology, and
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Respirology, University Health Network and Sinai Health, Toronto, Ontario, Canada
- Toronto General Hospital Research Institute, Toronto, Ontario, Canada
| | - Matthew Bacchetta
- Department of Cardiac Surgery, Vanderbilt Medical Center East, Nashville, Tennessee
| | - Matthieu Schmidt
- Sorbonne Université, GRC 30 RESPIRE, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris Hôpital Pitié–Salpêtrière, Paris, France; and
| | - Daniel Brodie
- Department of Medicine, School of Medicine, John Hopkins University, Baltimore, Maryland
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Miller PE, Abrams D. The Time Is Now to Investigate Ventilator Settings in Acute Cardiovascular Patients. JACC Heart Fail 2023; 11:969-971. [PMID: 37204364 PMCID: PMC10191154 DOI: 10.1016/j.jchf.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023]
Affiliation(s)
- P Elliott Miller
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York, USA
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12
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Gladstone DE, D'Alessio F, Howard C, Lyu MA, Mock JR, Gibbs KW, Abrams D, Huang M, Zeng K, Herlihy JP, Castillo ST, Bassett R, Sadeghi T, Parmar S, Flowers CR, Mukherjee S, Schoenfeld D, Thall PF, Slutsky AS. Randomized, double-blinded, placebo-controlled trial of allogeneic cord blood T-regulatory cells for treatment of COVID-19 ARDS. Blood Adv 2023; 7:3075-3079. [PMID: 36961352 PMCID: PMC10043947 DOI: 10.1182/bloodadvances.2022009619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- Douglas E Gladstone
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY
| | - Franco D'Alessio
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Mi-Ae Lyu
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jason R. Mock
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kevin W. Gibbs
- Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest School of Medicine, Winston-Salem, NC
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, and Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY
| | - Meixian Huang
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ke Zeng
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Roland Bassett
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | | | - Simrit Parmar
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Christopher R. Flowers
- Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Siddhartha Mukherjee
- Division of Hematology/ Oncology, Department of Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY
| | | | - Peter F. Thall
- Department of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Arthur S. Slutsky
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto and University of Toronto, Toronto, Canada
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13
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Abrams D, Fan E. Lower Flow, Higher Costs? Recognizing Tradeoffs on the Spectrum of Extracorporeal Support for ARDS. Am J Respir Crit Care Med 2023; 207:1116-1118. [PMID: 36913243 PMCID: PMC10161738 DOI: 10.1164/rccm.202303-0354ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Affiliation(s)
- Darryl Abrams
- Columbia University Medical Center, Medicine, Division of Pulmonary, Allergy, & Critical Care, New York, New York, United States
| | - Eddy Fan
- University of Toronto, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada;
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14
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Sleasman JR, Hijawi U, Alsalemi A, Rabie M, Noorizadeh M, Stead A, Cooley C, Donnelly C, Haft JW, Abrams D, Stead C, Ryan KR, Rycus P, Fox AD, Ogino MT, Alexander PM. Foundations of a Life Support Equipment Exchange Platform: ELSO Supplies. J Extra Corpor Technol 2023; 55:39-43. [PMID: 37034103 PMCID: PMC10071502 DOI: 10.1051/ject/2023001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/12/2022] [Indexed: 02/05/2023]
Abstract
The ELSO Supplies Platform (Supplies.ELSO.org) was created out of Extracorporeal Membrane Oxygenation (ECMO) disposable product deficiency prior to and during the Coronavirus Disease 2019 (COVID-19) pandemic. This novel Platform supports Centers in obtaining disposables when alternative avenues are exhausted. Driven by the opportunity for increased patient care by using the product availability of the 962 ELSO centers worldwide was the motivation to form an efficient online supply sharing platform. The pandemic created by COVID-19, became a catalyst to further recognize the magnitude of the supply disruption on a global scale, impacting allocations and guidelines for institutions, practice, and patient care. Records kept on the platform website are helpful to industry by providing insights where difficulties exist in the supply chain for needed equipment. Yet, the common thread is awareness, how critical situations can stretch resources and challenge our resolve for best patient care. ELSO is proud to support member centers in these situations, by providing a means of attaining needed ECMO life support products to cover supply deficiencies.
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Affiliation(s)
- Justin R. Sleasman
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Lead Perfusionist, Stanford Medicine Children’s Health 725 Welch Road Palo Alto CA 94304 USA
- Corresponding author:
| | - Ula Hijawi
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Researcher and Project Team Leader, Qatar University Doha Qatar
| | | | - Mohamed Rabie
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Researcher and Project Team Leader, Qatar University Doha Qatar
| | | | - Aidan Stead
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Interns, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Christopher Cooley
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Interns, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Conor Donnelly
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Interns, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Jonathan W. Haft
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Department of Cardiac Surgery, University of Michigan Ann Arbor MI 48109 USA
| | - Darryl Abrams
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Division of Pulmonary and Critical Care Medicine, Columbia University Irving Medical Center New York NY 10032 USA
| | - Christine Stead
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CEO, Extracorporeal Life Support Organization and Adjunct Faculty, University of Michigan School of Public Health, Health Management and Policy Ann Arbor MI 48103 USA
| | - Kathleen R. Ryan
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Department of Pediatrics, Division of Cardiology, Stanford Medicine Children’s Health and Stanford University School of Medicine Palo Alto CA 94304 USA
| | - Peter Rycus
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Executive Director, Extracorporeal Life Support Organization Ann Arbor MI 48103 USA
| | - Alexander D. Fox
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Project Manager, Extracorporeal Life support Organization Ann Arbor MI 48103 USA
| | - Mark T. Ogino
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Pediatric Neonatal-Perinatal, Critical Care Service, Division of Neonatology Nemours/Alfred I. du Pont Hospital for Children Wilmington DE 19803 USA
| | - Peta M.A. Alexander
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Lead Perfusionist, Stanford Medicine Children’s Health 725 Welch Road Palo Alto CA 94304 USA
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Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics Harvard Medical School Boston MA 02115 USA
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15
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Brodie D, Abrams D, MacLaren G, Brown CE, Evans L, Barbaro RP, Calfee CS, Hough CL, Fowles JA, Karagiannidis C, Slutsky AS, Combes A. Extracorporeal Membrane Oxygenation during Respiratory Pandemics: Past, Present, and Future. Am J Respir Crit Care Med 2022; 205:1382-1390. [PMID: 35213298 PMCID: PMC9875895 DOI: 10.1164/rccm.202111-2661cp] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The role of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory failure, including acute respiratory distress syndrome, has become better defined in recent years in light of emerging high-quality evidence and technological advances. Use of ECMO has consequently increased throughout many parts of the world. The coronavirus disease (COVID-19) pandemic, however, has highlighted deficiencies in organizational capacity, research capability, knowledge sharing, and resource use. Although governments, medical societies, hospital systems, and clinicians were collectively unprepared for the scope of this pandemic, the use of ECMO, a highly resource-intensive and specialized form of life support, presented specific logistical and ethical challenges. As the pandemic has evolved, there has been greater collaboration in the use of ECMO across centers and regions, together with more robust data reporting through international registries and observational studies. Nevertheless, centralization of ECMO capacity is lacking in many regions of the world, and equitable use of ECMO resources remains uneven. There are no widely available mechanisms to conduct large-scale, rigorous clinical trials in real time. In this critical care review, we outline lessons learned during COVID-19 and prior respiratory pandemics in which ECMO was used, and we describe how we might apply these lessons going forward, both during the ongoing COVID-19 pandemic and in the future.
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Affiliation(s)
- Daniel Brodie
- Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York;,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
| | - Darryl Abrams
- Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York;,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic, and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Crystal E. Brown
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, and
| | - Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
| | - Ryan P. Barbaro
- Division of Pediatric Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Carolyn S. Calfee
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Catherine L. Hough
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Jo-anne Fowles
- Intensive Care, Division of Surgery, Transplant and Anaesthetics, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Arthur S. Slutsky
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada;,Division of Critical Care Medicine, Department of Medicine, Unity Health Toronto, and,Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alain Combes
- Sorbonne University, INSERM, UMRS1166-ICAN, Institute of Cardiometabolism and Nutrition, Paris, France; and,Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique – Hôpitaux de Paris Sorbonne Hôpital Pitié-Salpêtrière, Paris, France
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16
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Abramov A, Fuller J, Su I, Flatley M, Abrams D, Stanifer BP, Agerstrand C, Brodie D, Sonett J, Azizi E, Lemaitre P. P94: COVID-19-related ARDS Supported with Extracorporeal Membrane Oxygenation: Using Machine Learning Models to Improve Care. ASAIO J 2022. [DOI: 10.1097/01.mat.0000841592.03089.c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Abrams D, Albataineh H, Aljawrneh BS, Alsalmi S, Androic D, Aniol K, Armstrong W, Arrington J, Atac H, Averett T, Gayoso CA, Bai X, Bane J, Barcus S, Beck A, Bellini V, Bhatt H, Bhetuwal D, Biswas D, Blyth D, Boeglin W, Bulumulla D, Butler J, Camsonne A, Carmignotto M, Castellanos J, Chen JP, Cohen EO, Covrig S, Craycraft K, Cruz-Torres R, Dongwi B, Duran B, Dutta D, Fuchey E, Gal C, Gautam TN, Gilad S, Gnanvo K, Gogami T, Gomez J, Gu C, Habarakada A, Hague T, Hansen JO, Hattawy M, Hauenstein F, Higinbotham DW, Holt RJ, Hughes EW, Hyde C, Ibrahim H, Jian S, Joosten S, Karki A, Karki B, Katramatou AT, Keith C, Keppel C, Khachatryan M, Khachatryan V, Khanal A, Kievsky A, King D, King PM, Korover I, Kulagin SA, Kumar KS, Kutz T, Lashley-Colthirst N, Li S, Li W, Liu H, Liuti S, Liyanage N, Markowitz P, McClellan RE, Meekins D, Beck SMT, Meziani ZE, Michaels R, Mihovilovic M, Nelyubin V, Nguyen D, Nycz M, Obrecht R, Olson M, Owen VF, Pace E, Pandey B, Pandey V, Paolone M, Papadopoulou A, Park S, Paul S, Petratos GG, Petti R, Piasetzky E, Pomatsalyuk R, Premathilake S, Puckett AJR, Punjabi V, Ransome RD, Rashad MNH, Reimer PE, Riordan S, Roche J, Salmè G, Santiesteban N, Sawatzky B, Scopetta S, Schmidt A, Schmookler B, Segal J, Segarra EP, Shahinyan A, Širca S, Sparveris N, Su T, Suleiman R, Szumila-Vance H, Tadepalli AS, Tang L, Tireman W, Tortorici F, Urciuoli GM, Wojtsekhowski B, Wood S, Ye ZH, Ye ZY, Zhang J. Measurement of the Nucleon F_{2}^{n}/F_{2}^{p} Structure Function Ratio by the Jefferson Lab MARATHON Tritium/Helium-3 Deep Inelastic Scattering Experiment. Phys Rev Lett 2022; 128:132003. [PMID: 35426713 DOI: 10.1103/physrevlett.128.132003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 01/23/2022] [Accepted: 02/09/2022] [Indexed: 06/14/2023]
Abstract
The ratio of the nucleon F_{2} structure functions, F_{2}^{n}/F_{2}^{p}, is determined by the MARATHON experiment from measurements of deep inelastic scattering of electrons from ^{3}H and ^{3}He nuclei. The experiment was performed in the Hall A Facility of Jefferson Lab using two high-resolution spectrometers for electron detection, and a cryogenic target system which included a low-activity tritium cell. The data analysis used a novel technique exploiting the mirror symmetry of the two nuclei, which essentially eliminates many theoretical uncertainties in the extraction of the ratio. The results, which cover the Bjorken scaling variable range 0.19<x<0.83, represent a significant improvement compared to previous SLAC and Jefferson Lab measurements for the ratio. They are compared to recent theoretical calculations and empirical determinations of the F_{2}^{n}/F_{2}^{p} ratio.
