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Robak O, Kastner MT, Voill-Glaninger A, Viveiros A, Steininger C. The Distinct Regulation of the Vitamin D and Aryl Hydrocarbon Receptors in COVID-19. Nutrients 2024; 16:598. [PMID: 38474725 DOI: 10.3390/nu16050598] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: SARS-CoV-2 affects several immune pathways, including the vitamin D (VDR) and the aryl hydrocarbon receptor pathways (AhR). The aim of the study was the evaluation of the VDR and AhR pathways in the blood of COVID-19 patients with regard to the severity of disease. (2) Methods: Observational, single-center, case-control design. A total of 240 samples were selected for exploration. Patients who tested negative for SARS-CoV-2 but suffered from other respiratory infections (ORIs) served as a control group. (3) Results: VDR-specific mRNA in the blood of patients with mild symptoms (131.2 ± 198.6) was significantly upregulated relative to the VDR expression of the ORI group (23.24 ± 42.60; p < 0.0001); however, VDR expression of critically ill patients showed an impaired upregulation (54.73 ± 68.34; p < 0.001). CYP27B1 expression was not significantly regulated during SARS-CoV-2 infection. There was a downregulation of VDR and CYP27B1 compared to survivors. There was no significant difference in 25(OH)-vitamin D3 levels between critically ill patients with regard to survival (24.3 ± 9.4 vs. 27.1 ± 11.3; p = 0.433). (4) Conclusion: The VDR and AhR pathways are distinctively regulated in patients suffering from COVID-19 depending on the severity of disease. A combination treatment of antiviral drugs and vitamin D substitution should be evaluated for potentially improved prognosis in COVID-19.
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Affiliation(s)
- Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | - Marie-Theres Kastner
- Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
| | | | - André Viveiros
- Department of Laboratory Medicine, Klinik Landstraße, 1030 Vienna, Austria
| | - Christoph Steininger
- Department of Internal Medicine I, Medical University of Vienna, 1090 Vienna, Austria
- Karl-Landsteiner Institute for Microbiome Research, Medical University of Vienna, 1090 Vienna, Austria
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2
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Harrison N, Pajenda S, Szarpak L, Buschsieweke AM, Somri M, Frass M, Panning B, Robak O. Ventilation with the esophageal-tracheal Combitube during general anaesthesia: assessing complications in 540 patients. Ups J Med Sci 2023; 128:9212. [PMID: 37323132 PMCID: PMC10265346 DOI: 10.48101/ujms.v128.9212] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background The esophageal-tracheal Combitube (ETC) was developed for the management of difficult airways but can also be used for general anaesthesia. Methods This clinical study collected data from patients undergoing anaesthesia with the ETC in order to assess the rate of complications. Results Five hundred forty patients were ventilated with the ETC. In 94.8% (512/540), insertion was performed for the first time by the respective physician. The following minor complications were observed: 38.7% sore throat, 30.9% blood on tube as sign of mucosal lesions and 17.0% cyanotic tongue. Experience decreased the risk of mucosal lesions (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.5-3.5). A higher than recommended volume of the oropharyngeal cuff was associated with blood on the ETC (OR: 1.5, 95% CI: 1.0-2.3) and tongue cyanosis (OR: 2.3, 95% CI: 1.4-3.7). Ventilation for more than 2 h was associated with tongue cyanosis (OR: 2.2, 95% CI: 1.6-3.1) and tongue protrusion (OR: 1.4, 95% CI: 1.1-1.9). Conclusion We conclude that the Combitube may be used for short procedures requiring general anaesthesia, but the high rate of minor complications limits its value when other alternatives such as a laryngeal mask airway are available. The tested method appears safe regarding major complications, but minor complications are common. Adherence to recommended cuff volumes, experience with the ETC and limiting its use to surgeries lasting less than 2 h might reduce the rate of complications.
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Affiliation(s)
- Nicole Harrison
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - Sahra Pajenda
- Department of Medicine III, Division of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Poland
| | - Anna-Maria Buschsieweke
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
| | - Mostafa Somri
- Department of Anaesthesiology, Bnai Zion Medical Centre, Haifa, Israel
| | - Michael Frass
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
| | - Bernhard Panning
- Department of Anaesthesiology, Medical University of Hannover, Hannover, Germany
| | - Oliver Robak
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
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Harrison N, Burgmann H, Rabitsch W, Honsig C, Robak O. Influence of Acute and Chronic Graft-Versus-Host Disease on Persistence of Antibodies against Measles, Mumps, Rubella and Varicella in the First Year after Autologous or Allogeneic Hematopoietic Stem Cell Transplantation. Vaccines (Basel) 2023; 11:vaccines11030656. [PMID: 36992240 DOI: 10.3390/vaccines11030656] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Patients after hematopoietic stem cell transplantation (HSCT) are vulnerable to infections due to severe immunosuppression. Live-attenuated vaccines are contraindicated for two years after HSCT. The aim of this study was to assess the persistence of antibodies against measles, mumps, rubella and varicella in the first year after HSCT. Forty patients undergoing autologous (n = 12) or allogeneic (n = 28) HSCT were included in this study. Specific IgG antibodies to measles, mumps, rubella and varicella virus in serum samples were assessed by the LIAISON XL, a fully automated chemiluminescence analyzer, at seven different time points starting one week before HSCT and up to 12 months after HSCT. At baseline, before HSCT, most patients showed antibodies against measles (100%), mumps (80%), rubella (97.5%) and varicella (92.5%). Although titers declined over time, most patients retained antibodies against measles (92.5%), mumps (62.5%), rubella (87.5%) and varicella (85%) up to 12 months after HSCT. There was no significant difference between patients with and without GvHD concerning persistence of antibody titers. Significantly higher varicella titers were detected in autologous patients compared to patients with chronic GvHD. Considering that live-attenuated vaccines should not be administered during the first year after HSCT, the persistence of antibodies against these diseases is relevant.
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Affiliation(s)
- Nicole Harrison
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Werner Rabitsch
- Department of Medicine I, Division of Bone Marrow Transplantation, Medical University of Vienna, 1090 Vienna, Austria
| | - Claudia Honsig
- Department of Laboratory Medicine, Division of Clinical Virology, Medical University of Vienna, 1090 Vienna, Austria
| | - Oliver Robak
- Intensive Care Unit, Department of Medicine I, Medical University of Vienna, 1090 Vienna, Austria
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4
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Kornfehl A, Brock R, Staudinger T, Schellongowski P, Nagler B, Hermann A, Robak O, Schwameis M, Quehenberger P, Buchtele N. Prevalence and Impact of Lupus Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation. Clin Appl Thromb Hemost 2023; 29:10760296231207062. [PMID: 37853541 PMCID: PMC10588400 DOI: 10.1177/10760296231207062] [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: 04/11/2023] [Revised: 09/05/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Monitoring of blood coagulation is essential in ECMO patients. We investigated the prevalence of lupus anticoagulant (LA) and its association with coagulation testing and hemostaseologic complications in patients treated with ECMO. METHODS This is a retrospective analysis including adult patients who received ECMO at a medical intensive care unit at the Medical University of Vienna. The primary outcome was the prevalence of LA. Secondary outcomes included conditions associated with LA positivity, rates of bleeding and thromboembolic events, as well as the proportions of aPTT and antiXa measurements within the target range. RESULTS Between 2013 and 2021 193 patients received ECMO, in 62 (32%) of whom LA diagnostics were performed. Twenty-two (35%) patients tested positive. LA positive patients had more frequently received VV ECMO (77.3% vs 34.3%; p = 0.002), were more frequently diagnosed with viral respiratory infections (SARS-CoV2: 45.5% vs 20%; p = 0.041, influenza virus: 22.7% vs 0%; p = 0.003), had a longer ECMO treatment duration (25 vs 10 days; p = 0.011) and a longer ICU stay (48 vs 25 days; p = 0.022), but similar rates of bleeding and thromboembolic events.
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Affiliation(s)
- Andrea Kornfehl
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
| | - Roman Brock
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
| | - Bernhard Nagler
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
| | - Alexander Hermann
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Quehenberger
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- Department of Medicine I, Intensive Care Unit 13i2; Medical University of Vienna, Vienna, Austria
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5
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Weiss-Tessbach M, Ratzinger F, Obermueller M, Burgmann H, Staudinger T, Robak O, Schmid M, Roessler B, Jilma B, Kussmann M, Traby L. Biomarkers for differentiation of coronavirus disease 2019 or extracorporeal membrane oxygenation related inflammation and bacterial/fungal infections in critically ill patients: A prospective observational study. Front Med (Lausanne) 2022; 9:917606. [PMID: 36275812 PMCID: PMC9582266 DOI: 10.3389/fmed.2022.917606] [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: 04/11/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
Abstract
Secondary infections in coronavirus disease 2019 (COVID-19) patients are difficult to distinguish from inflammation associated with COVID-19 and/or extracorporeal membrane oxygenation (ECMO). Therefore, highly specific and sensitive biomarkers are needed to identify patients in whom antimicrobial therapy can be safely withheld. In this prospective monocentric study, 66 COVID-19 patients admitted to the intensive care unit (ICU) for ECMO evaluation were included. A total of 46 (70%) patients with secondary infections were identified by using broad microbiological and virological panels and standardized diagnostic criteria. Various laboratory parameters including C-reactive protein (CRP), interleukin (IL)-6, procalcitonin (PCT), and IL-10 were determined at time of study inclusion. The best test performance for differentiating bacterial/fungal secondary infections and COVID-19 and/or ECMO associated inflammation was achieved by IL-10 (ROC-AUC 0.84) and a multivariant step-wise regression model including CRP, IL-6, PCT, and IL-10 (ROC-AUC 0.93). Data obtained in the present study highlights the use of IL-10 to differentiate secondary bacterial/fungal infections from COVID-19 and/or ECMO associated inflammation in severely ill COVID-19 patients.