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Affiliation(s)
- D Abrams
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - H Albataineh
- Texas A & M University, Kingsville, Texas 78363, USA
| | - B S Aljawrneh
- North Carolina A & T State University, Greensboro, North Carolina 27411, USA
| | - S Alsalmi
- Kent State University, Kent, Ohio 44240, USA
- King Saud University, Riyadh 11451, Kingdom of Saudi Arabia
| | - D Androic
- University of Zagreb, 10000 Zagreb, Croatia
| | - K Aniol
- California State University, Los Angeles, California 90032, USA
| | - W Armstrong
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - J Arrington
- Argonne National Laboratory, Lemont, Illinois 60439, USA
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - H Atac
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - T Averett
- William & Mary, Williamsburg, Virginia 23187, USA
| | | | - X Bai
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - J Bane
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Barcus
- William & Mary, Williamsburg, Virginia 23187, USA
| | - A Beck
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - V Bellini
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
| | - H Bhatt
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - D Bhetuwal
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - D Biswas
- Hampton University, Hampton, Virginia 23669, USA
| | - D Blyth
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - W Boeglin
- Florida International University, Miami, Florida 33199, USA
| | - D Bulumulla
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - J Butler
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - A Camsonne
- Jefferson Lab, Newport News, Virginia 23606, USA
| | | | - J Castellanos
- Florida International University, Miami, Florida 33199, USA
| | - J-P Chen
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - E O Cohen
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - S Covrig
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - K Craycraft
- William & Mary, Williamsburg, Virginia 23187, USA
| | - R Cruz-Torres
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Dongwi
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
| | - B Duran
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - D Dutta
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - E Fuchey
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - C Gal
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - T N Gautam
- Hampton University, Hampton, Virginia 23669, USA
| | - S Gilad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - K Gnanvo
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - T Gogami
- Tohoku University, Sendai 980-8576, Japan
| | - J Gomez
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - C Gu
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - A Habarakada
- Hampton University, Hampton, Virginia 23669, USA
| | - T Hague
- Kent State University, Kent, Ohio 44240, USA
| | - J-O Hansen
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Hattawy
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - F Hauenstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | | | - R J Holt
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - E W Hughes
- Columbia University, New York, New York 10027, USA
| | - C Hyde
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - H Ibrahim
- Cairo University, Cairo, Giza 12613 Egypt
| | - S Jian
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - S Joosten
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - A Karki
- Mississippi State University, Mississipi State, Mississippi 39762, USA
| | - B Karki
- Ohio University, Athens, Ohio 45701, USA
| | | | - C Keith
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - C Keppel
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Khachatryan
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - V Khachatryan
- Stony Brook, State University of New York, New York 11794, USA
| | - A Khanal
- Florida International University, Miami, Florida 33199, USA
| | - A Kievsky
- Istituto Nazionale di Fisica Nucleare, Sezione di Pisa, 56127 Pisa, Italy
| | - D King
- Syracuse University, Syracuse, New York 13244, USA
| | - P M King
- Ohio University, Athens, Ohio 45701, USA
| | - I Korover
- Nuclear Research Center-Negev, Beer-Sheva 84190, Israel
| | - S A Kulagin
- Institute for Nuclear Research of the Russian Academy of Sciences, 117312 Moscow, Russia
| | - K S Kumar
- Stony Brook, State University of New York, New York 11794, USA
| | - T Kutz
- Stony Brook, State University of New York, New York 11794, USA
| | | | - S Li
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - W Li
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H Liu
- Columbia University, New York, New York 10027, USA
| | - S Liuti
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - N Liyanage
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - P Markowitz
- Florida International University, Miami, Florida 33199, USA
| | | | - D Meekins
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - S Mey-Tal Beck
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Z-E Meziani
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - R Michaels
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Mihovilovic
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana 1000, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
- Institut für Kernphysik, Johannes Gutenberg-Universität, Mainz 55122, Germany
| | - V Nelyubin
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - D Nguyen
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - M Nycz
- Kent State University, Kent, Ohio 44240, USA
| | - R Obrecht
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - M Olson
- Saint Norbert College, De Pere, Wisconsin 54115, USA
| | - V F Owen
- William & Mary, Williamsburg, Virginia 23187, USA
| | - E Pace
- University of Rome Tor Vergata and INFN, Sezione di Roma Tor Vergata, 00133 Rome, Italy
| | - B Pandey
- Hampton University, Hampton, Virginia 23669, USA
| | - V Pandey
- Center for Neutrino Physics, Virginia Tech, Blacksburg, Virginia 24061, USA
| | - M Paolone
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - A Papadopoulou
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Park
- Stony Brook, State University of New York, New York 11794, USA
| | - S Paul
- William & Mary, Williamsburg, Virginia 23187, USA
| | | | - R Petti
- University of South Carolina, Columbia, South Carolina 29208, USA
| | - E Piasetzky
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv, Israel
| | - R Pomatsalyuk
- Institute of Physics and Technology, 61108 Kharkov, Ukraine
| | - S Premathilake
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - A J R Puckett
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - V Punjabi
- Norfolk State University, Norfolk, Virginia 23504, USA
| | - R D Ransome
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08855, USA
| | - M N H Rashad
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - P E Reimer
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - S Riordan
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - J Roche
- Ohio University, Athens, Ohio 45701, USA
| | - G Salmè
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, 00185 Rome, Italy
| | - N Santiesteban
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - B Sawatzky
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - S Scopetta
- University of Perugia and INFN, Sezione di Perugia, 06123 Perugia, Italy
| | - A Schmidt
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Schmookler
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Segal
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - E P Segarra
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Shahinyan
- Yerevan Physics Institute, Yerevan 375036, Armenia
| | - S Širca
- Faculty of Mathematics and Physics, University of Ljubljana, Ljubljana 1000, Slovenia
- Jožef Stefan Institute, Ljubljana, Slovenia
| | - N Sparveris
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - T Su
- Kent State University, Kent, Ohio 44240, USA
- Shandong Institute of Advanced Technology, Jinan, Shandong 250100, China
| | - R Suleiman
- Jefferson Lab, Newport News, Virginia 23606, USA
| | | | - A S Tadepalli
- Rutgers, The State University of New Jersey, Piscataway, New Jersey 08855, USA
| | - L Tang
- Hampton University, Hampton, Virginia 23669, USA
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - W Tireman
- Northern Michigan University, Marquette, Michigan 49855, USA
| | - F Tortorici
- Istituto Nazionale di Fisica Nucleare, Sezione di Catania, 95123 Catania, Italy
| | - G M Urciuoli
- Istituto Nazionale di Fisica Nucleare, Sezione di Roma, 00185 Rome, Italy
| | | | - S Wood
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - Z H Ye
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - Z Y Ye
- University of Illinois-Chicago, Chicago, Illinois 60607, USA
| | - J Zhang
- Stony Brook, State University of New York, New York 11794, USA
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18
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Abstract
PURPOSE OF REVIEW To understand the potential role of extracorporeal membrane oxygenation (ECMO) in coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS), highlighting evolving practices and outcomes. RECENT FINDINGS The role for ECMO in COVID-19-related ARDS has evolved throughout the pandemic. Early reports of high mortality led to some to advocate for withholding ECMO in this setting. Subsequent data suggested mortality rates were on par with those from studies conducted prior to the pandemic. However, outcomes are evolving and mortality in these patients may be worsening with time. SUMMARY ECMO has an established role in the treatment of severe forms of ARDS. Current data suggest adherence to the currently accepted algorithm for management of ARDS, including the use of ECMO. However, planning related to resource utilization and strain on healthcare systems are necessary to determine the feasibility of ECMO in specific regions at any given time. Utilization of national and local networks, pooling of resources and ECMO mobilization units are important to optimize access to ECMO as appropriate. Reported complications of ECMO in the setting of COVID-19-related ARDS have been predominantly similar to those reported in studies of non-COVID-19-related ARDS. Further high-quality research is needed.
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Affiliation(s)
- Briana Short
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York, USA
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19
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Abrams D, Agerstrand C, Beitler JR, Karagiannidis C, Madahar P, Yip NH, Pesenti A, Slutsky AS, Brochard L, Brodie D. Risks and Benefits of Ultra-Lung-Protective Invasive Mechanical Ventilation Strategies with a Focus on Extracorporeal Support. Am J Respir Crit Care Med 2022; 205:873-882. [PMID: 35044901 DOI: 10.1164/rccm.202110-2252cp] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lung-protective ventilation strategies are the current standard of care for patients with acute respiratory distress syndrome (ARDS) in an effort to provide adequate ventilatory requirements while minimizing ventilator-induced lung injury. Some patients may benefit from ultra-lung-protective ventilation, a strategy that achieves lower airway pressures and tidal volumes than the current standard. Specific physiological parameters beyond severity of hypoxemia, such as driving pressure and respiratory system elastance, may be predictive of those most likely to benefit. Since application of ultra-lung-protective ventilation is often limited by respiratory acidosis, extracorporeal membrane oxygenation (ECMO) or extracorporeal carbon dioxide removal (ECCO2R), which remove carbon dioxide from blood, are attractive options. These strategies are associated with hematological complications, especially when applied at low blood flow rates with devices designed for higher blood flows, and a recent large randomized, controlled trial failed to show a benefit from an ECCO2R-facilitated ultra-lung-protective ventilation strategy. Only in patients with very severe forms of ARDS has the use of an ultra-lung-protective ventilation strategy - accomplished with ECMO - been suggested to have a favorable risk-to-benefit profile. In this Critical Care Perspective, we address key areas of controversy related to ultra-lung-protective ventilation, including the trade-offs between minimizing ventilator-induced lung injury and the risks from strategies to achieve this added protection. In addition, we suggest which patients might benefit most from an ultra-lung-protective strategy and propose areas of future research.
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Affiliation(s)
- Darryl Abrams
- Columbia University Medical Center, Medicine, Division of Pulmonary, Allergy, & Critical Care, New York, New York, United States
| | - Cara Agerstrand
- Columbia University Medical Center, Medicine, Division of Pulmonary, Allergy, & Critical Care, New York, New York, United States
| | - Jeremy R Beitler
- Columbia University College of Physicians and Surgeons, 12294, Center for Acute Respiratory Failure and Division of Pulmonary, Allergy, and Critical Care Medicine, New York, New York, United States.,NewYork-Presbyterian Hospital, 25065, New York, New York, United States
| | - Christian Karagiannidis
- Hospital Cologne-Merheim, 61060, Department of Pneumology and Critical Care Medicine, Koln, Germany.,Witten/Herdecke University, 12263, Cologne, Germany
| | - Purnema Madahar
- Columbia University Medical Center, Medicine, Division of Pulmonary, Allergy, & Critical Care, New York, New York, United States
| | - Natalie H Yip
- Columbia University Medical Center, Dept of Medicine Pulmonary, New York City, New York, United States
| | - Antonio Pesenti
- Universita degli Studi di Milano, 9304, Department of Pathophysiology and Transplantation, Milano, Italy
| | | | - Laurent Brochard
- St Michael's Hospital in Toronto, Li Ka Shing Knowledge Institute, Keenan Research Centre, Toronto, Ontario, Canada.,University of Toronto, 7938, Interdepartmental Division of Critical Care Medicine, Toronto, Ontario, Canada
| | - Daniel Brodie
- Columbia, Critical Care, New York, New York, United States;
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Nunez JI, Gosling AF, O'Gara B, Kennedy KF, Rycus P, Abrams D, Brodie D, Shaefi S, Garan AR, Grandin EW. Correction to: Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis. Intensive Care Med 2022; 48:644-645. [PMID: 35041017 DOI: 10.1007/s00134-021-06605-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jose I Nunez
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andre F Gosling
- Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Brian O'Gara
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kevin F Kennedy
- Smith Center for Cardiology Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI, USA
| | - Darryl Abrams
- Division of Pulmonary and Critical Care Medicine, Columbia Presbyterian Medical Center, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Columbia Presbyterian Medical Center, New York, NY, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Reshad Garan
- Division of Cardiovascular Medicine, Section of Advanced Heart Failure, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, DE-319, Boston, MA, 02215, USA
| | - E Wilson Grandin
- Smith Center for Cardiology Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Division of Cardiovascular Medicine, Section of Advanced Heart Failure, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, DE-319, Boston, MA, 02215, USA.
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Itabashi K, Suzuki K, Pandey B, Okuyama K, Gogami T, Nagao S, Nakamura S, Tang L, Abrams D, Akiyama T, Androic D, Aniol K, Ayerbe Gayoso C, Bane J, Barcus S, Barrow J, Bellini V, Bhatt H, Bhetuwal D, Biswas D, Camsonne A, Castellanos J, Chen JP, Chen J, Covrig S, Chrisman D, Cruz-Torres R, Das R, Fuchey E, Gnanvo K, Garibaldi F, Gautam T, Gomez J, Gueye P, Hague T, Hansen O, Henry W, Hauenstein F, Higinbotham D, Hyde C, Kaneta M, Keppel C, Kutz T, Lashley-Colthirst N, Li S, Liu H, Mammei J, Markowitz P, McClellan RE, Meddi F, Meekins D, Michaels R, Mihovilovic M, Moyer A, Nguyen D, Nycz M, Owen V, Palatchi C, Park S, Petkovic T, Premathilake S, Reimer P, Reinhold J, Riordan S, Rodriguez V, Samanta C, Santiesteban S, Sawatzky B, Širca S, Slifer K, Su T, Tian Y, Toyama Y, Uehara K, Urciuoli G, Votaw D, Williamson J, Wojtsekhowski B, Wood S, Yale B, Ye Z, Zhang J, Zheng X. Study of Λ n FSI with Λ quasi-free productions on the 3H( e, e′K+) X reaction at JLab. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202227102006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract. An nnΛ is a neutral baryon system with no charge. The study of the pure Λ-neutron system such as nnΛ gives us information on the Λn interaction. The nnΛ search experiment (E12-17-003) was performed at JLab Hall A in 2018. In this article, the Λn FSI was investigated by a shape analysis of the 3H(e, e′K+)X missing mass spectrum, and a preliminary result for the Λn FSI study is given.
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Gogami T, Suzuki KN, Pandey B, Itabashi K, Nagao S, Okuyama K, Nakamura SN, Tang L, Abrams D, Akiyama T, Androic D, Aniol K, Ayerbe Gayoso C, Bane J, Barcus S, Barrow J, Bellini V, Bhatt H, Bhetuwal D, Biswas D, Camsonne A, Castellanos J, Chen JP, Chen J, Covrig S, Chrisman D, Cruz-Torres R, Das R, Fuchey E, Gnanvo K, Garibaldi F, Gautam T, Gomez J, Gueye P, Hague TJ, Hansen O, Henry W, Hauenstein F, Higinbotham DW, Hyde CE, Kaneta M, Keppel C, Kutz T, Lashley-Colthirst N, Li S, Liu H, Mammei J, Markowitz P, McClellan RE, Meddi F, Meekins D, Michaels R, Mihovilovic M, Moyer A, Nguyen D, Nycz M, Owen V, Palatchi C, Park S, Petkovic T, Premathilake S, Reimer PE, Reinhold J, Riordan S, Rodriguez V, Samanta C, Santiesteban SN, Sawatzky B, Širca S, Slifer K, Su T, Tian Y, Toyama Y, Uehara K, Urciuoli GM, Votaw D, Williamson J, Wojtsekhowski B, Wood SA, Yale B, Ye Z, Zhang J, Zheng X. Cross-section measurement of virtual photoproduction of iso-triplet three-body hypernucleus, Λ nn. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202227102002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Missing-mass spectroscopy with the 3H(e, e′K+) reaction was carried out at Jefferson Lab’s (JLab) Hall A in Oct–Nov, 2018. The differential cross section for the 3H(γ∗, K+)Λnn was deduced at ω = Ee − Ee′ = 2.102 GeV and at the forward K+-scattering angle (0° ≤ θγ∗K ≤ 5°) in the laboratory frame. Given typical predicted energies and decay widths, which are (BΛ, Γ) = (−0.25, 0.8) and (−0.55, 4.7) MeV, the cross sections were found to be 11.2 ± 4.8(stat.)+4.1−2.1(sys.) and 18.1 ± 6.8(stat.)+4.2−2.9(sys.) nb/sr, respectively. The obtained result would impose a constraint for interaction models particularly between Λ and neutron by comparing to theoretical calculations.
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Abrams D, MacLaren G, Lorusso R, Price S, Yannopoulos D, Vercaemst L, Bělohlávek J, Taccone FS, Aissaoui N, Shekar K, Garan AR, Uriel N, Tonna JE, Jung JS, Takeda K, Chen YS, Slutsky AS, Combes A, Brodie D. Extracorporeal cardiopulmonary resuscitation in adults: evidence and implications. Intensive Care Med 2022; 48:1-15. [PMID: 34505911 PMCID: PMC8429884 DOI: 10.1007/s00134-021-06514-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 01/15/2023]
Abstract
Rates of survival with functional recovery for both in-hospital and out-of-hospital cardiac arrest are notably low. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a modality to improve prognosis by augmenting perfusion to vital end-organs by utilizing extracorporeal membrane oxygenation (ECMO) during conventional CPR and stabilizing the patient for interventions aimed at reversing the aetiology of the arrest. Implementing this emergent procedure requires a substantial investment in resources, and even the most successful ECPR programs may nonetheless burden healthcare systems, clinicians, patients, and their families with unsalvageable patients supported by extracorporeal devices. Non-randomized and observational studies have repeatedly shown an association between ECPR and improved survival, versus conventional CPR, for in-hospital cardiac arrest in select patient populations. Recently, randomized controlled trials suggest benefit for ECPR over standard resuscitation, as well as the feasibility of performing such trials, in out-of-hospital cardiac arrest within highly coordinated healthcare delivery systems. Application of these data to clinical practice should be done cautiously, with outcomes likely to vary by the setting and system within which ECPR is initiated. ECPR introduces important ethical challenges, including whether it should be considered an extension of CPR, at what point it becomes sustained organ replacement therapy, and how to approach patients unable to recover or be bridged to heart replacement therapy. The economic impact of ECPR varies by health system, and has the potential to outstrip resources if used indiscriminately. Ideally, studies should include economic evaluations to inform health care systems about the cost-benefits of this therapy.
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Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 622 W168th St., PH 8E, Room 101, New York, NY 10032 USA ,Center for Acute Respiratory Failure, Columbia University Irving Medical Center, New York, NY USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, Department of Cardiac, Thoracic and Vascular Surgery, National University Health System, Singapore, Singapore
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK ,National Heart and Lung Institute, Imperial College, London, UK
| | - Demetris Yannopoulos
- Center for Resuscitation Medicine, University of Minnesota Medical School, Minneapolis, MN USA
| | - Leen Vercaemst
- Department of Perfusion, University Hospital Gasthuisberg, Leuven, Belgium
| | - Jan Bělohlávek
- Second Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Fabio S. Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nadia Aissaoui
- Intensive Care Unit, APHP, Hopital Européen Georges Pompidou, Inserm U 970, Université de Paris, Paris, France
| | - Kiran Shekar
- Adult Intensive Care Services, Prince Charles Hospital, Brisbane, Australia ,University of Queensland, Brisbane, Australia ,Bond University, Gold Coast, Australia
| | - A. Reshad Garan
- Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, NewYork-Presbyterian, Columbia University Irving Medical Center, New York, NY USA
| | - Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT USA ,Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, UT USA
| | - Jae Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Medicine, Seoul, Republic of Korea
| | - Koji Takeda
- Division of Cardiac, Vascular and Thoracic Surgery, Columbia University Medical Center, New York, USA
| | - Yih-Sharng Chen
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Arthur S. Slutsky
- Keenan Research Center, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada ,Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France ,Service de Médecine Intensive-Réanimation, Hôpitaux Universitaires Pitié Salpêtrière, Assistance Publique–Hôpitaux de Paris, Institut de Cardiologie, Paris, France
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 622 W168th St., PH 8E, Room 101, New York, NY 10032 USA ,Center for Acute Respiratory Failure, Columbia University Irving Medical Center, New York, NY USA
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Okuyama K, Itabashi K, Nagao S, Nakamura SN, Suzuki KN, Gogami T, Pandey B, Tang L, Abrams D, Akiyama T, Androic D, Aniol K, Ayerbe Gayoso C, Bane J, Barcus S, Barrow J, Bellini V, Bhatt H, Bhetuwal D, Biswas D, Camsonne A, Castellanos J, Chen JP, Chen J, Covrig S, Chrisman D, Cruz-Torres R, Das R, Fuchey E, Gnanvo K, Garibaldi F, Gautam T, Gomez J, Gueye P, Hague TJ, Hansen O, Henry W, Hauenstein F, Higinbotham DW, Hyde CE, Kaneta M, Keppel C, Kutz T, Lashley-Colthirst N, Li S, Liu H, Mammei J, Markowitz P, McClellan RE, Meddi F, Meekins D, Michaels R, Mihovilovic M, Moyer A, Nguyen D, Nycz M, Owen V, Palatchi C, Park S, Petkovic T, Premathilake S, Reimer PE, Reinhold J, Riordan S, Rodriguez V, Samanta C, Santiesteban SN, Sawatzky B, Širca S, Slifer K, Su T, Tian Y, Toyama Y, Uehara K, Urciuoli GM, Votaw D, Williamson J, Wojtsekhowski B, Wood SA, Yale B, Ye Z, Zhang J, Zheng X. Study of the Λ/Σ 0 electroproduction in the low- Q2 region at JLab. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202227102003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We performed an experiment using tritium and hydrogen cryogenic gas targets at Thomas Jefferson National Accelerator Facility (JLab) in 2018 (E12-17-003)[1, 2]. In this article, we discuss the Λ/Σ0 hyperon electroproduction from hydrogen target. Elementary Λ/Σ0 hyperon production processes are important not only for an absolute mass scale calibration in our experiment, but also for the study of the electroproduction mechanisms themselves. In this article, we reported the results of the differential cross section for the p(e, e’K+)Λ/Σ0 reaction at Q2 ∼ 0.5 (GeV/c)2.
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Nunez JI, Gosling AF, O'Gara B, Kennedy KF, Rycus P, Abrams D, Brodie D, Shaefi S, Garan AR, Grandin EW. Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis. Intensive Care Med 2021; 48:213-224. [PMID: 34921625 DOI: 10.1007/s00134-021-06593-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE This study aimed at analyzing the prevalence, mortality association, and risk factors for bleeding and thrombosis events (BTEs) among adults supported with venovenous extracorporeal membrane oxygenation (VV-ECMO). METHODS We queried the Extracorporeal Life Support Organization registry for adults supported with VV-ECMO from 2010 to 2017. Multivariable logistic regression modeling was used to assess the association between BTEs and in-hospital mortality and the predictors of BTEs. RESULTS Among 7579 VV-ECMO patients meeting criteria, 40.2% experienced ≥ 1 BTE. Thrombotic events comprised 54.9% of all BTEs and were predominantly ECMO circuit thrombosis. BTE rates decreased significantly over the study period (p < 0.001). The inpatient mortality rate was 34.9%. Bleeding events (1.69 [1.49-1.93]) were more strongly associated with in-hospital mortality than thrombotic events (1.23 [1.08-1.41]) p < 0.01 for both. The BTEs most strongly associated with mortality were ischemic stroke (4.50 [2.55-7.97]) and medical bleeding, including intracranial (5.71 [4.02-8.09]), pulmonary (2.02 [1.54-2.67]), and gastrointestinal (1.54 [1.2-1.98]) hemorrhage, all p < 0.01. Risk factors for bleeding included acute kidney injury and pre-ECMO vasopressor support and for thrombosis were higher weight, multisite cannulation, pre-ECMO arrest, and higher PaCO2 at ECMO initiation. Longer time on ECMO, younger age, higher pH, and earlier year of support were associated with bleeding and thrombosis. CONCLUSIONS Although decreasing over time, BTEs remain common during VV-ECMO and have a strong, cumulative association with in-hospital mortality. Thrombotic events are more frequent, but bleeding carries a higher risk of inpatient mortality. Differential risk factors for bleeding and thrombotic complications exist, raising the possibility of a tailored approach to VV-ECMO management.
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Affiliation(s)
- Jose I Nunez
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andre F Gosling
- Department of Anesthesiology, Duke University Hospital, Durham, NC, USA
| | - Brian O'Gara
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kevin F Kennedy
- Smith Center for Cardiology Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI, USA
| | - Darryl Abrams
- Division of Pulmonary and Critical Care Medicine, Columbia Presbyterian Medical Center, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Columbia Presbyterian Medical Center, New York, NY, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Reshad Garan
- Division of Cardiovascular Medicine, Section of Advanced Heart Failure, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, DE-319, Boston, MA, 02215, USA
| | - E Wilson Grandin
- Smith Center for Cardiology Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Division of Cardiovascular Medicine, Section of Advanced Heart Failure, Department of Medicine, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, DE-319, Boston, MA, 02215, USA.