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Affiliation(s)
- Matthias Weiss-Tessbach
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria,Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Franz Ratzinger
- Ihr Labor, Medical Diagnostics Laboratories, Vienna, Austria
| | - Markus Obermueller
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Monika Schmid
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Bernhard Roessler
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical Simulation and Emergency Management Research Group, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Manuel Kussmann
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria,*Correspondence: Manuel Kussmann,
| | - Ludwig Traby
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria,Ludwig Traby,
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Buchtele N, Schörgenhofer C, Schwameis M, Jilma B, Schellongowski P, Herkner H, Riss K, Schmid M, Hermann A, Robak O, Nagler B, Traby L, Bojic A, Staudinger T. Add-on Prostaglandin E1 in Venovenous Extracorporeal Membrane Oxygenation: A Randomized, Double-blind, Placebo-controlled Pilot Trial. Am J Respir Crit Care Med 2022; 206:170-177. [DOI: 10.1164/rccm.202110-2359oc] [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: 11/16/2022] Open
Affiliation(s)
- Nina Buchtele
- Medical University of Vienna, Department of Medicine I, Vienna, Austria
| | | | - Michael Schwameis
- Medical University of Vienna, Department of Emergency Medicine, Vienna, Austria
| | - Bernd Jilma
- Clinical Pharmacology, AKH Wien, vienna, Austria
| | | | | | | | - Monika Schmid
- Medical University of Vienna, 27271, Department of Medicine III, Wien, Austria
| | | | - Oliver Robak
- Medical University of Vienna, 1Department of Internal Medicine I, Vienna, Austria
| | - Bernhard Nagler
- Medical University of Vienna, Department of Medicine I, Vienna, Austria
| | - Ludwig Traby
- Medical University of Vienna, Department of Medicine I, Vienna, Austria
| | - Andja Bojic
- Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Medical University of Vienna, Dept. of Internal Medicine I, Vienna, Austria
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7
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Hermann M, Laxar D, Krall C, Hafner C, Herzog O, Kimberger O, Koenig S, Kraft F, Maleczek M, Markstaller K, Robak O, Rössler B, Schaden E, Schellongowski P, Schneeweiss-Gleixner M, Staudinger T, Ullrich R, Wiegele M, Willschke H, Zauner C, Hermann A. Duration of invasive mechanical ventilation prior to extracorporeal membrane oxygenation is not associated with survival in acute respiratory distress syndrome caused by coronavirus disease 2019. Ann Intensive Care 2022; 12:6. [PMID: 35024972 PMCID: PMC8755897 DOI: 10.1186/s13613-022-00980-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/02/2022] [Indexed: 01/16/2023] Open
Abstract
Background Duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults treated with ECMO due to severe COVID-19-related ARDS between 01/2020 and 05/2021. The primary objective was to determine whether duration of IMV prior to ECMO cannulation influenced ICU mortality. Results During the study period, 101 patients (mean age 56 [SD ± 10] years; 70 [69%] men; median RESP score 2 [IQR 1–4]) were treated with ECMO for COVID-19. Sixty patients (59%) survived to ICU discharge. Median ICU length of stay was 31 [IQR 20.7–51] days, median ECMO duration was 16.4 [IQR 8.7–27.7] days, and median time from intubation to ECMO start was 7.7 [IQR 3.6–12.5] days. Fifty-three (52%) patients had a pre-ECMO IMV duration of > 7 days. Pre-ECMO IMV duration had no effect on survival (p = 0.95). No significant difference in survival was found when patients with a pre-ECMO IMV duration of < 7 days (< 10 days) were compared to ≥ 7 days (≥ 10 days) (p = 0.59 and p = 1.0). Conclusions The role of prolonged pre-ECMO IMV duration as a contraindication for ECMO in patients with COVID-19-related ARDS should be scrutinised. Evaluation for ECMO should be assessed on an individual and patient-centred basis. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00980-3.
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8
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Kovarik JJ, Kämpf AK, Gasser F, Herdina AN, Breuer M, Kaltenecker CC, Wahrmann M, Haindl S, Mayer F, Traby L, Touzeau-Roemer V, Grabmeier-Pfistershammer K, Kussmann M, Robak O, Willschke H, Ay C, Säemann MD, Schmetterer KG, Strassl R. Identification of Immune Activation Markers in the Early Onset of COVID-19 Infection. Front Cell Infect Microbiol 2021; 11:651484. [PMID: 34540715 PMCID: PMC8446609 DOI: 10.3389/fcimb.2021.651484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/09/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
This study aimed to determine the specific cytokine profile in peripheral blood during the early onset of COVID-19 infection. This was a cross-sectional exploratory, single center study. A total of 55 plasma samples were studied. Serum samples of adults showing symptoms of COVID-19 infection who were tested positive for SARS-CoV-2 infection (CoV+, n=18) at the COVID-19 outpatient clinic of the Medical University of Vienna were screened for immune activation markers by Luminex technology. Additionally, age and gender-matched serum samples of patients displaying COVID-19 associated symptoms, but tested negative for SARS-CoV-2 (CoV-, n=16) as well as healthy controls (HC, n=21) were analyzed. COVID-19 positive (CoV+) patients showed a specific upregulation of BLC (141; 74-189 pg/mL), SCD30 (273; 207-576 pg/mL), MCP-2 (18; 12-30 pg/mL) and IP-10 (37; 23-96 pg/mL), compared to patients with COVID19-like symptoms but negative PCR test (CoV-), BLC (61; 22-100 pg/mL), sCD30L (161; 120-210 pg/mL), MCP-2 (8; 5-12 pg/mL) and IP-10 (9; 6-12 pg/mL) and healthy controls (HC) (BLC 22; 11-36 pg/mL, sCD30 74; 39-108 pg/mL, MCP-2 6; 3-9. pg/mL, IP-10 = 8; 5-13). The markers APRIL, sIL-2R, IL7, MIF, MIP-1b, SCF, SDF-1a, sTNF-RII were elevated in both CoV+ and CoV- patient groups compared to healthy controls. HGF, MDC and VEGF-A were elevated in CoV- but not CoV+ compared to healthy controls. BLC, sCD30, MCP-2 and IP-10 are specifically induced during early stages of COVID-19 infection and might constitute attractive targets for early diagnosis and treatment of this disease.
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Affiliation(s)
- Johannes J Kovarik
- Department of Internal Medicine III, Division of Nephrology and Dialysis Medical University Vienna, Vienna, Austria
| | - Anna K Kämpf
- Department of Internal Medicine III, Division of Nephrology and Dialysis Medical University Vienna, Vienna, Austria
| | - Fabian Gasser
- Department of Internal Medicine III, Division of Nephrology and Dialysis Medical University Vienna, Vienna, Austria
| | - Anna N Herdina
- Department of Laboratory Medicine, Institute of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | - Monika Breuer
- Department of Laboratory Medicine, Institute of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | | | - Markus Wahrmann
- Department of Internal Medicine III, Division of Nephrology and Dialysis Medical University Vienna, Vienna, Austria
| | - Susanne Haindl
- Department of Internal Medicine III, Division of Nephrology and Dialysis Medical University Vienna, Vienna, Austria
| | - Florian Mayer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Ludwig Traby
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Katharina Grabmeier-Pfistershammer
- Department of Dermatology, Medical University Vienna, Vienna, Austria.,Institute of Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria
| | - Manuel Kussmann
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Harald Willschke
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Care Ay
- Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Marcus D Säemann
- 6th Medical Department With Nephrology and Dialysis, Wilhelminen Hospital, Vienna, Austria.,Sigmund Freud University, Vienna, Austria
| | - Klaus G Schmetterer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Institute of Clinical Virology, Medical University of Vienna, Vienna, Austria
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9
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Nagler B, Hermann A, Robak O, Schellongowski P, Buchtele N, Bojic A, Schmid M, Zauner C, Winter MP, Heinz G, Ullrich R, Kraft F, Wiedemann D, Bernardi MH, Staudinger T, Lamm W. Incidence and Etiology of System Exchanges in Patients Receiving Extracorporeal Membrane Oxygenation. ASAIO J 2021; 67:776-784. [PMID: 34170882 DOI: 10.1097/mat.0000000000001332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/23/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) has established as a cornerstone therapy in severe acute respiratory distress syndrome and refractory hemodynamic failure. As circuit integrity is crucial for adequate organ support, component failure may necessitate a system exchange. In this retrospective study, incidence and etiology of system exchanges during applications of venovenous, venoarterial ECMO, and extracorporeal CO2 removal were examined. Sixty-three (44.4%) of 142 patients were affected by one or more exchanges, totaling 105 replaced circuits. The predominant exchange reason was clotting (n = 20), followed by hemolysis (n = 19), systemic coagulation disorders (n = 13), reconfiguration (n = 13), impaired gas exchange (n = 10), mechanical complications (n = 8), bleeding (n = 6), failed weaning (n = 5), prophylactic exchange (n = 3), and undocumented/other (n = 8). Nineteen (18.1%) events were classified as acute and 70 (66.7%) events as elective exchanges. Patients with circuit exchanges more frequently underwent renal replacement therapy at ECMO initiation (49.2% vs. 29.1%; p = 0.023), had a longer ECMO treatment duration (18 vs. 7.5 days, p < 0.001), and lower hospital survival (29.5% vs. 57.1%; p = 0.002). Considering the high occurrence of coagulation complications, further optimization of coagulation management is deemed necessary.