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Sinha P, Furfaro D, Cummings MJ, Abrams D, Delucchi K, Maddali MV, He J, Thompson A, Murn M, Fountain J, Rosen A, Robbins-Juarez SY, Adan MA, Satish T, Madhavan M, Gupta A, Lyashchenko AK, Agerstrand C, Yip NH, Burkart KM, Beitler JR, Baldwin MR, Calfee CS, Brodie D, O'Donnell MR. Latent Class Analysis Reveals COVID-19-related Acute Respiratory Distress Syndrome Subgroups with Differential Responses to Corticosteroids. Am J Respir Crit Care Med 2021; 204:1274-1285. [PMID: 34543591 PMCID: PMC8786071 DOI: 10.1164/rccm.202105-1302oc] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale Two distinct subphenotypes have been identified in acute respiratory distress syndrome (ARDS), but the presence of subgroups in ARDS associated with coronavirus disease (COVID-19) is unknown. Objectives To identify clinically relevant, novel subgroups in COVID-19–related ARDS and compare them with previously described ARDS subphenotypes. Methods Eligible participants were adults with COVID-19 and ARDS at Columbia University Irving Medical Center. Latent class analysis was used to identify subgroups with baseline clinical, respiratory, and laboratory data serving as partitioning variables. A previously developed machine learning model was used to classify patients as the hypoinflammatory and hyperinflammatory subphenotypes. Baseline characteristics and clinical outcomes were compared between subgroups. Heterogeneity of treatment effect for corticosteroid use in subgroups was tested. Measurements and Main Results From March 2, 2020, to April 30, 2020, 483 patients with COVID-19–related ARDS met study criteria. A two-class latent class analysis model best fit the population (P = 0.0075). Class 2 (23%) had higher proinflammatory markers, troponin, creatinine, and lactate, lower bicarbonate, and lower blood pressure than class 1 (77%). Ninety-day mortality was higher in class 2 versus class 1 (75% vs. 48%; P < 0.0001). Considerable overlap was observed between these subgroups and ARDS subphenotypes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR cycle threshold was associated with mortality in the hypoinflammatory but not the hyperinflammatory phenotype. Heterogeneity of treatment effect to corticosteroids was observed (P = 0.0295), with improved mortality in the hyperinflammatory phenotype and worse mortality in the hypoinflammatory phenotype, with the caveat that corticosteroid treatment was not randomized. Conclusions We identified two COVID-19–related ARDS subgroups with differential outcomes, similar to previously described ARDS subphenotypes. SARS-CoV-2 PCR cycle threshold had differential value for predicting mortality in the subphenotypes. The subphenotypes had differential treatment responses to corticosteroids.
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Affiliation(s)
- Pratik Sinha
- Department of Anesthesiology, Washington University Medical School, Saint Louis, Missouri
| | - David Furfaro
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | | | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | | | | | - June He
- Department of Anesthesiology, Washington University Medical School, Saint Louis, Missouri
| | | | - Michael Murn
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | | | | | | | - Matthew A Adan
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Tejus Satish
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | | | | - Alexander K Lyashchenko
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York
| | | | - Natalie H Yip
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | | | | | | | - Carolyn S Calfee
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine.,Cardiovascular Research Institute, and.,Department of Anesthesia, University of California, San Francisco, San Francisco, California; and
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine.,Department of Epidemiology, Mailman School of Public Health, and
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Furfaro D, Rosenzweig EB, Shah L, Robbins H, Anderson M, Kim H, Abrams D, Agerstrand CL, Brodie D, Feldhaus D, Costa J, Lemaitre P, Stanifer BP, D'Ovidio F, Sonett JR, Arcasoy S, Benvenuto L. Lung transplantation disparities based on diagnosis for patients bridging to transplant on extracorporeal membrane oxygenation. J Heart Lung Transplant 2021; 40:1641-1648. [PMID: 34548196 DOI: 10.1016/j.healun.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/02/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is increasingly utilized as a bridge to lung transplantation, but ECMO status is not explicitly accounted for in the Lung Allocation Score (LAS). We hypothesized that among waitlist patients on ECMO, patients with pulmonary arterial hypertension (PAH) would have lower transplantation rates. METHODS Using United Network for Organ Sharing data, we conducted a retrospective cohort study of patients who were ≥12 years old, active on the lung transplant waitlist, and required ECMO support from June 1, 2015 through June 12, 2020. Multivariable competing risk analysis was used to examine waitlist outcomes. RESULTS 1064 waitlist subjects required ECMO support; 40 (3.8%) had obstructive lung disease (OLD), 97 (9.1%) had PAH,138 (13.0%) had cystic fibrosis (CF), and 789 (74.1%) had interstitial lung disease (ILD). Ultimately, 671 (63.1%) underwent transplant, while 334 (31.4%) died or were delisted. The transplant rate per person-years on the waitlist on ECMO was 15.41 for OLD, 6.05 for PAH, 15.66 for CF, and 15.62 for ILD. Compared to PAH patients, OLD, CF, and ILD patients were 78%, 69%, and 62% more likely to undergo transplant throughout the study period, respectively (adjusted SHRs 1.78 p = 0.007, 1.69 p = 0.002, and 1.62 p = 0.001). The median LAS at waitlist removal for transplantation, death, or delisting were 75.1 for OLD, 79.6 for PAH, 91.0 for CF, and 88.3 for ILD (p < 0.001). CONCLUSIONS Among patients bridging to transplant on ECMO, patients with PAH had a lower transplantation rate than patients with OLD, CF, and ILD.
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Affiliation(s)
- David Furfaro
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York.
| | - Erika B Rosenzweig
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Lori Shah
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hilary Robbins
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Michaela Anderson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Hanyoung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Darryl Abrams
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Cara L Agerstrand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel Brodie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Danielle Feldhaus
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Joseph Costa
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Philippe Lemaitre
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Bryan P Stanifer
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Frank D'Ovidio
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Joshua R Sonett
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, New York
| | - Selim Arcasoy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Luke Benvenuto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Lorusso R, Shekar K, MacLaren G, Schmidt M, Pellegrino V, Meyns B, Haft J, Vercaemst L, Pappalardo F, Bermudez C, Belohlavek J, Hou X, Boeken U, Castillo R, Donker DW, Abrams D, Ranucci M, Hryniewicz K, Chavez I, Chen YS, Salazar L, Whitman G. ELSO Interim Guidelines for Venoarterial Extracorporeal Membrane Oxygenation in Adult Cardiac Patients. ASAIO J 2021; 67:827-844. [PMID: 34339398 DOI: 10.1097/mat.0000000000001510] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Kiran Shekar
- Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Graeme MacLaren
- Cardio-Thoracic Intensive Care Unit, National University Hospital, Singapore, Singapore
| | - Matthieu Schmidt
- Medical Intensive Care Unit, Hopital La Pitie'-Salpetriere, University Pierre et Marie Curie, Paris, France
| | - Vincent Pellegrino
- Intensive Care Unit, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia
| | - Bart Meyns
- Cardiac Surgery Unit, Gasthuisberg University Hospital, Catholic University, Leuven, Belgium
| | - Jonathan Haft
- Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Leen Vercaemst
- Cardiac Surgery Unit, Gasthuisberg University Hospital, Catholic University, Leuven, Belgium
| | - Federico Pappalardo
- Department of Anesthesia and Intensive Care, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Christian Bermudez
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jan Belohlavek
- 2nd Department of Medicine, Cardiovascular Medicine, General University Hospital, Charles University, Prague, Czech Republic
| | - Xiaotong Hou
- Cardiac Intensive Care, Beijing Anzhem Hospital, Capital Medical University, Beijing, China
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Dirk W Donker
- Intensive Care Unit, Utrecht University Medical Centre, Utrecht, The Netherlands
- CRPH Cardiovascular & Respiratory Physiology Group, TechMed Centre, Faculty of Science & Technology, University of Twente, Enschede, The Netherlands
| | - Darryl Abrams
- Division of Pulmonology, Allergy and Critical Care, NewYork Presbiterian Hospital, Columbia University, New York, New York
| | - Marco Ranucci
- Cardio-Thoracic and Vascular Anesthesia and ICU Department, IRCCS Policlinico San Donato Hospital, Milan, Italy
| | - Kasia Hryniewicz
- Minneapolis Heart Institute Foundation, Abbot Northwestern University, Minneapolis, Minnesota
| | - Ivan Chavez
- Minneapolis Heart Institute Foundation, Abbot Northwestern University, Minneapolis, Minnesota
| | - Yih-Sharng Chen
- Cardiovascular Centre, National Taiwan University Hospital, Taiwan, Taipei
| | - Leonardo Salazar
- Department of Intensive Care, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Glenn Whitman
- Cardiovascular Surgery Intensive Care Unit and Heart Transplant, Johns Hopkins Hospital, Baltimore, Maryland
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Schmidt M, Fisser C, Martucci G, Abrams D, Frapard T, Popugaev K, Arcadipane A, Bromberger B, Lino G, Serra A, Rozencwajg S, Lubnow M, Petrikov S, Mueller T, Combes A, Pham T, Brodie D. Tracheostomy management in patients with severe acute respiratory distress syndrome receiving extracorporeal membrane oxygenation: an International Multicenter Retrospective Study. Crit Care 2021; 25:238. [PMID: 34233748 PMCID: PMC8261805 DOI: 10.1186/s13054-021-03649-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/21/2021] [Indexed: 01/19/2023]
Abstract
Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use. Methods International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. Results Of the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48–72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the “after ECMO” group, whereas it was unchanged in the “during-ECMO” group. Conclusion In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03649-8.
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Affiliation(s)
- Matthieu Schmidt
- Sorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651, Paris Cedex 13, France. .,Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Christoph Fisser
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Gennaro Martucci
- IRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive Care, Palermo, Italy
| | - Darryl Abrams
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA.,Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Thomas Frapard
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - Konstantin Popugaev
- Sklifosovsky Research Institute of Emergency Medicine, Bolshaya Sukharevskaya squire, 3, Moscow, Russia
| | - Antonio Arcadipane
- IRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive Care, Palermo, Italy
| | - Bianca Bromberger
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Giovanni Lino
- IRCCS-ISMETT Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione - Department of Anesthesia and Intensive Care, Palermo, Italy
| | - Alexis Serra
- Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - Sacha Rozencwajg
- Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - Matthias Lubnow
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Sergey Petrikov
- Sklifosovsky Research Institute of Emergency Medicine, Bolshaya Sukharevskaya squire, 3, Moscow, Russia
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Alain Combes
- Sorbonne Université, Paris 06, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, 75651, Paris Cedex 13, France.,Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, 47, bd de l'Hôpital, 75651, Paris Cedex 13, France
| | - Tài Pham
- Université Paris-Saclay, AP-HP, Service de médecine intensive-réanimation, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Equipe d'Epidémiologie respiratoire intégrative, CESP, Villejuif, France
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, USA.,Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
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O’Donnell MR, Grinsztejn B, Cummings MJ, Justman JE, Lamb MR, Eckhardt CM, Philip NM, Cheung YK, Gupta V, João E, Pilotto JH, Diniz MP, Cardoso SW, Abrams D, Rajagopalan KN, Borden SE, Wolf A, Sidi LC, Vizzoni A, Veloso VG, Bitan ZC, Scotto DE, Meyer BJ, Jacobson SD, Kantor A, Mishra N, Chauhan LV, Stone EF, Dei Zotti F, La Carpia F, Hudson KE, Ferrara SA, Schwartz J, Stotler BA, Lin WHW, Wontakal SN, Shaz B, Briese T, Hod EA, Spitalnik SL, Eisenberger A, Lipkin WI. A randomized double-blind controlled trial of convalescent plasma in adults with severe COVID-19. J Clin Invest 2021; 131:150646. [PMID: 33974559 PMCID: PMC8245169 DOI: 10.1172/jci150646] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDAlthough convalescent plasma has been widely used to treat severe coronavirus disease 2019 (COVID-19), data from randomized controlled trials that support its efficacy are limited.METHODSWe conducted a randomized, double-blind, controlled trial among adults hospitalized with severe and critical COVID-19 at 5 sites in New York City (USA) and Rio de Janeiro (Brazil). Patients were randomized 2:1 to receive a single transfusion of either convalescent plasma or normal control plasma. The primary outcome was clinical status at 28 days following randomization, measured using an ordinal scale and analyzed using a proportional odds model in the intention-to-treat population.RESULTSOf 223 participants enrolled, 150 were randomized to receive convalescent plasma and 73 to receive normal control plasma. At 28 days, no significant improvement in the clinical scale was observed in participants randomized to convalescent plasma (OR 1.50, 95% confidence interval [CI] 0.83-2.68, P = 0.180). However, 28-day mortality was significantly lower in participants randomized to convalescent plasma versus control plasma (19/150 [12.6%] versus 18/73 [24.6%], OR 0.44, 95% CI 0.22-0.91, P = 0.034). The median titer of anti-SARS-CoV-2 neutralizing antibody in infused convalescent plasma units was 1:160 (IQR 1:80-1:320). In a subset of nasopharyngeal swab samples from Brazil that underwent genomic sequencing, no evidence of neutralization-escape mutants was detected.CONCLUSIONIn adults hospitalized with severe COVID-19, use of convalescent plasma was not associated with significant improvement in day 28 clinical status. However, convalescent plasma was associated with significantly improved survival. A possible explanation is that survivors remained hospitalized at their baseline clinical status.TRIAL REGISTRATIONClinicalTrials.gov, NCT04359810.FUNDINGAmazon Foundation, Skoll Foundation.
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Affiliation(s)
- Max R. O’Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Epidemiology, and
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Matthew J. Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Jessica E. Justman
- Department of Epidemiology, and
- ICAP, Columbia University Mailman School of Public Health, New York, New York, USA
- Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Matthew R. Lamb
- Department of Epidemiology, and
- ICAP, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Christina M. Eckhardt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Neena M. Philip
- ICAP, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Vinay Gupta
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Esau João
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Jose Henrique Pilotto
- Hospital Geral de Nova Iguaçu, Rio de Janeiro, Brazil and Laboratório de Aids e Imunologia Molecular, Instituto Oswaldo Cruz – Fiocruz, Rio de Janeiro, Brazil
| | - Maria Pia Diniz
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | | | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kartik N. Rajagopalan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Sarah E. Borden
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Allison Wolf
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Leon Claude Sidi
- Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Alexandre Vizzoni
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas-Fiocruz, Rio de Janeiro, Brazil
| | - Zachary C. Bitan
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Dawn E. Scotto
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Benjamin J. Meyer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Samuel D. Jacobson
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Alex Kantor
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Nischay Mishra
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lokendra V. Chauhan
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Elizabeth F. Stone
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Flavia Dei Zotti
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Francesca La Carpia
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Krystalyn E. Hudson
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Stephen A. Ferrara
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Brie A. Stotler
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Wen-Hsuan W. Lin
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Sandeep N. Wontakal
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Beth Shaz
- New York Blood Center, New York, New York, USA
| | - Thomas Briese
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Eldad A. Hod
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Steven L. Spitalnik
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Andrew Eisenberger
- Division of Hematology and Oncology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Walter I. Lipkin
- Department of Epidemiology, and
- Center for Infection and Immunity, Columbia University Mailman School of Public Health, New York, New York, USA
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
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Tonna JE, Abrams D, Brodie D, Greenwood JC, Rubio Mateo-Sidron JA, Usman A, Fan E. Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO). ASAIO J 2021; 67:601-610. [PMID: 33965970 PMCID: PMC8315725 DOI: 10.1097/mat.0000000000001432] [Citation(s) in RCA: 215] [Impact Index Per Article: 71.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Disclaimer: The use of venovenous extracorporeal membrane oxygenation (VV ECMO) in adults has rapidly increased worldwide. This ELSO guideline is intended to be a practical guide to patient selection, initiation, cannulation, management, and weaning of VV ECMO for adult respiratory failure. This is a consensus document which has been updated from the previous version to provide guidance to the clinician.
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Affiliation(s)
- Joseph E Tonna
- From the Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
- Division of Emergency Medicine, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Daniel Brodie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - John C Greenwood
- Department of Anesthesiology and Critical Care, Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Asad Usman
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network and Sinai Health System, Toronto, Canada
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Agerstrand C, Dubois R, Takeda K, Uriel N, Lemaitre P, Fried J, Masoumi A, Cheung EW, Kaku Y, Witer L, Liou P, Gerall C, Klein-Cloud R, Abrams D, Cunningham J, Madahar P, Parekh M, Short B, Yip NH, Serra A, Beck J, Brewer M, Fung K, Mullin D, Oommen R, Stanifer BP, Middlesworth W, Sonett J, Brodie D. Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Crisis Standards of Care. ASAIO J 2021; 67:245-249. [PMID: 33627596 DOI: 10.1097/mat.0000000000001376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed extraordinary strain on global healthcare systems. Use of extracorporeal membrane oxygenation (ECMO) for patients with severe respiratory or cardiac failure attributed to COVID-19 has been debated due to uncertain survival benefit and the resources required to safely deliver ECMO support. We retrospectively investigated adult patients supported with ECMO for COVID-19 at our institution during the first 80 days following New York City's declaration of a state of emergency. The primary objective was to evaluate survival outcomes in patients supported with ECMO for COVID-19 and describe the programmatic adaptations made in response to pandemic-related crisis conditions. Twenty-two patients with COVID-19 were placed on ECMO during the study period. Median age was 52 years and 18 (81.8%) were male. Twenty-one patients (95.4%) had severe ARDS and seven (31.8%) had cardiac failure. Fifteen patients (68.1%) were managed with venovenous ECMO while 7 (31.8%) required arterial support. Twelve patients (54.5%) were transported on ECMO from external institutions. Twelve patients were discharged alive from the hospital (54.5%). Extracorporeal membrane oxygenation was used successfully in patients with respiratory and cardiac failure due to COVID-19. The continued use of ECMO, including ECMO transport, during crisis conditions was possible even at the height of the COVID-19 pandemic.
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Affiliation(s)
- Cara Agerstrand
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Richard Dubois
- Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Philippe Lemaitre
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Justin Fried
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Amirali Masoumi
- Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Eva W Cheung
- Divisions of Pediatric Cardiology and Critical Care, Department of Pediatrics, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Yuji Kaku
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Lucas Witer
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Peter Liou
- Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Claire Gerall
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Rafael Klein-Cloud
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Darryl Abrams
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Jennifer Cunningham
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Purnema Madahar
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Madhavi Parekh
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Briana Short
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Natalie H Yip
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Alexis Serra
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - James Beck
- Department of Clinical Perfusion and Anesthesia Support Services, NewYork-Presbyterian Hospital, New York, New York
| | - Michael Brewer
- Department of Clinical Perfusion and Anesthesia Support Services, NewYork-Presbyterian Hospital, New York, New York
| | - Kenmund Fung
- Department of Clinical Perfusion and Anesthesia Support Services, NewYork-Presbyterian Hospital, New York, New York
| | - Dana Mullin
- Department of Clinical Perfusion and Anesthesia Support Services, NewYork-Presbyterian Hospital, New York, New York
| | - Roy Oommen
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Bryan Payne Stanifer
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - William Middlesworth
- Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Joshua Sonett
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
| | - Daniel Brodie
- From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/NewYork-Presbyterian Hospital, New York, New York
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Bhetuwal D, Matter J, Szumila-Vance H, Kabir ML, Dutta D, Ent R, Abrams D, Ahmed Z, Aljawrneh B, Alsalmi S, Ambrose R, Androic D, Armstrong W, Asaturyan A, Assumin-Gyimah K, Ayerbe Gayoso C, Bandari A, Basnet S, Berdnikov V, Bhatt H, Biswas D, Boeglin WU, Bosted P, Brash E, Bukhari MHS, Chen H, Chen JP, Chen M, Christy EM, Covrig S, Craycraft K, Danagoulian S, Day D, Diefenthaler M, Dlamini M, Dunne J, Duran B, Evans R, Fenker H, Fomin N, Fuchey E, Gaskell D, Gautam TN, Gonzalez FA, Hansen JO, Hauenstein F, Hernandez AV, Horn T, Huber GM, Jones MK, Joosten S, Karki A, Keppel C, Khanal A, King PM, Kinney E, Ko HS, Kohl M, Lashley-Colthirst N, Li S, Li WB, Liyanage AH, Mack D, Malace S, Markowitz P, Meekins D, Michaels R, Mkrtchyan A, Mkrtchyan H, Nazeer SJ, Nanda S, Niculescu G, Niculescu I, Nguyen D, Pandey B, Park S, Pooser E, Puckett A, Rehfuss M, Reinhold J, Santiesteban N, Sawatzky B, Smith GR, Sun A, Tadevosyan V, Trotta R, Wood SA, Yero C, Zhang J. Ruling out Color Transparency in Quasielastic ^{12}C(e,e^{'}p) up to Q^{2} of 14.2 (GeV/c)^{2}. Phys Rev Lett 2021; 126:082301. [PMID: 33709760 DOI: 10.1103/physrevlett.126.082301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
Quasielastic ^{12}C(e,e^{'}p) scattering was measured at spacelike 4-momentum transfer squared Q^{2}=8, 9.4, 11.4, and 14.2 (GeV/c)^{2}, the highest ever achieved to date. Nuclear transparency for this reaction was extracted by comparing the measured yield to that expected from a plane-wave impulse approximation calculation without any final state interactions. The measured transparency was consistent with no Q^{2} dependence, up to proton momenta of 8.5 GeV/c, ruling out the quantum chromodynamics effect of color transparency at the measured Q^{2} scales in exclusive (e,e^{'}p) reactions. These results impose strict constraints on models of color transparency for protons.
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Affiliation(s)
- D Bhetuwal
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - J Matter
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - H Szumila-Vance
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M L Kabir
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Dutta
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - R Ent
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D Abrams
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - Z Ahmed
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - B Aljawrneh
- North Carolina A & T State University, Greensboro, North Carolina 27411, USA
| | - S Alsalmi
- Kent State University, Kent, Ohio 44240, USA
| | - R Ambrose
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - D Androic
- University of Zagreb, Zagreb, Croatia
| | - W Armstrong
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - A Asaturyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - K Assumin-Gyimah
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C Ayerbe Gayoso
- Mississippi State University, Mississippi State, Mississippi 39762, USA
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A Bandari
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - S Basnet
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - V Berdnikov
- Catholic University of America, Washington, DC 20064, USA
| | - H Bhatt
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Biswas
- Hampton University, Hampton, Virginia 23669, USA
| | - W U Boeglin
- Florida International University, University Park, Florida 33199, USA
| | - P Bosted
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - E Brash
- Christopher Newport University, Newport News, Virginia 23606, USA
| | | | - H Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - J P Chen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - E M Christy
- Hampton University, Hampton, Virginia 23669, USA
| | - S Covrig
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - K Craycraft
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Danagoulian
- North Carolina A & T State University, Greensboro, North Carolina 27411, USA
| | - D Day
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - M Diefenthaler
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Dlamini
- Ohio University, Athens, Ohio 45701, USA
| | - J Dunne
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - B Duran
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - R Evans
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H Fenker
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - N Fomin
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - E Fuchey
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - D Gaskell
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T N Gautam
- Hampton University, Hampton, Virginia 23669, USA
| | - F A Gonzalez
- Stony Brook University, Stony Brook, New York 11794, USA
| | - J O Hansen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - F Hauenstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - A V Hernandez
- Catholic University of America, Washington, DC 20064, USA
| | - T Horn
- Catholic University of America, Washington, DC 20064, USA
| | - G M Huber
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - M K Jones
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Joosten
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - A Karki
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C Keppel
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Khanal
- Florida International University, University Park, Florida 33199, USA
| | - P M King
- Ohio University, Athens, Ohio 45701, USA
| | - E Kinney
- University of Colorado Boulder, Boulder, Colorado 80309, USA
| | - H S Ko
- Institut de Physique Nucleaire, Orsay, France
| | - M Kohl
- Hampton University, Hampton, Virginia 23669, USA
| | | | - S Li
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - W B Li
- The College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A H Liyanage
- Hampton University, Hampton, Virginia 23669, USA
| | - D Mack
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Malace
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - P Markowitz
- Florida International University, University Park, Florida 33199, USA
| | - D Meekins
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - R Michaels
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - H Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - S J Nazeer
- Hampton University, Hampton, Virginia 23669, USA
| | - S Nanda
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - G Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - I Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - D Nguyen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - B Pandey
- Hampton University, Hampton, Virginia 23669, USA
| | - S Park
- Stony Brook University, Stony Brook, New York 11794, USA
| | - E Pooser
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Puckett
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - M Rehfuss
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - J Reinhold
- Florida International University, University Park, Florida 33199, USA
| | - N Santiesteban
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - B Sawatzky
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - G R Smith
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Sun
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - V Tadevosyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), Yerevan 0036, Armenia
| | - R Trotta
- Catholic University of America, Washington, DC 20064, USA
| | - S A Wood
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - C Yero
- Florida International University, University Park, Florida 33199, USA
| | - J Zhang
- Stony Brook University, Stony Brook, New York 11794, USA
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Supady A, Curtis JR, Abrams D, Lorusso R, Bein T, Boldt J, Brown CE, Duerschmied D, Metaxa V, Brodie D. Allocating scarce intensive care resources during the COVID-19 pandemic: practical challenges to theoretical frameworks. Lancet Respir Med 2021; 9:430-434. [PMID: 33450202 PMCID: PMC7837018 DOI: 10.1016/s2213-2600(20)30580-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic strained health-care systems throughout the world. For some, available medical resources could not meet the increased demand and rationing was ultimately required. Hospitals and governments often sought to establish triage committees to assist with allocation decisions. However, for institutions operating under crisis standards of care (during times when standards of care must be substantially lowered in the setting of crisis), relying on these committees for rationing decisions was impractical—circumstances were changing too rapidly, occurring in too many diverse locations within hospitals, and the available information for decision making was notably scarce. Furthermore, a utilitarian approach to decision making based on an analysis of outcomes is problematic due to uncertainty regarding outcomes of different therapeutic options. We propose that triage committees could be involved in providing policies and guidance for clinicians to help ensure equity in the application of rationing under crisis standards of care. An approach guided by egalitarian principles, integrated with utilitarian principles, can support physicians at the bedside when they must ration scarce resources.