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Affiliation(s)
- Bernhard Nagler
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Alexander Hermann
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Andja Bojic
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Monika Schmid
- Department of Medicine III, Intensive Care Unit 13h1, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Department of Medicine III, Intensive Care Unit 13h1, Medical University of Vienna, Vienna, Austria
| | - Max Paul Winter
- Department of Medicine II, Intensive Care Unit 13h3, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- Department of Medicine II, Intensive Care Unit 13h3, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Felix Kraft
- Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin H Bernardi
- Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Lamm
- From the Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
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10
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Bojic A, Schellongowski P, Robak O, Hermann A, Buchtele N, Nagler B, Lamm W, Staudinger T. Long-term Respiratory Extracorporeal Membrane Oxygenation and Prognosis: A Retrospective Analysis. ASAIO J 2021; 67:345-352. [PMID: 33627611 DOI: 10.1097/mat.0000000000001225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 01/10/2023] Open
Abstract
The duration of extracorporeal membrane oxygenation (ECMO) treatments increases, however, data presented from prolonged support is limited. We retrospectively analyzed all patients during a 4-year period undergoing respiratory ECMO for duration of therapy, demographics, therapy-associated parameters, and outcome according to ECMO duration (<28 days and ≥28 days = long-term ECMO). Out of 55 patients undergoing ECMO for ARDS or during bridging to lung transplantation, 18 were on ECMO for ≥28 days (33%). In the long-term group, median ECMO run time was 40 days (interquartile range 34-54 days). Hospital survival was not significantly different between the groups (54% in short-term and 50% in long-term ECMO patients). There was a significantly higher proportion of patients suffering from malignancy in the group of long-term nonsurvivors. Recovery occurred after more than 40 days on ECMO in 3 patients. The longest ECMO run time in a hospital survivor was 65 days. Duration of ECMO support alone was no prognostic factor and should not represent a basis for decision-making. In patients suffering from malignancy, long-term ECMO support seems to be a factor of adverse prognosis, if not futile.
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Affiliation(s)
- Andja Bojic
- From the Department of Medicine I, Intensive Care Unit 13.i2, Medical University of Vienna, Vienna General Hospital, Waehringer Guertel, Vienna, Austria
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11
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Robak O, Dudek M, Ladny JR, Szarpak L, Gilis-Malinowska N, Frass M. Cardiac tamponade as a cause of COVID-19. Cardiol J 2021; 27:900-901. [PMID: 33432570 DOI: 10.5603/cj.2020.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Maciej Dudek
- Polish Society of Disaster Medicine, Warsaw, Poland
| | - Jerzy R Ladny
- Polish Society of Disaster Medicine, Warsaw, Poland.,Chair of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Lukasz Szarpak
- Polish Society of Disaster Medicine, Warsaw, Poland. .,Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland. .,Maria Sklodowska-Curie Bialystok Oncology Centre, Bialystok, Poland.
| | | | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
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12
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Lang C, Jaksch P, Hoda MA, Lang G, Staudinger T, Tschernko E, Zapletal B, Geleff S, Prosch H, Gawish R, Knapp S, Robak O, Thalhammer F, Indra A, Koestenberger M, Strassl R, Klikovits T, Ali K, Fischer G, Klepetko W, Hoetzenecker K, Schellongowski P. Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient. Lancet Respir Med 2020; 8:1057-1060. [PMID: 32857987 PMCID: PMC7447215 DOI: 10.1016/s2213-2600(20)30361-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/18/2020] [Accepted: 07/30/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Christian Lang
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Jaksch
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Mir Alireza Hoda
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - György Lang
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Bernhard Zapletal
- Division of Cardiac, Thoracic and Vascular Anesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Silvana Geleff
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Riem Gawish
- Research Laboratory of Infection Biology, Department of Medicine, Medical University of Vienna, Vienna, Austria; CeMM, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Sylvia Knapp
- Research Laboratory of Infection Biology, Department of Medicine, Medical University of Vienna, Vienna, Austria; CeMM, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Oliver Robak
- Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Florian Thalhammer
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Alexander Indra
- Institute for Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Markus Koestenberger
- Department of Anaesthesiology and Intensive Care, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Robert Strassl
- Division of Clinical Virology, Department of Virology, Medical University of Vienna, Vienna, Austria
| | - Thomas Klikovits
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Kamran Ali
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Gottfried Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
| | - Peter Schellongowski
- Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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13
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Hermann A, Winkler A, Paschen C, Kuzmina Z, Hladik A, Icme S, Robak O. Erratum to "Lipocalin-2 levels in acute and chronic graft-versus-host disease following allogeneic hematopoietic stem cell transplantation"[Experimental Hematology 74 (2019) 25-32]. Exp Hematol 2020; 85:70. [PMID: 32325014 DOI: 10.1016/j.exphem.2020.04.003] [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: 11/27/2022]
Affiliation(s)
- Alexander Hermann
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Andreas Winkler
- Department of Cardiac Surgery, Vascular Surgery, and Endovascular Surgery, Medical University of Salzburg, Salzburg, Austria
| | | | - Zoya Kuzmina
- Department of Haematology and Oncology, Wilhelminenspital, Vienna, Austria
| | - Anastasiya Hladik
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Suphan Icme
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
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14
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Ruetzler K, Smereka J, Abelairas-Gomez C, Frass M, Dabrowski M, Bialka S, Misiolek H, Plusa T, Robak O, Aniolek O, Ladny JR, Gorczyca D, Ahuja S, Szarpak L. Comparison of the new flexible tip bougie catheter and standard bougie stylet for tracheal intubation by anesthesiologists in different difficult airway scenarios: a randomized crossover trial. BMC Anesthesiol 2020; 20:90. [PMID: 32312225 PMCID: PMC7171857 DOI: 10.1186/s12871-020-01009-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/05/2019] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Incidence of difficult endotracheal intubation ranges between 3 and 10%. Bougies have been recommended as an airway adjunct for difficult intubation, but reported success rates are variable. A new generation flexible tip bougie appears promising but was not investigated so far. We therefore compared the new flexible tip with a standard bougie in simulated normal and difficult airway scenarios, and used by experienced anesthesiologists. Methods We conducted a observational, randomized, cross-over simulation study. Following standardized training, experienced anesthesiologists performed endotracheal intubation using a Macintosh blade and one of the bougies in six different airway scenarios in a randomized sequence: normal airway, tongue edema, pharyngeal obstruction, manual cervical inline stabilization, cervical collar stabilization, cervical collar stabilization and pharyngeal obstruction. Overall success rate with a maximum of 3 intubation attempts was the primary endpoint. Secondary endpoints included number of intubation attempts, time to intubation and dental compression. Results Thirty-two anesthesiologist participated in this study between January 2019 and May 2019. Overall success rate was similar for the flexible tip bougie and the standard bougie. The flexible tip bougie tended to need less intubation attempts in more difficult airway scenarios. Time to intubation was less if using the flexible tip bougie compared to the standard bougie. Reduced severity of dental compression was noted for the flexible tip bougie in difficult airway scenarios except cervical collar stabilization. Conclusion In this simulation study of normal and difficult airways scenarios, overall success rate was similar for the flexible tip and standard bougie. Especially in more difficult airway scenarios, less intubation attempts, and less optimization maneuvers were needed if using the flexible tip bougie. Trial registration clinicaltrials.gov Identifier: NCT03733158. 7th November 2018.