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Affiliation(s)
- Alexander Supady
- Interdisciplinary Medical Intensive Care, Department of Medicine III, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Heidelberg Institute of Global Health, University of Heidelberg, Germany.
| | - J Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Darryl Abrams
- Columbia University College of Physicians & Surgeons, New York-Presbyterian Hospital, New York, NY, USA; Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Thomas Bein
- Department of Anesthesia and Operative Intensive Care, University Hospital Regensburg, Germany
| | - Joachim Boldt
- Department of Medical Ethics and the History of Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Crystal E Brown
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA; Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | - Daniel Duerschmied
- Interdisciplinary Medical Intensive Care, Department of Medicine III, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Cardiology and Angiology I, Heart Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Daniel Brodie
- Columbia University College of Physicians & Surgeons, New York-Presbyterian Hospital, New York, NY, USA; Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
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Yero C, Abrams D, Ahmed Z, Ahmidouch A, Aljawrneh B, Alsalmi S, Ambrose R, Armstrong W, Asaturyan A, Assumin-Gyimah K, Ayerbe Gayoso C, Bandari A, Bane J, Basnet S, Berdnikov VV, Bericic J, Bhatt H, Bhetuwal D, Biswas D, Boeglin WU, Bosted P, Brash E, Bukhari MHS, Chen H, Chen JP, Chen M, Christy ME, Covrig S, Craycraft K, Danagoulian S, Day D, Diefenthaler M, Dlamini M, Dunne J, Duran B, Dutta D, Ent R, Evans R, Fenker H, Fomin N, Fuchey E, Gaskell D, Gautam TN, Gonzalez FA, Hansen JO, Hauenstein F, Hernandez AV, Horn T, Huber GM, Jones MK, Joosten S, Kabir ML, Karki A, Keppel CE, Khanal A, King P, Kinney E, Lashley-Colthirst N, Li S, Li WB, Liyanage AH, Mack DJ, Malace SP, Matter J, Meekins D, Michaels R, Mkrtchyan A, Mkrtchyan H, Nazeer SJ, Nanda S, Niculescu G, Niculescu M, Nguyen D, Nuruzzaman N, Pandey B, Park S, Perdrisat CF, Pooser E, Rehfuss M, Reinhold J, Sawatzky B, Smith GR, Sun A, Szumila-Vance H, Tadevosyan V, Wood SA, Zhang J. Probing the Deuteron at Very Large Internal Momenta. Phys Rev Lett 2020; 125:262501. [PMID: 33449750 DOI: 10.1103/physrevlett.125.262501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
We measure ^{2}H(e,e^{'}p)n cross sections at 4-momentum transfers of Q^{2}=4.5±0.5 (GeV/c)^{2} over a range of neutron recoil momenta p_{r}, reaching up to ∼1.0 GeV/c. We obtain data at fixed neutron recoil angles θ_{nq}=35°, 45°, and 75° with respect to the 3-momentum transfer q[over →]. The new data agree well with previous data, which reached p_{r}∼500 MeV/c. At θ_{nq}=35° and 45°, final state interactions, meson exchange currents, and isobar currents are suppressed and the plane wave impulse approximation provides the dominant cross section contribution. We compare the new data to recent theoretical calculations, where we observe a significant discrepancy for recoil momenta p_{r}>700 MeV/c.
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Affiliation(s)
- C Yero
- Florida International University, University Park, Florida 33199, USA
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D Abrams
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - Z Ahmed
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - A Ahmidouch
- North Carolina Agricultural and Technical State University, Greensboro, North Carolina 27411, USA
| | - B Aljawrneh
- North Carolina Agricultural and Technical State University, Greensboro, North Carolina 27411, USA
| | - S Alsalmi
- Kent State University, Kent, Ohio 44240, USA
| | - R Ambrose
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - W Armstrong
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - A Asaturyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - K Assumin-Gyimah
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C Ayerbe Gayoso
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A Bandari
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - J Bane
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Basnet
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - V V Berdnikov
- Catholic University of America, Washington, D.C. 20064, USA
| | - J Bericic
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - H Bhatt
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Bhetuwal
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - D Biswas
- Hampton University, Hampton, Virginia 23669, USA
| | - W U Boeglin
- Florida International University, University Park, Florida 33199, USA
| | - P Bosted
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - E Brash
- Christopher Newport University, Newport News, Virginia 23606, USA
| | | | - H Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - J P Chen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Chen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - M E Christy
- Hampton University, Hampton, Virginia 23669, USA
| | - S Covrig
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - K Craycraft
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - S Danagoulian
- North Carolina Agricultural and Technical State University, Greensboro, North Carolina 27411, USA
| | - D Day
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - M Diefenthaler
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Dlamini
- Ohio University, Athens, Ohio 45701, USA
| | - J Dunne
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - B Duran
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - D Dutta
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - R Ent
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - R Evans
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H Fenker
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - N Fomin
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - E Fuchey
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - D Gaskell
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T N Gautam
- Hampton University, Hampton, Virginia 23669, USA
| | - F A Gonzalez
- Stony Brook University, Stony Brook, New York 11794, USA
| | - J O Hansen
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - F Hauenstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - A V Hernandez
- Catholic University of America, Washington, D.C. 20064, USA
| | - T Horn
- Catholic University of America, Washington, D.C. 20064, USA
| | - G M Huber
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - M K Jones
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S Joosten
- Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - M L Kabir
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - A Karki
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - C E Keppel
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Khanal
- Florida International University, University Park, Florida 33199, USA
| | - P King
- Ohio University, Athens, Ohio 45701, USA
| | - E Kinney
- University of Colorado Boulder, Boulder, Colorado 80309, USA
| | | | - S Li
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - W B Li
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - A H Liyanage
- Hampton University, Hampton, Virginia 23669, USA
| | - D J Mack
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - S P Malace
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - J Matter
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - D Meekins
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - R Michaels
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - H Mkrtchyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - S J Nazeer
- Hampton University, Hampton, Virginia 23669, USA
| | - S Nanda
- Mississippi State University, Mississippi State, Mississippi 39762, USA
| | - G Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - M Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - D Nguyen
- University of Virginia, Charlottesville, Virginia 22903, USA
| | - N Nuruzzaman
- Rutgers University, New Brunswick, New Jersey 08854, USA
| | - B Pandey
- Hampton University, Hampton, Virginia 23669, USA
| | - S Park
- Stony Brook University, Stony Brook, New York 11794, USA
| | - C F Perdrisat
- College of William & Mary, Williamsburg, Virginia 23185, USA
| | - E Pooser
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - M Rehfuss
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - J Reinhold
- Florida International University, University Park, Florida 33199, USA
| | - B Sawatzky
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - G R Smith
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - A Sun
- Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA
| | - H Szumila-Vance
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - V Tadevosyan
- A.I. Alikhanyan National Science Laboratory (Yerevan Physics Institute), 2 Alikhanian Brothers Street, 0036, Yerevan, Armenia
| | - S A Wood
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - J Zhang
- Stony Brook University, Stony Brook, New York 11794, USA
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Affiliation(s)
- Darryl Abrams
- Columbia University College of Physicians and Surgeons, New York, New York.,New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Antonio Pesenti
- University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Laurent Brochard
- University of Toronto, Toronto, Ontario, Canada and.,St. Michael's Hospital, Toronto, Ontario, Canada
| | - Daniel Brodie
- Columbia University College of Physicians and Surgeons, New York, New York.,New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
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Combes A, Peek GJ, Hajage D, Hardy P, Abrams D, Schmidt M, Dechartres A, Elbourne D. ECMO for severe ARDS: systematic review and individual patient data meta-analysis. Intensive Care Med 2020; 46:2048-2057. [PMID: 33021684 PMCID: PMC7537368 DOI: 10.1007/s00134-020-06248-3] [Citation(s) in RCA: 171] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To assess the effect of venovenous extracorporeal membrane oxygenation (ECMO) compared to conventional management in patients with severe acute respiratory distress syndrome (ARDS). METHODS We conducted a systematic review and individual patient data meta-analysis of randomised controlled trials (RCTs) performed after Jan 1, 2000 comparing ECMO to conventional management in patients with severe ARDS. The primary outcome was 90-day mortality. Primary analysis was by intent-to-treat. RESULTS We identified two RCTs (CESAR and EOLIA) and combined data from 429 patients. On day 90, 77 of the 214 (36%) ECMO-group and 103 of the 215 (48%) control group patients had died (relative risk (RR), 0.75, 95% confidence interval (CI) 0.6-0.94; P = 0.013; I2 = 0%). In the per-protocol and as-treated analyses the RRs were 0.75 (95% CI 0.6-0.94) and 0.86 (95% CI 0.68-1.09), respectively. Rescue ECMO was used for 36 (17%) of the 215 control patients (35 in EOLIA and 1 in CESAR). The RR of 90-day treatment failure, defined as death for the ECMO-group and death or crossover to ECMO for the control group was 0.65 (95% CI 0.52-0.8; I2 = 0%). Patients randomised to ECMO had more days alive out of the ICU and without respiratory, cardiovascular, renal and neurological failure. The only significant treatment-covariate interaction in subgroups was lower mortality with ECMO in patients with two or less organs failing at randomization. CONCLUSIONS In this meta-analysis of individual patient data in severe ARDS, 90-day mortality was significantly lowered by ECMO compared with conventional management.
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Affiliation(s)
- Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France. .,Service de médecine Intensive-réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université INSERM, UMRS_1166-ICA, Institute of Cardiometabolism and Nutrition, 47, boulevard de l'Hôpital, N75013, Paris, France.
| | - Giles J Peek
- Congenital Heart Center, Shands Children's Hospital, University of Florida, Gainesville, FL, 32610, USA
| | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, 75013, Paris, France
| | - Pollyanna Hardy
- Birmingham Clinical Trials Unit, University of Birmingham, Edgbaston, B15 2TT, UK
| | - Darryl Abrams
- Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY, USA.,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Matthieu Schmidt
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, 75013, Paris, France.,Service de médecine Intensive-réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université INSERM, UMRS_1166-ICA, Institute of Cardiometabolism and Nutrition, 47, boulevard de l'Hôpital, N75013, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, 75013, Paris, France
| | - Diana Elbourne
- Medical Statistics Department, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Abrams D, Lorusso R, Vincent JL, Brodie D. ECMO during the COVID-19 pandemic: when is it unjustified? Crit Care 2020; 24:507. [PMID: 32807189 PMCID: PMC7429936 DOI: 10.1186/s13054-020-03230-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Darryl Abrams
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, 622 W168th St, PH 8E, Rm 101, New York, NY, 10032, USA.,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Daniel Brodie
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, 622 W168th St, PH 8E, Rm 101, New York, NY, 10032, USA. .,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA.
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Díaz R, Antonini MV, Orrego R, Abrams D. [With regard to COVID-19 contingency. ECMO in adults. Extracorporeal Membrane Oxygenation). To whom, how and when]. Rev Med Chil 2020; 148:349-361. [PMID: 32730380 DOI: 10.4067/s0034-98872020000300349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022]
Abstract
ECMO (Extracorporeal Membrane Oxygenation) is an extracorporeal life support system in catastrophic lung failure, shock and cardiopulmonary resuscitation, in different age groups, with multiple physiologic features. When the candidate to be submitted is too unstable to be transported to a hospital with ECMO, cannulation before transfer allows stabilization and subsequent transport. The aim of this article is to review the current concepts of extracorporeal support, its indications, national and international experience, and its possible role in the SARS-Cov2 pandemic.
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Affiliation(s)
- Rodrigo Díaz
- Unidad de ECMO, Clínica Las Condes, Santiago, Chile
| | | | | | - Darryl Abrams
- Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
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Abstract
Intensive care unit (ICU)-acquired weakness is a common and serious sequela of critical illness. There is a growing body of evidence supporting the use of early mobilization in the ICU to mitigate this adverse effect. Recent data suggest that such a strategy may be feasible in patients with the most severe forms of cardiopulmonary failure—those requiring temporary mechanical circulatory support (TCS) or extracorporeal life support (ECLS). Both the modality of mechanical support and patient-specific characteristics must be taken into consideration when determining the appropriateness of an early mobilization strategy. The purpose of this review is to explore the current understanding of and evidence for mobilization and rehabilitation of patients receiving TCS or ECLS, including the identification of factors that may predict greater success for early mobilization and potential risks and contraindications to active physical therapy. While it is not yet known which of these patients are most likely to benefit from physical rehabilitation, a common theme is the importance of an interprofessional team approach to ensure patient safety and maximize the likelihood of successful mobilization.
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Affiliation(s)
- Michael Salna
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, Aaron JG, Claassen J, Rabbani LE, Hastie J, Hochman BR, Salazar-Schicchi J, Yip NH, Brodie D, O'Donnell MR. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020; 395:1763-1770. [PMID: 32442528 PMCID: PMC7237188 DOI: 10.1016/s0140-6736(20)31189-2] [Citation(s) in RCA: 1496] [Impact Index Per Article: 374.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Over 40 000 patients with COVID-19 have been hospitalised in New York City (NY, USA) as of April 28, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed. METHODS This prospective observational cohort study took place at two NewYork-Presbyterian hospitals affiliated with Columbia University Irving Medical Center in northern Manhattan. We prospectively identified adult patients (aged ≥18 years) admitted to both hospitals from March 2 to April 1, 2020, who were diagnosed with laboratory-confirmed COVID-19 and were critically ill with acute hypoxaemic respiratory failure, and collected clinical, biomarker, and treatment data. The primary outcome was the rate of in-hospital death. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal replacement therapy, and time to in-hospital clinical deterioration following admission. The relation between clinical risk factors, biomarkers, and in-hospital mortality was modelled using Cox proportional hazards regression. Follow-up time was right-censored on April 28, 2020 so that each patient had at least 28 days of observation. FINDINGS Between March 2 and April 1, 2020, 1150 adults were admitted to both hospitals with laboratory-confirmed COVID-19, of which 257 (22%) were critically ill. The median age of patients was 62 years (IQR 51-72), 171 (67%) were men. 212 (82%) patients had at least one chronic illness, the most common of which were hypertension (162 [63%]) and diabetes (92 [36%]). 119 (46%) patients had obesity. As of April 28, 2020, 101 (39%) patients had died and 94 (37%) remained hospitalised. 203 (79%) patients received invasive mechanical ventilation for a median of 18 days (IQR 9-28), 170 (66%) of 257 patients received vasopressors and 79 (31%) received renal replacement therapy. The median time to in-hospital deterioration was 3 days (IQR 1-6). In the multivariable Cox model, older age (adjusted hazard ratio [aHR] 1·31 [1·09-1·57] per 10-year increase), chronic cardiac disease (aHR 1·76 [1·08-2·86]), chronic pulmonary disease (aHR 2·94 [1·48-5·84]), higher concentrations of interleukin-6 (aHR 1·11 [95%CI 1·02-1·20] per decile increase), and higher concentrations of D-dimer (aHR 1·10 [1·01-1·19] per decile increase) were independently associated with in-hospital mortality. INTERPRETATION Critical illness among patients hospitalised with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extrapulmonary organ dysfunction, and substantial in-hospital mortality. FUNDING National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health, and the Columbia University Irving Institute for Clinical and Translational Research.
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Affiliation(s)
- Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Matthew R Baldwin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Samuel D Jacobson
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Benjamin J Meyer
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elizabeth M Balough
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Justin G Aaron
- Division of Infectious Diseases, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jan Claassen
- Department of Medicine; Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - LeRoy E Rabbani
- Division of Cardiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Jonathan Hastie
- Division of Critical Care Medicine, Department of Anesthesiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Beth R Hochman
- Division of Critical Care Medicine, Department of Anesthesiology, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA; Division of General Surgery, Department of Surgery, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - John Salazar-Schicchi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Natalie H Yip
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, NY, USA; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
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Cruz-Torres R, Nguyen D, Hauenstein F, Schmidt A, Li S, Abrams D, Albataineh H, Alsalmi S, Androic D, Aniol K, Armstrong W, Arrington J, Atac H, Averett T, Ayerbe Gayoso C, Bai X, Bane J, Barcus S, Beck A, Bellini V, Benmokhtar F, Bhatt H, Bhetuwal D, Biswas D, Blyth D, Boeglin W, Bulumulla D, Camsonne A, Castellanos J, Chen JP, Cohen EO, Covrig S, Craycraft K, Dongwi B, Duer M, Duran B, Dutta D, Fuchey E, Gal C, Gautam TN, Gilad S, Gnanvo K, Gogami T, Golak J, Gomez J, Gu C, Habarakada A, Hague T, Hansen O, Hattawy M, Hen O, Higinbotham DW, Hughes E, Hyde C, Ibrahim H, Jian S, Joosten S, Kamada H, Karki A, Karki B, Katramatou AT, Keppel C, Khachatryan M, Khachatryan V, Khanal A, King D, King P, Korover I, Kutz T, Lashley-Colthirst N, Laskaris G, Li W, Liu H, Liyanage N, Markowitz P, McClellan RE, Meekins D, Mey-Tal Beck S, Meziani ZE, Michaels R, Mihovilovič M, Nelyubin V, Nuruzzaman N, Nycz M, Obrecht R, Olson M, Ou L, Owen V, Pandey B, Pandey V, Papadopoulou A, Park S, Patsyuk M, Paul S, Petratos GG, Piasetzky E, Pomatsalyuk R, Premathilake S, Puckett AJR, Punjabi V, Ransome R, Rashad MNH, Reimer PE, Riordan S, Roche J, Sargsian M, Santiesteban N, Sawatzky B, Segarra EP, Schmookler B, Shahinyan A, Širca S, Skibiński R, Sparveris N, Su T, Suleiman R, Szumila-Vance H, Tadepalli AS, Tang L, Tireman W, Topolnicki K, Tortorici F, Urciuoli G, Weinstein LB, Witała H, Wojtsekhowski B, Wood S, Ye ZH, Ye ZY, Zhang J. Probing Few-Body Nuclear Dynamics via ^{3}H and ^{3}He (e,e^{'}p)pn Cross-Section Measurements. Phys Rev Lett 2020; 124:212501. [PMID: 32530643 DOI: 10.1103/physrevlett.124.212501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/12/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
We report the first measurement of the (e,e^{'}p) three-body breakup reaction cross sections in helium-3 (^{3}He) and tritium (^{3}H) at large momentum transfer [⟨Q^{2}⟩≈1.9 (GeV/c)^{2}] and x_{B}>1 kinematics, where the cross section should be sensitive to quasielastic (QE) scattering from single nucleons. The data cover missing momenta 40≤p_{miss}≤500 MeV/c that, in the QE limit with no rescattering, equals the initial momentum of the probed nucleon. The measured cross sections are compared with state-of-the-art ab initio calculations. Overall good agreement, within ±20%, is observed between data and calculations for the full p_{miss} range for ^{3}H and for 100≤p_{miss}≤350 MeV/c for ^{3}He. Including the effects of rescattering of the outgoing nucleon improves agreement with the data at p_{miss}>250 MeV/c and suggests contributions from charge-exchange (SCX) rescattering. The isoscalar sum of ^{3}He plus ^{3}H, which is largely insensitive to SCX, is described by calculations to within the accuracy of the data over the entire p_{miss} range. This validates current models of the ground state of the three-nucleon system up to very high initial nucleon momenta of 500 MeV/c.