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Affiliation(s)
- Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesia, Cleveland Clinic, Anesthesiology Institute, Cleveland, OH, USA
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Cristian Abelairas-Gomez
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.,Faculty of Education, University Santiago de Compostela, Santiago de Compostela, Spain.,Institute of Research of Santiago (IDIS) and SAMID-II Network, Santiago de Compostela, Spain
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marek Dabrowski
- Chair and Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland
| | - Szymon Bialka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Hanna Misiolek
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Tadeusz Plusa
- Medical Faculty, Lazarski University, Warsaw, Poland
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Olga Aniolek
- Polish Society of Disaster Medicine, Swieradowska 43 Str, 02-662, Warsaw, Poland
| | - Jerzy Robert Ladny
- Department of Emergency Medicine, Medical University Bialystok, Bialystok, Poland
| | - Damian Gorczyca
- Polish Society of Disaster Medicine, Swieradowska 43 Str, 02-662, Warsaw, Poland
| | - Sanchit Ahuja
- Department of Anesthesia, Henry Ford Health System, Detroit, MI, USA
| | - Lukasz Szarpak
- Polish Society of Disaster Medicine, Swieradowska 43 Str, 02-662, Warsaw, Poland.
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15
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Hermann A, Schellongowski P, Bojic A, Robak O, Buchtele N, Staudinger T. ECMO without anticoagulation in patients with disease-related severe thrombocytopenia: Feasible but futile? Artif Organs 2019; 43:1077-1084. [PMID: 31188474 DOI: 10.1111/aor.13514] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 03/29/2019] [Revised: 05/11/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
Abstract
Severe thrombocytopenia poses a high risk for bleeding thus representing a relative contraindication for anticoagulation and therefore extracorporeal membrane oxygenation (ECMO). We herein report on a series of immunocompromised patients with severe thrombocytopenia undergoing long-term ECMO without systemic anticoagulation. We retrospectively identified seven adult patients with anticoagulation withdrawal for ≥3 days (range 5-317) during venovenous ECMO therapy due to thrombocytopenia < 50 G/L treated in a university-affiliated hospital from January 2013 to April 2017. All ECMO systems used were heparin coated. Overall, 530 ECMO days were observed, 404 (76%) of them without systemic anticoagulation. Platelet count during ECMO treatment was 24 G/L (median, range 1-138), ECMO duration was 35 days (5-317), and ECMO was run without any anticoagulation for 20 days (5-317). Altogether, five clotting events were seen leading to oxygenator exchanges. Bleeding was common including one fatal intracerebral hemorrhage. Altogether, 29 platelet concentrates per patient (7-207) were administered, which correspond to 0.8 per day (0.6-1.3). One patient survived ICU and hospital. In patients with thrombocytopenia, ECMO can be run without anticoagulation even for considerably long periods of time. Bleeding remains common, while clotting events seem to be rare. However, prognosis of this patient population undergoing ECMO support seems grim.
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Affiliation(s)
- Alexander Hermann
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Andja Bojic
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Nina Buchtele
- Department of Clinical Pharmacology, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Thomas Staudinger
- Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
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16
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Smereka J, Szarpak L, Czekajlo M, Abelson A, Zwolinski P, Plusa T, Dunder D, Dabrowski M, Wiesniewska Z, Robak O, Frass M, Sivrikaya G. U, Ruetzler K. The TrueCPR device in the process of teaching cardiopulmonary resuscitation: A randomized simulation trial. Medicine (Baltimore) 2019; 98:e15995. [PMID: 31277091 PMCID: PMC6635263 DOI: 10.1097/md.0000000000015995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND International resuscitation guidelines emphasize the importance of high quality chest compressions, including correct chest compression depth and rate and complete chest recoil. The aim of the study was to assess the role of the TrueCPR device in the process of teaching cardiopulmonary resuscitation in nursing students. METHODS A prospective randomized experimental study was performed among 94 first year students of nursing. On the next day, the participants were divided into 2 groups-the control group practiced chest compressions without the use of any device for half an hour, and the experimental group practiced with the use of TrueCPR. Further measurement of chest compressions was performed after a month. RESULTS The chest compression rate achieved the value of 113 versus 126 (P < .001), adequate chest compression rate (%) was 86 versus 68 (P < .001), full chest release (%) 92 versus 69 (P = .001), and correct hand placement (%) 99 versus 99 (P, not significant) in TrueCPR and standard BLS groups, respectively. As for the assessment of the confidence of chest compression quality, 1 month after the training, the evaluation in the experimental group was statistically significantly higher (91 vs 71; P < .001) than in the control group. CONCLUSIONS Cardiopulmonary resuscitation training with the use of the TrueCPR device is associated with better resuscitation skills 1 month after the training. The participants using TrueCPR during the training achieved a better chest compression rate and depth with in international recommendations and better full chest release percentage and self-assessed confidence of chest compression quality comparing with standard cardiopulmonary resuscitation training.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw
| | - Lukasz Szarpak
- Lazarski University, Warsaw
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, Virginia
| | - Michael Czekajlo
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, Virginia
| | - Anna Abelson
- Department of Health Science, Karlstad University, Karlstad, Sweden
| | | | | | | | - Marek Dabrowski
- Department of Rescue and Disaster Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulufer Sivrikaya G.
- Academy of Interventional Medicine, Education and Simulation (RMK AIMES), Istanbul, Turkey
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
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17
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Hermann A, Winkler A, Paschen C, Kuzmina Z, Hladik A, Icme S, Robak O. Lipocalin-2 levels in acute and chronic graft-versus-host disease following allogeneic hematopoietic stem cell transplantation. Exp Hematol 2019; 74:25-32.e1. [PMID: 31078634 DOI: 10.1016/j.exphem.2019.05.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/01/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
Lipocalin-2 (LCN2) is an immunomodulatory protein holding major metabolic and immune functions. It is involved in several inflammatory processes and induced by cytokines of the interleukin-1 family known as contributors to the morbidity in graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation (HSCT). The possible role of LCN2 in predicting outcome and course of illness has never been elucidated in patients undergoing HSCT for hematologic malignancies. We conducted a prospective cohort study including 40 patients following autologous or allogeneic HSCT by collecting plasma samples at seven time points with respect to GVHD, relapse, and outcome. LCN2 levels were significantly increased in acute patients with GVHD compared with autologous and healthy controls (125.7 ng/mL vs. 65.9 and 71.4 ng/mL) and correlated with its severity. Similarly, LCN2 levels were significantly elevated in chronic GHVD compared with autologous and healthy controls (295.0 ng/mL vs. 54.9 and 76.5 ng/mL). Moreover, LCN2 correlated with mortality. The suspected role of LCN2 as a predictive parameter for outcome and prognosis needs to be further investigated.
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Affiliation(s)
- Alexander Hermann
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Andreas Winkler
- Department of Cardiac Surgery, Vascular Surgery, and Endovascular Surgery, Medical University of Salzburg, Salzburg, Austria
| | | | - Zoya Kuzmina
- Department of Haematology and Oncology, Wilhelminenspital, Vienna, Austria
| | - Anastasiya Hladik
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Süphan Icme
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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18
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Lamm W, Nagler B, Hermann A, Robak O, Schellongowski P, Buchtele N, Bojic A, Schmid M, Zauner C, Heinz G, Ullrich R, Staudinger T. Propofol-based sedation does not negatively influence oxygenator running time compared to midazolam in patients with extracorporeal membrane oxygenation. Int J Artif Organs 2019; 42:233-240. [PMID: 30819020 DOI: 10.1177/0391398819833376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/17/2022]
Abstract
OBJECTIVE Patients on extracorporeal membrane oxygenation are frequently in need for sedation. Use of propofol has been associated with impaired oxygenator function due to adsorption to the membrane as well as lipid load. The aim of our retrospective analysis was to compare two different sedation regimens containing either propofol or midazolam with respect to oxygenator running time. METHODS Midazolam was used in 73 patients whereas propofol was used in 49 patients, respectively. In the propofol group, veno-arterial-extracorporeal membrane oxygenation was used predominantly (84%), while veno-venous-extracorporeal membrane oxygenation was used more often in the midazolam group (64%). RESULTS Oxygenator running time until first exchange was 7 days in both groups ( p = 0.759). No statistically significant differences could be observed between the subgroup of patients receiving lipid-free (n = 24) and lipid-containing (n = 31) parenteral nutrition, respectively. Laboratory parameters like triglycerides, free hemoglobin, fibrinogen, platelets, and activated partial thromboplastin time were not significantly different between both sedation regimens ( p = 0.462, p = 0.489, p = 0.960, p = 0.134, and p = 0.843) and were not associated with oxygenator running time. CONCLUSION The use of propofol as sedative seems suitable in patients undergoing extracorporeal membrane oxygenation therapy.