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Affiliation(s)
- R Cruz-Torres
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - D Nguyen
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
- University of Education, Hue University, Hue City, Vietnam
| | - F Hauenstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - A Schmidt
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Li
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - D Abrams
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - H Albataineh
- Texas A & M University, Kingsville, Texas 78363, USA
| | - S Alsalmi
- King Saud University, Riyadh 11451, Kingdom of Saudi Arabia
| | - D Androic
- University of Zagreb, 10000 Zagreb, Croatia
| | - K Aniol
- California State University, Los Angeles, California 90032, USA
| | - W Armstrong
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - J Arrington
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - H Atac
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - T Averett
- The College of William and Mary, Williamsburg, Virginia 23185, USA
| | - C Ayerbe Gayoso
- The College of William and Mary, Williamsburg, Virginia 23185, USA
| | - X Bai
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - J Bane
- University of Tennessee, Knoxville, Tennessee 37966, USA
| | - S Barcus
- The College of William and Mary, Williamsburg, Virginia 23185, USA
| | - A Beck
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - V Bellini
- INFN Sezione di Catania, 95123 Catania, Italy
| | - F Benmokhtar
- Duquesne University, Pittsburgh, Pennsylvania 15282, USA
| | - H Bhatt
- Mississippi State University, Mississippi 39762, USA
| | - D Bhetuwal
- Mississippi State University, Mississippi 39762, USA
| | - D Biswas
- Hampton University, Hampton, Virginia 23669, USA
| | - D Blyth
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - W Boeglin
- Florida International University, Miami, Florida 33199, USA
| | - D Bulumulla
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - A Camsonne
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - J Castellanos
- Florida International University, Miami, Florida 33199, USA
| | - J-P Chen
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - E O Cohen
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv 69978, Israel
| | - S Covrig
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - K Craycraft
- University of Tennessee, Knoxville, Tennessee 37966, USA
| | - B Dongwi
- Hampton University, Hampton, Virginia 23669, USA
| | - M Duer
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv 69978, Israel
| | - B Duran
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - D Dutta
- Mississippi State University, Mississippi 39762, USA
| | - E Fuchey
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - C Gal
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - T N Gautam
- Hampton University, Hampton, Virginia 23669, USA
| | - S Gilad
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - K Gnanvo
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - T Gogami
- Tohoku University, Sendai, Miyagi 980-8577, Japan
| | - J Golak
- M. Smoluchowski Institute of Physics, Jagiellonian University, PL-30348 Kraków, Poland
| | - J Gomez
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - C Gu
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - A Habarakada
- Hampton University, Hampton, Virginia 23669, USA
| | - T Hague
- Kent State University, Kent, Ohio 44240, USA
| | - O Hansen
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Hattawy
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - O Hen
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | | | - E Hughes
- Columbia University, New York, New York 10027, USA
| | - C Hyde
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - H Ibrahim
- Cairo University, 12613 Cairo, Egypt
| | - S Jian
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - S Joosten
- Temple University, Philadelphia, Pennsylvania 19122, USA
| | - H Kamada
- Department of Physics, Faculty of Engineering, Kyushu Institute of Technology, Kitakyushu 804-8550, Japan
| | - A Karki
- Mississippi State University, Mississippi 39762, USA
| | - B Karki
- Ohio University, Athens, Ohio 45701, USA
| | | | - C Keppel
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Khachatryan
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - V Khachatryan
- Stony Brook, State University of New York, New York 11794, USA
| | - A Khanal
- Florida International University, Miami, Florida 33199, USA
| | - D King
- Syracuse University, Syracuse, New York 13244, USA
| | - P King
- Ohio University, Athens, Ohio 45701, USA
| | - I Korover
- Nuclear Research Center-Negev, Beer-Sheva, Israel
| | - T Kutz
- Stony Brook, State University of New York, New York 11794, USA
| | | | - G Laskaris
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - W Li
- University of Regina, Regina, SK S4S 0A2, Canada
| | - H Liu
- Columbia University, New York, New York 10027, USA
| | - N Liyanage
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - P Markowitz
- Florida International University, Miami, Florida 33199, USA
| | | | - D Meekins
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - S Mey-Tal Beck
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Z-E Meziani
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
- Columbia University, New York, New York 10027, USA
| | - R Michaels
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - M Mihovilovič
- University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics, Jožef Stefan Institute, Ljubljana, Slovenia
- Institut für Kernphysik, Johannes Gutenberg-Universität Mainz, DE-55128 Mainz, Germany
| | - V Nelyubin
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - N Nuruzzaman
- Hampton University, Hampton, Virginia 23669, USA
| | - M Nycz
- Kent State University, Kent, Ohio 44240, USA
| | - R Obrecht
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - M Olson
- Saint Norbert College, De Pere, Wisconsin 54115, USA
| | - L Ou
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - V Owen
- The College of William and Mary, Williamsburg, Virginia 23185, USA
| | - B Pandey
- Hampton University, Hampton, Virginia 23669, USA
| | - V Pandey
- Department of Physics, University of Florida, Gainesville, Florida 32611, USA
| | - A Papadopoulou
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Park
- Stony Brook, State University of New York, New York 11794, USA
| | - M Patsyuk
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Paul
- The College of William and Mary, Williamsburg, Virginia 23185, USA
| | | | - E Piasetzky
- School of Physics and Astronomy, Tel Aviv University, Tel Aviv 69978, Israel
| | - R Pomatsalyuk
- Institute of Physics and Technology, Kharkov 61108, Ukraine
| | - S Premathilake
- University of Virginia, Charlottesville, Virginia 22904, USA
| | - A J R Puckett
- University of Connecticut, Storrs, Connecticut 06269, USA
| | - V Punjabi
- Norfolk State University, Norfolk, Virginia 23504, USA
| | - R Ransome
- Rutgers University, New Brunswick, New Jersey 08901, USA
| | - M N H Rashad
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - P E Reimer
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - S Riordan
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - J Roche
- Ohio University, Athens, Ohio 45701, USA
| | - M Sargsian
- Florida International University, Miami, Florida 33199, USA
| | - N Santiesteban
- University of New Hampshire, Durham, New Hampshire 03824, USA
| | - B Sawatzky
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - E P Segarra
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Schmookler
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - A Shahinyan
- Yerevan Physics Institute, 0036 Yerevan, Armenia
| | - S Širca
- University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics, Jožef Stefan Institute, SI-1000, Ljubljana, Slovenia
| | - R Skibiński
- M. Smoluchowski Institute of Physics, Jagiellonian University, PL-30348 Kraków, Poland
| | - N Sparveris
- Columbia University, New York, New York 10027, USA
| | - T Su
- Kent State University, Kent, Ohio 44240, USA
| | - R Suleiman
- Jefferson Lab, Newport News, Virginia 23606, USA
| | | | - A S Tadepalli
- Rutgers University, New Brunswick, New Jersey 08901, USA
| | - L Tang
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - W Tireman
- Northern Michigan University, Marquette, Michigan 49855, USA
| | - K Topolnicki
- M. Smoluchowski Institute of Physics, Jagiellonian University, PL-30348 Kraków, Poland
| | - F Tortorici
- INFN Sezione di Catania, 95123 Catania, Italy
| | | | - L B Weinstein
- Old Dominion University, Norfolk, Virginia 23529, USA
| | - H Witała
- M. Smoluchowski Institute of Physics, Jagiellonian University, PL-30348 Kraków, Poland
| | | | - S Wood
- Jefferson Lab, Newport News, Virginia 23606, USA
| | - Z H Ye
- Physics Division, Argonne National Laboratory, Lemont, Illinois 60439, USA
| | - Z Y Ye
- University of Illinois-Chicago, Chicago, Illinois 60607, USA
| | - J Zhang
- Stony Brook, State University of New York, New York 11794, USA
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Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, Aaron JG, Claassen J, Rabbani LE, Hastie J, Hochman BR, Salazar-Schicchi J, Yip NH, Brodie D, O'Donnell MR. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. medRxiv 2020:2020.04.15.20067157. [PMID: 32511638 PMCID: PMC7276994 DOI: 10.1101/2020.04.15.20067157] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Nearly 30,000 patients with coronavirus disease-2019 (COVID-19) have been hospitalized in New York City as of April 14th, 2020. Data on the epidemiology, clinical course, and outcomes of critically ill patients with COVID-19 in this setting are needed. METHODS We prospectively collected clinical, biomarker, and treatment data on critically ill adults with laboratory-confirmed-COVID-19 admitted to two hospitals in northern Manhattan between March 2nd and April 1st, 2020. The primary outcome was in-hospital mortality. Secondary outcomes included frequency and duration of invasive mechanical ventilation, frequency of vasopressor use and renal-replacement-therapy, and time to clinical deterioration following hospital admission. The relationship between clinical risk factors, biomarkers, and in-hospital mortality was modeled using Cox-proportional-hazards regression. Each patient had at least 14 days of observation. RESULTS Of 1,150 adults hospitalized with COVID-19 during the study period, 257 (22%) were critically ill. The median age was 62 years (interquartile range [IQR] 51-72); 170 (66%) were male. Two-hundred twelve (82%) had at least one chronic illness, the most common of which were hypertension (63%; 162/257) and diabetes mellitus (36%; 92/257). One-hundred-thirty-eight patients (54%) were obese, and 13 (5%) were healthcare workers. As of April 14th, 2020, in-hospital mortality was 33% (86/257); 47% (122/257) of patients remained hospitalized. Two-hundred-one (79%) patients received invasive mechanical ventilation (median 13 days [IQR 9-17]), and 54% (138/257) and 29% (75/257) required vasopressors and renal-replacement-therapy, respectively. The median time to clinical deterioration following hospital admission was 3 days (IQR 1-6). Older age, hypertension, chronic lung disease, and higher concentrations of interleukin-6 and d-dimer at admission were independently associated with in-hospital mortality. CONCLUSIONS Critical illness among patients hospitalized with COVID-19 in New York City is common and associated with a high frequency of invasive mechanical ventilation, extra-pulmonary organ dysfunction, and substantial in-hospital mortality.
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Rudym D, Melville KE, Cummings MJ, Abrams D. Understanding the Current Role and Future Application of Extracorporeal Life Support in Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2020; 200:1057-1059. [PMID: 31314547 DOI: 10.1164/rccm.201904-0814rr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Darya Rudym
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; and
| | - Kathleen E Melville
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; and
| | - Matthew J Cummings
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; and
| | - Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; and.,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
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Abrams D, Schmidt M, Pham T, Beitler JR, Fan E, Goligher EC, McNamee JJ, Patroniti N, Wilcox ME, Combes A, Ferguson ND, McAuley DF, Pesenti A, Quintel M, Fraser J, Hodgson CL, Hough CL, Mercat A, Mueller T, Pellegrino V, Ranieri VM, Rowan K, Shekar K, Brochard L, Brodie D. Mechanical Ventilation for Acute Respiratory Distress Syndrome during Extracorporeal Life Support. Research and Practice. Am J Respir Crit Care Med 2020; 201:514-525. [DOI: 10.1164/rccm.201907-1283ci] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Darryl Abrams
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, New York
- Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
| | - Matthieu Schmidt
- INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Tài Pham
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | - Jeremy R. Beitler
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, New York
- Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ewan C. Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - James J. McNamee
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdom
| | - Nicolò Patroniti
- Anaesthesia and Intensive Care, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) for Oncology, San Martino Policlinico Hospital, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - M. Elizabeth Wilcox
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Alain Combes
- INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique–Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Niall D. Ferguson
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Danny F. McAuley
- Centre for Experimental Medicine, Queen’s University Belfast, Belfast, United Kingdom
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, United Kingdom
| | - Antonio Pesenti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Critical Care and Emergency Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Michael Quintel
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - John Fraser
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Carol L. Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
- Physiotherapy Department and
| | - Catherine L. Hough
- Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Alain Mercat
- Département de Médecine Intensive-Réanimation et Médecine Hyperbare, Centre Hospitalier Universitaire d’Angers, Université d’Angers, Angers, France
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Vin Pellegrino
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
| | - V. Marco Ranieri
- Alma Mater Studiorum–Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant’Orsola, Università di Bologna, Bologna, Italy; and
| | - Kathy Rowan
- Clinical Trials Unit, Intensive Care National Audit & Research Centre, London, United Kingdom
| | - Kiran Shekar
- Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Daniel Brodie
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, New York
- Center for Acute Respiratory Failure, Columbia University Medical Center, New York, New York
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Rosenzweig EB, Gannon WD, Madahar P, Agerstrand C, Abrams D, Liou P, Brodie D, Bacchetta M. Extracorporeal life support bridge for pulmonary hypertension: A high-volume single-center experience. J Heart Lung Transplant 2019; 38:1275-1285. [DOI: 10.1016/j.healun.2019.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/29/2019] [Accepted: 09/03/2019] [Indexed: 11/15/2022] Open
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Abstract
Extracorporeal life support can support patients with severe forms of cardiac and respiratory failure. Uncertainty remains about its optimal use owing in large part to its resource-intensive nature and the high acuity illness in supported patients. Specific issues include the identification of patients most likely to benefit, the appropriate duration of support when prognosis is uncertain, and what to do when patients become dependent on extracorporeal life support but no longer have hope for recovery or transplantation. Careful deliberation of ethical principles and potential dilemmas should be made when considering the use of extracorporeal life support in advanced cardiopulmonary failure.
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Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, 101, New York, NY 10032, USA.
| | - J Randall Curtis
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA 98104, USA
| | - Kenneth M Prager
- Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 161 Ft. Washington Avenue, Room 307, New York, NY 10032, USA
| | - A Reshad Garan
- Division of Cardiology, Columbia University College of Physicians and Surgeons, 177 Ft. Washington Avenue, 5th Floor, Room 5-435, New York, NY 10032, USA
| | - Jonathan Hastie
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 5-505, New York, NY 10032, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH 8E, 101, New York, NY 10032, USA
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Dzierba AL, Abrams D, Madahar P, Muir J, Agerstrand C, Brodie D. Current practice and perceptions regarding pain, agitation and delirium management in patients receiving venovenous extracorporeal membrane oxygenation. J Crit Care 2019; 53:98-106. [DOI: 10.1016/j.jcrc.2019.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/09/2019] [Accepted: 05/27/2019] [Indexed: 11/15/2022]
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Affiliation(s)
- Darryl Abrams
- 1 Columbia University College of Physicians and Surgeons New York, New York and
| | - Eddy Fan
- 2 University of Toronto Toronto, Canada
| | | | - Daniel Brodie
- 1 Columbia University College of Physicians and Surgeons New York, New York and
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Shekar K, Abrams D, Schmidt M. Awake extracorporeal membrane oxygenation in immunosuppressed patients with severe respiratory failure-a stretch too far? J Thorac Dis 2019; 11:2656-2659. [PMID: 31463086 DOI: 10.21037/jtd.2019.05.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kiran Shekar
- Adult Intensive Care Services and Critical Care Research Group, the Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland and Bond University, Queensland, Australia
| | - Darryl Abrams
- Columbia University College of Physicians & Surgeons/New York-Presbyterian Hospital, New York, NY, USA.,Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY, USA
| | - Matthieu Schmidt
- Sorbonne Université, INSERM UMRS_1166-iCAN, Institute of Cardiometabolism and Nutrition, Paris, France.,Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Medical Intensive Care Unit, Paris, France
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