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Affiliation(s)
- Wolfgang Lamm
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Bernhard Nagler
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Alexander Hermann
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Andja Bojic
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Monika Schmid
- 2 Department of Medicine III, Intensive Care Unit 13h1, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- 2 Department of Medicine III, Intensive Care Unit 13h1, Medical University of Vienna, Vienna, Austria
| | - Gottfried Heinz
- 3 Department of Medicine II, Intensive Care Unit 13h3, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- 4 Department of Anaesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- 1 Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
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Smereka J, Iskrzycki Ł, Makomaska-Szaroszyk E, Bielski K, Frass M, Robak O, Ruetzler K, Czekajło M, Rodríguez-Núnez A, López-Herce J, Szarpak Ł. The effect of chest compression frequency on the quality of resuscitation by lifeguards. A prospective randomized crossover multicenter simulation trial. Cardiol J 2018; 26:769-776. [PMID: 30338845 DOI: 10.5603/cj.a2018.0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/12/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The ability to perform high-quality cardiopulmonary resuscitation is one of the basic skills for lifeguards. The aim of the study was to assess the influence of chest compression frequency on the quality of the parameters of chest compressions performed by lifeguards. METHODS This prospective observational, randomized, crossover simulation study was performed with 40 lifeguards working in Warsaw, Wroclaw, and Poznan, Poland. The subjects then participated in a target study, in which they were asked to perform 2-min cycles of metronome-guided chest compressions at different rates: 80, 90, 100, 110, 120, 130, 140, and 150 compressions per minute (CPM). RESULTS The study involved 40 lifeguards. Optimal chest compression score calculated by manikin software was achieved for 110-120 CPM. Chest compression depth achieved 53 (interquartile range [IQR] 52-54) mm, 56 (IQR 54-57) mm, 52.5 (IQR 50-54) mm, 53 (IQR 52-53) mm, 50 (IQR 49-51) mm, 47 (IQR 44-51) mm, 41 (IQR 40-42) mm, 38 (IQR 38-43) mm for 80, 90, 100, 110, 120, 130, 140 and 150 CPM, respectively. The percentage of chest compressions with the correct depth was lower for rates exceeding 120 CPM. CONCLUSIONS The rate of 100-120 CPM, as recommended by international guidelines, is the optimal chest compression rate for cardiopulmonary resuscitation performed by lifeguards. A rate above 120 CPM was associated with a dramatic decrease in chest compression depth and overall chest compression quality. The role of full chest recoil should be emphasized in basic life support training.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland., Wroclaw, Poland
| | - Łukasz Iskrzycki
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland., Wroclaw, Poland
| | | | | | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesia, Cleveland Clinic, Cleveland, OH, USA., Cleveland, United States
| | - Michael Czekajło
- Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, VA, USA, Richmond, United States
| | - Antonio Rodríguez-Núnez
- Paediatric Emergency and Critical Care Division, Paediatric Area Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain., Santiago de Compostela, Spain
| | - Jesús López-Herce
- Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marannón, Medical School, Complutense University of Madrid, Madrid, Spain., Madrid, Spain
| | - Łukasz Szarpak
- Lazarski University, Warsaw, Poland. .,Hounter Holmes McGuire Center for Simulation and Healthcare, Virginia Commonwealth University, Richmond, VA, USA, Richmond, United States.
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20
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Bielski A, Rivas E, Ruetzler K, Smereka J, Puslecki M, Dabrowski M, Ladny JR, Frass M, Robak O, Evrin T, Szarpak L. Comparison of blind intubation via supraglottic airway devices versus standard intubation during different airway emergency scenarios in inexperienced hand: Randomized, crossover manikin trial. Medicine (Baltimore) 2018; 97:e12593. [PMID: 30290627 PMCID: PMC6200544 DOI: 10.1097/md.0000000000012593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Securing the airway and enabling adequate oxygenation and ventilation is essential during cardiopulmonary resuscitation (CPR). The aim of the study was to evaluate the success rate of blind intubation via the I-Gel and the Air-Q compared with direct laryngoscopy guided endotracheal intubation by inexperienced physician and to measure time to successful intubation. METHODS The study was designed as a randomized, cross-over simulation study. A total of 134 physicians, from specialties other than Anesthesia or Emergency Medicine, who considered themselves skilled in endotracheal intubation but who have never used any kind of supraglottic airway device performed blind intubation via the I-Gel and Air-Q and direct laryngoscopy guided endotracheal intubation in 3 randomized scenarios: normal airway without chest compression during intubation attempt; normal airway with continuous chest compression during intubation attempt; difficult airway with continuous chest compression. RESULTS Scenario A: Success rate with initial intubation attempt was 72% for endotracheal intubation, 75% in Air-Q, and 81% in I-Gel. Time to endotracheal intubation and ease of intubation was comparable with all 3 airway devices used. Scenario B: Success rate with the initial intubation attempt was 42% for endotracheal intubation, compared with 75% in Air-Q and 80% in I-Gel. Time for endotracheal intubation was significantly prolonged in endotracheal intubation (42 seconds, 35-49), compared with Air-Q (21 seconds, 18-32) and I-Gel (19 seconds, 17-27). Scenario C: The success rate with the initial intubation attempt was 23% in endotracheal intubation, compared with 65% in Air-Q and 74% in I-Gel. Time to intubation was comparable with both supraglottic airway devices (20 vs 22 seconds) but was significantly shorter compared with endotracheal intubation (50 seconds, P < .001). CONCLUSIONS Less to moderately experienced providers are able to perform endotracheal intubation in easy airways but fail during ongoing chest compressions and simulated difficult airway. Consequently, less to moderately experienced providers should refrain from endotracheal intubation during ongoing chest compressions during CPR and in expected difficult airways. Supraglottic airway devices are reliable alternatives and blind intubation through these devices is a valuable airway management strategy.
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Affiliation(s)
| | - Eva Rivas
- Department of Anesthesiology, Hospital Clinic, IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
- Department of OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kurt Ruetzler
- Department of OUTCOMES RESEARCH, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw
| | - Mateusz Puslecki
- Department of Rescue Medical Service, Poznan University of Medical Sciences, Poznan
| | - Marek Dabrowski
- Department of Rescue Medical Service, Poznan University of Medical Sciences, Poznan
| | - Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Togay Evrin
- Department of Emergency Medicine, UFuK University Medical Faculty, Dr Ridvan Ege Education and Research Hospital, Ankara, Turkey
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Smereka J, Ruetzler K, Rodríguez-Núñez A, Frass M, Robak O, Szarpak L. New infant chest compression technique. A prospective randomized crossover manikin trial. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.252] [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: 11/30/2022]
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Szarpak L, Wieczorek W, Smereka J, Ruetzler K, Rodríguez-Núñez A, Robak O, Frass M. Which position is optimal when providing CRP to a pediatric patient? Pilot data. Resuscitation 2018. [DOI: 10.1016/j.resuscitation.2018.07.254] [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: 10/28/2022]
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Majer J, Jaguszewski MJ, Frass M, Leskiewicz M, Smereka J, Ładny JR, Robak O, Szarpak Ł. Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study. Cardiol J 2018; 26:529-535. [PMID: 30155865 DOI: 10.5603/cj.a2018.0091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 07/16/2018] [Revised: 08/24/2018] [Accepted: 07/22/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of the study was to compare the quality of chest compressions (CCs) carried out with and without the use of the TrueCPR device during simulated cardiopulmonary resuscitations conducted by trainee doctors. METHODS The study was a prospective, randomized, cross-over simulation study. The study involved 65 trainee doctors who were tasked with performing a 2-min cycle of uninterrupted CCs under conditions of a simulated cardiopulmonary resuscitation of adults. CC were carried out in two scenarios: with and without TrueCPR chest compression support. Participants did not have experience in the use of CCs prior to this study. RESULTS The depth of compressions in regard to CC techniques were varied by 45 mm (IQR 43-48) for manual CC and 53 mm (IQR 51-55) for the TrueCPR device (p < 0.001). The incidence of CCs with and without TrueCPR was: 112 (IQR 103-113) vs. 129 (IQR 122-135) compressions (p = 0.002). The degree of complete chest relaxation with the TrueCPR device was 95% (IQR 76-99) and without the device, 33% (IQR 29-38) (p < 0.001). CONCLUSIONS In the simulation study performed, the use of the TrueCPR device resulted in a significant improvement in the quality of CCs in relation to frequency and depth of CCs and correctness of chest relaxation.
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Affiliation(s)
| | | | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Marcin Leskiewicz
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy R Ładny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Smereka J, Kaminska H, Wieczorek W, Dąbrowski M, Ładny JR, Ruetzler K, Szarpak Ł, Robak O, Frass M. Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial. Kardiol Pol 2018; 76:980-986. [PMID: 29350383 DOI: 10.5603/kp.a2018.0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/30/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique. AIM We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the posi-tion of the rescuer during resuscitation. METHODS This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer's forearm. The Newborn Tory® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations. RESULTS Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median per-centage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min-1), and lowest for scenario A (9 × min-1). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer's forearm. CONCLUSIONS The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer's forearm.
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Affiliation(s)
| | | | | | | | | | | | - Łukasz Szarpak
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland; Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4, 02-005 Warsaw, Poland.
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Karczewska K, Szarpak L, Smereka J, Dabrowski M, Ladny JR, Wieczorek W, Robak O, Frass M, Ahuja S, Ruetzler K. ET-View compared to direct laryngoscopy in patients with immobilized cervical spine by unexperienced physicians: A randomized crossover manikin trial. Anaesthesiol Intensive Ther 2017; 49:274-282. [PMID: 28953308 DOI: 10.5603/ait.a2017.0047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 08/03/2017] [Accepted: 09/03/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Immobilization of the cervical spine is indicated in all patients with the potential risk of any cervical spine injury. Airway management in these patients is challenging and direct laryngoscopy is the standard of care. Videolaryngoscopes like the ET-View were introduced into clinical practice to provide better airway visualization and ease intubation. The ET-View is essentially a conventional endotracheal tube, but is equipped with a miniature camera on the tip. The ET-View has not been investigated in patients with immobilized cervical spine so far. The aim was to evaluate the performance of the VivaSight SL compared with Macintosh when performed in patients with immobilized cervical spine by unexperienced physicians. METHODS This was prospective, randomized, cross-over manikin trial. 50 novice physicians were randomly assigned to intubate a manikin in three airway scenarios including a normal airway and two cervical immobilization techniques. Overall and first intubation attempt success rate, time to intubation, dental compression and airway visualization according to the Cormack&Lehane graduation were assessed. RESULTS All physicians were able to intubate the manikin in all scenarios using the ETView, whereas direct laryngoscopy failed in 16 % with immobilized cervical spine using the patriot cervical extraction collar. First intubation attempt success rate was higher and airway visualization was better in all three scenarios using the ET-View compared to direct laryngoscopy. CONCLUSION The ET-View offered much better 62 airway visualization and provided higher overall and first intubation attempt success rates. Therefore, the ET-View is a valuable alternative in patients with difficult intubation due to immobilized cervical spine. Further clinical trials are indicated to confirm these findings. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02733536.
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Affiliation(s)
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 Str., 02-005, Warsaw, Poland.
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Wohlfarth P, Agis H, Gualdoni GA, Weber J, Staudinger T, Schellongowski P, Robak O. Interleukin 1 Receptor Antagonist Anakinra, Intravenous Immunoglobulin, and Corticosteroids in the Management of Critically Ill Adult Patients With Hemophagocytic Lymphohistiocytosis. J Intensive Care Med 2017. [PMID: 28631531 DOI: 10.1177/0885066617711386] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [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: 01/24/2023]
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) causes multiple organ dysfunction frequently leading to intensive care unit (ICU) referral and/or death. We report on a series of critically ill adult patients treated with a non-etoposide-based regimen including interleukin 1 antagonist anakinra, intravenous immunoglobulin (IVIG), and/or corticosteroids (CS) for HLH. METHODS Eight adult (≥18 years) ICU patients having received treatment with anakinra ± IVIG ± CS for HLH between March 2014 and March 2016 at a large tertiary care university hospital (Medical University of Vienna, Vienna, Austria) were retrospectively analyzed. RESULTS Eight patients (median age: 38 years; range: 20-58 years; 4 males and 4 females) received anakinra together with IVIG (n = 7) and/or high-dose CS (n = 5) for suspected reactive HLH (median H-score: 214; range: 171-288). Seven (88%) patients required vasopressors and invasive mechanical ventilation and 6 (75%) patients required renal replacement therapy (median Sequential Organ Failure Assessment [SOFA] score at HLH diagnosis: 9.5; range: 6-14). Six patients showed a significant decline in the SOFA score at 1 and 2 weeks following treatment initiation (P = .03), and the remainder 2 patients experienced early death. Five patients survived to ICU discharge, 4 of them could further be discharged from hospital (hospital survival rate: 50%). No overt treatment-related toxicity was noted. CONCLUSION Anakinra in combination with IVIG and/or CS resulted in a hospital survival rate of 50% in 8 critically ill adult patients with HLH despite a vast degree of organ dysfunction and the need for aggressive ICU treatment. Further research on non-etoposide-based treatment strategies for HLH in critically ill adults is warranted.
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Affiliation(s)
- Philipp Wohlfarth
- 1 Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Hermine Agis
- 1 Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria.,2 Clinical Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Guido A Gualdoni
- 3 Clinical Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Johannes Weber
- 4 Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Staudinger
- 1 Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Peter Schellongowski
- 1 Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- 1 Intensive Care Unit 13i2, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Robak O, Vaida S, Somri M, Gaitini L, Füreder L, Frass M, Szarpak L. Inter-center comparison of EasyTube and endotracheal tube during general anesthesia in minor elective surgery. PLoS One 2017; 12:e0178756. [PMID: 28575056 PMCID: PMC5456362 DOI: 10.1371/journal.pone.0178756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/18/2017] [Indexed: 12/27/2022] Open
Abstract
Background The EasyTube® (EzT) is a supraglottic airway device (SAD) enabling ventilation irrespective of its placement into the esophagus or trachea. Data obtained on SADs from multicenter studies, performed in highly specialized centers cannot always be transferred to other sites. However, data on comparability of different sites are scarce. This study focused on inter-site variability of ventilatory and safety parameters during general anesthesia with the EzT. Methods 400 patients with ASA physical status I-II undergoing general anesthesia for elective surgery in four medical centers (EzT group (n = 200), ETT group (n = 200)). Mallampati classification, success of insertion, insertion time, duration of ventilation, number of insertion attempts, ease of insertion, tidal volumes, leakage, hemodynamic parameters, oxygenation, and complications rates with the EasyTube (EzT) or endotracheal tube (ETT) in comparison within the sites and in between the sites were recorded. Results Intra-site and inter-site comparison of insertion success as primary outcome did not differ significantly. The inter-site comparison of expiratory minute volumes showed that the volumes achieved over the course of anesthesia did not differ significantly, however, mean leakage at one site was significantly higher with the EzT (0.63 l/min, p = 0.02). No significant inter-site differences in heart rate, blood pressure, or oxygenation were observed. Sore throat and blood on the cuff after removal of the device were the most frequent complications with significantly more complications at one site with the EzT (p = 0.01) where insertion was also reported significantly more difficult (p = 0.02). Conclusion Performance of the EzT but not the ETT varied between sites with regard to insertion difficulty, leakage, and complications but not insertion success, ventilation, hemodynamics, and oxygenation parameters in patients with ASA physical status 1–2 during general anesthesia undergoing minor elective surgery.
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Affiliation(s)
- Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Sonia Vaida
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Centre, Hershey, PA, United States of America
| | - Mostafa Somri
- Department of Anesthesiology, Bnai Zion Medical Centre, Haifa, Israel
| | - Luis Gaitini
- Department of Anesthesiology, Bnai Zion Medical Centre, Haifa, Israel
| | - Lisa Füreder
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
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Robak O, Vaida S, Gaitini L, Thierbach A, Urtubia R, Krafft P, Frass M. The EasyTube during general anesthesia for minor surgery: A randomized, controlled trial. Medicine (Baltimore) 2017; 96:e7195. [PMID: 28640104 PMCID: PMC5484212 DOI: 10.1097/md.0000000000007195] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The EasyTube (EzT) is a supraglottic airway device that is used for emergency airway situations. Ventilation during general anesthesia should also be feasible, but literature on the EzT is scarce. We evaluated the EzT in comparison with the endotracheal tube (ETT) in its use during general anesthesia in a comparative study. METHODS A total of 400 patients with American Society of Anesthesiologists (ASA) physical status I to II scheduled for minor surgery in 4 centers were randomized for ventilation via the ETT or EzT. RESULTS In all patients, the EzT and the ETT could be inserted within 3 attempts. In all EzT patients, the inspiratory and expiratory minute volumes (6.64 ± 0.71 and 6.34 ± 0.69 L/min) were sufficient to reach target oxygenation values, similar to ETT patients (P = .59). Mean peak pressure, mean plateau pressure, and mean dynamic compliance did not differ between the groups. Sore throat and blood on the cuff after removal were the most frequent complications in both groups. CONCLUSION Ventilation for up to 1 hour during general anesthesia in patients with ASA physical status I to II with the EzT is feasible and safe.
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Affiliation(s)
- Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Sonia Vaida
- Department of Anaesthesiology, Penn State Milton S. Hershey Medical Centre, Hershey, PA
| | - Luis Gaitini
- Department of Anaesthesiology, Bnai Zion Medical Centre, Haifa, Israel
| | - Andreas Thierbach
- Department of Anaesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, University of Mainz and Klinikum Idar-Oberstein, Idar-Oberstein, Germany
| | - Ricardo Urtubia
- Department of Anaesthesiology Clinica Vespucio, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - Peter Krafft
- Department of Anaesthesiology and General Intensive Care, Medical University of Vienna and Rudolfstiftung, Vienna, Austria
| | - Michael Frass
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Karavana V, Smith I, Kanellis G, Sigala I, Kinsella T, Zakynthinos S, Liu L, Chen J, Zhang X, Liu A, Guo F, Liu S, Yang Y, Qiu H, Grimaldi DG, Kaya E, Acicbe O, Kayaalp I, Asar S, Dogan M, Eren G, Hergunsel O, Pavelescu D, Grintescu I, Mirea L, Guanziroli M, Gotti M, Marino A, Cressoni M, Vergani G, Chiurazzi C, Chiumello D, Gattinoni L, Guanziroli M, Gotti M, Vergani G, Cressoni M, Chiurazzi C, Marino A, Spano S, Chiumello D, Gattinoni L, Guanziroli M, Gotti M, Vergani G, Marino A, Cressoni M, Chiurazzi C, Chiumello D, Gattinoni L, Massaro F, Moustakas A, Johansson S, Larsson A, Perchiazzi G, Zhang XW, Guo FM, Chen JX, Xue M, Yang Y, Qiu HB, Chen JX, Liu L, Yang L, Zhang XW, Guo FM, Yang Y, Qiu HB, Fister M, Knafelj R, Suzer MA, Kavlak ME, Atalan HK, Gucyetmez B, Cakar N, Weller D, Grootendorst AF, Dijkstra A, Kuijper TM, Cleffken BI, Regli A, De Keulenaer B, Van Heerden P, Hadfield D, Hopkins PA, Penhaligon B, Reid F, Hart N, Rafferty GF, Grasselli G, Mauri T, Lazzeri M, Carlesso E, Cambiaghi B, Eronia N, Maffezzini E, Bronco A, Abbruzzese C, Rossi N, Foti G, Bellani G, Pesenti A, Bassi GL, Panigada M, Ranzani O, Kolobow T, Zanella A, Cressoni M, Berra L, Parrini V, Kandil H, Salati G, Livigni S, Livigni S, Amatu A, Girardis M, Barbagallo M, Moise G, Mercurio G, Costa A, Vezzani A, Lindau S, Babel J, Cavana M, Torres A, Panigada M, Bassi GL, Ranzani OT, Kolobow T, Zanella A, Cressoni M, Berra L, Parrini V, Kandil H, Salati G, Livigni S, Amatu A, Girardis M, Barbagallo M, Moise G, Mercurio G, Costa A, Vezzani A, Lindau S, Babel J, Cavana M, Torres A, Umbrello M, Taverna M, Formenti P, Mistraletti G, Vetrone F, Marino A, Vergani G, Baisi A, Chiumello D, Garnero AG, Novotni DN, Arnal JA, Urner M, Fan E, Dres M, Vorona S, Brochard L, Ferguson ND, Goligher EC, Leung C, Joynt G, Wong W, Lee A, Gomersall C, Poels S, Casaer M, Schetz M, Van den Berghe G, Meyfroidt G, Holzgraefe B, Von Kobyletzki LB, Larsson A, Cianchi G, Becherucci F, Batacchi S, Cozzolino M, Franchi F, Di Valvasone S, Ferraro MC, Peris A, Phiphitthanaban H, Wacharasint P, Wongsrichanalai V, Lertamornpong A, Pengpinij O, Wattanathum A, Oer-areemitr N, Boddi M, Cianchi G, Cappellini E, Ciapetti M, Batacchi S, Di Lascio G, Bonizzoli M, Cozzolino M, Peris A, Lazzeri C, Cianchi G, Bonizzoli M, Di Lascio G, Cozzolino M, Peris A, Katsin ML, Hurava MY, Dzyadzko AM, Hermann A, Schellongowski P, Bojic A, Riss K, Robak O, Lamm W, Sperr W, Staudinger T, Buoninsegni LT, Bonizzoli M, Cozzolino M, Parodo J, Ottaviano A, Cecci L, Corsi E, Ricca V, Peris A, de Garibay APR, Ende-Schneider B, Schreiber C, Kreymann B, Turani F, Resta M, Niro D, Castaldi P, Boscolo G, Gonsales G, Martini S, Belli A, Zamidei L, Falco M, Lamas T, Mendes J, Galazzi A, Mauri T, Benco B, Binda F, Masciopinto L, Lazzeri M, Carlesso E, Lissoni A, Grasselli G, Adamini I, Pesenti A, Thamjamrassri T, Watcharotayangul J, Numthavaj P, Kongsareepong S, Higuera J, Cabestrero D, Rey L, Narváez G, Blandino A, Aroca M, Saéz S, De Pablo R, Mohamed A, Sklar M, Munshi L, Mauri T, Lazzeri M, Alban L, Turrini C, Panigada M, Taccone P, Carlesso E, Marenghi C, Spadaro S, Grasselli G, Volta C, Pesenti A, Higuera J, Alonso DC, Blandino A, Narváez G, González LR, Aroca M, Saéz S, De Pablo R, Franci A, Stocchi G, Cappuccini G, Socci F, Cozzolino M, Guetti C, Rastrelli P, Peris A, Nestorowicz A, Glapinski J, Fijalkowska-Nestorowicz A, Wosko J, Fijalkowska-Nestorowicz A, Glapinski J, Wosko J, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Ollieuz S, Reychler G, Bonus T, Duprez F, Cuvelier G, Mashayekhi S, Ollieuz S, Reychler G, Kuchyn I, Bielka K, Sergienko A, Jones H, Day C, Park SC, Yeom SR, Myatra SN, Gupta S, Rajnala V, Divatia J, Silva JV, Olvera OA, Schulte RC, Bermudez MC, Zorrilla LP, Ferretis HL, García KT, Balciuniene N, Ramsaite J, Kriukelyte O, Krikscionaitiene A, Tamosuitis T, Terragni P, Brazzi L, Falco D, Pistidda L, Magni G, Bartoletti L, Mascia L, Filippini C, Ranieri V, Kyriakoudi A, Rovina N, Koltsida O, Konstantellou E, Kardara M, Kostakou E, Gavriilidis G, Vasileiadis I, Koulouris N, Koutsoukou A, Van Snippenburg W, Kröner A, Flim M, Buise M, Hemler R, Spronk P, Regli A, Noffsinger B, De Keulenaer B, Singh B, Hockings L, Van Heerden P, Spina C, Bronco A, Magni F, Di Giambattista C, Vargiolu A, Bellani G, Foti G, Citerio G, Scaramuzzo G, Spadaro S, Waldmann AD, Böhm SH, Ragazzi R, Volta CA, Heines SJ, Strauch U, Van de Poll MC, Roekaerts PM, Bergmans DC, Sosio S, Gatti S, Maffezzini E, Punzi V, Asta A, Foti G, Bellani G, Glapinski J, Mroczka J, Nestorowicz A, Fijalkowska-Nestorowicz A, Yaroshetskiy AI, Rezepov NA, Mandel IA, Gelfand BR, Ozen E, Karakoc E, Ayyildiz A, Kara S, Ekemen S, Yelken BB, Saasouh W, Freeman J, Turan A, Hajjej Z, Sellami W, Bousselmi M, Samoud W, Gharsallah H, Labbene I, Ferjani M, Vetrugno L, Barbariol F, Forfori F, Regeni I, Della Rocca G, Jansen D, Jonkman A, Doorduin J, Roesthuis L, Van der Hoeven J, Heunks L, Marocco SA, Bottiroli M, Pinciroli R, Galanti V, Calini A, Gagliardone M, Bellani G, Fumagalli R, Gatti S, Abbruzzese C, Ippolito D, Sala VL, Meroni V, Bronco A, Foti G, Bellani G, Elbanna M, Nassar Y, Abdelmohsen A, Yahia M, Mongodi S, Mojoli F, Via G, Tavazzi G, Fava F, Pozzi M, Iotti GA, Bouhemad B, Ruiz-Ferron F, Simón JS, Gordillo-Resina M, Chica-Saez V, Garcia MR, Vela-Colmenero R, Redondo-Orts M, Gontijo-Coutinho C, Ozahata T, Nocera P, Franci D, Santos T, Carvalho-Filho M, Fochi O, Gatti S, Nacoti M, Signori D, Bronco A, Bonacina D, Bellani G, Bonanomi E, Mongodi S, Bonvecchio E, Stella A, Roldi E, Orlando A, Luperto M, Bouhemad B, Iotti GA, Mojoli F, Trunfio D, Licitra G, Martinelli R, Vannini D, Giuliano G, Vetrugno L, Forfori F, Näslund E, Lindberg LG, Lund I, Larsson A, Frithiof R, Nichols A, Freeman J, Pentakota S, Kodali B, Pranskunas A, Kiudulaite I, Simkiene J, Damanskyte D, Pranskuniene Z, Arstikyte J, Vaitkaitis D, Pilvinis V, Brazaitis M, Pool R, Haugaa H, Botero A, Escobar D, Maberry D, Tønnessen T, Zuckerbraun B, Pinsky M, Gomez H, Lyons H, Trimmings A, Domizi R, Scorcella C, Damiani E, Pierantozzi S, Tondi S, Monaldi V, Carletti A, Zuccari S, Adrario E, Pelaia P, Donati A, Kazune S, Grabovskis A, Volceka K, Rubins U, Bol M, Suverein M, Delnoij T, Driessen R, Heines S, Delhaas T, Vd Poll M, Sels J, Jozwiak M, Chambaz M, Sentenac P, Richard C, Monnet X, Teboul JL, Bitar Z, Maadarani O, Al Hamdan R, Huber W, Malbrain M, Chew M, Mallat J, Tagami T, Hundeshagen S, Wolf S, Huber W, Mair S, Schmid R, Aron J, Adlam M, Dua G, Mu L, Chen L, Yoon J, Clermont G, Dubrawski A, Duhailib Z, Al Assas K, Shafquat A, Salahuddin N, Donaghy J, Morgan P, Valeanu L, Stefan M, Provenchere S, Longrois D, Shaw A, Mythen MG, Shook D, Hayashida D, Zhang X, Munson SH, Sawyer A, Mariyaselvam M, Blunt M, Young P, Nakwan N, Khwannimit B, Checharoen P, Berger D, Moller P, Bloechlinger S, Bloch A, Jakob S, Takala J, Van den Brule JM, Stolk R, Vinke E, Van Loon LM, Pickkers P, Van der Hoeven JG, Kox M, Hoedemaekers CW, Werner-Moller P, Jakob S, Takala J, Berger D, Bertini P, Guarracino F, Colosimo D, Gonnella S, Brizzi G, Mancino G, Baldassarri R, Pinsky MR, Bertini P, Gonnella S, Brizzi G, Mancino G, Amitrano D, Guarracino F, Goslar T, Stajer D, Radsel P, De Vos R, Dijk NBV, Stringari G, Cogo G, Devigili A, Graziadei MC, Bresadola E, Lubli P, Amella S, Marani F, Polati E, Gottin L, Colinas L, Hernández G, Vicho R, Serna M, Canabal A, Cuena R, Jozwiak M, Gimenez J, Teboul JL, Mercado P, Depret F, Richard C, Monnet X, Hajjej Z, Sellami W, Sassi K, Gharsallah H, Labbene I, Ferjani M, Herner A, Schmid R, Huber W, Abded N, Nassar Y, Elghonemi M, Monir A, Nikhilesh J, Apurv T, Uber AU, Grossestreuer A, Moskowitz A, Patel P, Holmberg MJ, Donnino MW, Graham CA, Hung K, Lo R, Leung LY, Lee KH, Yeung CY, Chan SY, Trembach N, Zabolotskikh I, Caldas J, Panerai R, Camara L, Ferreira G, Almeida J, de Oliveira GQ, Jardim J, Bor-Seng-Shu E, Lima M, Nogueira R, Jatene F, Zeferino S, Galas F, Robinson T, Hajjar LA, Caldas J, Panerai R, Ferreira G, Camara L, Zeferino S, Jardim J, Bor-Seng-Shu E, Oliveira M, Norgueira R, Groehs R, Ferreira-Santos L, Galas F, Oliveira G, Almeida J, Robinson T, Jatene F, Hajjar L, Ferreira G, Ribeiro J, Galas F, Gaiotto F, Lisboa L, Fukushima J, Rizk S, Almeida J, Jatene F, Osawa E, Franco R, Kalil R, Hajjar L, Chlabicz M, Sobkowicz B, Kaminski K, Kazimierczyk R, Musial W, Tycińska A, Siranovic M, Gopcevic A, Gavranovic ZG, Horvat AH, Krolo H, Rode B, Videc L, Trifi A, Abdellatif S, Ismail KB, Bouattour A, Daly F, Nasri R, Lakhal SB, Beurton A, Teboul JL, Girotto V, Galarza L, Richard C, Monnet X, Beurton A, Teboul JL, Girotto V, Galarza L, Richard C, Monnet X, Girotto V, Teboul JL, Beurton A, Galarza L, Guedj T, Monnet X, Galarza L, Mercado P, Teboul JL, Girotto V, Beurton A, Richard C, Monnet X, Iliæ MK, Sakic L, NN V, Stojcic L, Jozwiak M, Depret F, Teboul JL, Alphonsine J, Lai C, Richard C, Monnet X, Tapanwong N, Chuntupama P, Wacharasint P, Huber W, Hoellthaler J, Lahmer T, Schmid R, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Latham H, Bengtson CD, Satterwhite L, Stites M, Simpson SQ, Skladzien T, Cicio M, Garlicki J, Serednicki W, Wordliczek J, Vargas P, Salazar A, Mercado P, Espinoza M, Graf J, Kongpolprom N, Sanguanwong N, Jonnada S, Gerrard C, Jones N, Morley T, Thorburn PT, Trimmings A, Musaeva T, Zabolotskikh I, Salazar A, Vargas P, Mercado P, Espinoza M, Graf J, Horst S, Lipcsey M, Kawati R, Pikwer A, Rasmusson J, Castegren M, Shilova A, Yafarova A, Gilyarov M, Shilova A, Yafarova A, Gilyarov M, Stojiljkovic DLL, Ulici A, Reidt S, Lam T, Jancik J, Ragab D, Taema K, Farouk W, Saad M, Liu X, Holmberg MJ, Uber A, Montissol S, Donnino M, Andersen LW, Perlikos F, Lagiou M, Papalois A, Kroupis C, Toumpoulis I, Osawa E, Carter D, Sardo S, Almeida J, Galas F, Rizk S, Franco R, Hajjar L, Landoni G, Kongsayreepong S, Sungsiri R, Wongsripunetit P, Marchio P, Guerra-Ojeda S, Gimeno-Raga M, Mauricio MD, Valles SL, Aldasoro C, Jorda A, Aldasoro M, Vila JM, Borg UB, Neitenbach AM, García M, González PG, Romero MG, Orduña PS, Cano AG, Rhodes A, Grounds RM, Cecconi M, Lee C, Hatib F, Jian Z, Rinehart J, De Los Santos J, Canales C, Cannesson M, García MIM, Hatib F, Jian Z, Scheeren T, Jian Z, Hatib F, Pinsky M, Chantziara V, Vassi A, Michaloudis G, Sanidas E, Golemati S, Bateman RM, Mokhtar A, Omar W, Aziz KA, El Azizy H, Nielsen DLL, Holler JG, Lassen A, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Capoletto C, Almeida J, Ferreira G, Fukushima J, Nakamura R, Risk S, Osawa E, Park C, Oliveira G, Galas F, Franco R, Hajjar L, Dias F, D’Arrigo N, Fortuna F, Redaelli S, Zerman L, Becker L, Serrano T, Cotes L, Ramos F, Fadel L, Coelho F, Mendes C, Real J, Pedron B, Kuroki M, Costa E, Azevedo L. 37th International Symposium on Intensive Care and Emergency Medicine (part 1 of 3). Crit Care 2017. [PMCID: PMC5374603 DOI: 10.1186/s13054-017-1628-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gawlowski P, Smereka J, Madziala M, Szarpak L, Frass M, Robak O. Comparison of the Macintosh laryngoscope and blind intubation via the iGEL for Intubation With C-spine immobilization: A Randomized, crossover, manikin trial. Am J Emerg Med 2016; 35:484-487. [PMID: 28041757 DOI: 10.1016/j.ajem.2016.11.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Endotracheal intubation (ETI) using a Macintosh laryngoscope (MAC) requires the head to be positioned in a modified Jackson position, slightly reclined and elevated. Intubation of trauma patients with an injured neck or spine is therefore difficult, since the neck usually cannot be turned or is already immobilized in order to prevent further injury. The iGEL supraglottic airway seems optimal for such conditions due to its blind insertion without the need of a modified Jackson position. METHODS Prospective, randomized, crossover study in 46 paramedics. Participants performing standard intubation and blind intubation via iGEL supraglottic airway device in three airway scenarios: Scenario A - normal airway; Scenario B - manual inline cervical immobilization, performed by an independent instructor; scenario C: cervical immobilization using a standard Patriot cervical extraction collar. RESULTS In Scenario A, nearly all participants performed ETI successfully both with MAC and iGEL (100% vs. 95.7%). The time to intubation (TTI) using the MAC and iGEL amounted to 19 [IQR, 18-21]s vs. 12 [IQR, 11-13]s (P<0.001). Head extension angle as well as tooth compression were significantly better with the iGEL compared to the MAC (P<0.001). In scenario B and C, the results with the iGEL were significantly better than with MAC for all analyzed variables (TTI, success of first intubation attempt, head extension angle, tooth compression and VAS scores). CONCLUSION We showed that blind intubation with the iGEL supraglottic airway was superior to ETI performed by paramedics in a simulated cervical immobilization scenario in a manikin in terms of success rate, time to definite tube placement, head extension angle, tooth compression, and rating.
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Affiliation(s)
- Pawel Gawlowski
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Marcin Madziala
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Truszewski Z, Krajewski P, Fudalej M, Smereka J, Frass M, Robak O, Nguyen B, Ruetzler K, Szarpak L. A comparison of a traditional endotracheal tube versus ETView SL in endotracheal intubation during different emergency conditions: A randomized, crossover cadaver trial. Medicine (Baltimore) 2016; 95:e5170. [PMID: 27858851 PMCID: PMC5591099 DOI: 10.1097/md.0000000000005170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Airway management is a crucial skill essential to paramedics and personnel working in Emergency Medical Services and Emergency Departments: Lack of practice, a difficult airway, or a trauma situation may limit the ability of paramedics to perform direct laryngoscopy during cardiopulmonary resuscitation. Videoscope devices are alternatives for airway management in these situations. The ETView VivaSight SL (ETView; ETView Ltd., Misgav, Israel) is a new, single-lumen airway tube with an integrated high-resolution imaging camera. To assess if the ETView VivaSight SL can be a superior alternative to a standard endotracheal tube for intubation in an adult cadaver model, both during and without simulated CPR. METHODS ETView VivaSight SL tube was investigated via an interventional, randomized, crossover, cadaver study. A total of 52 paramedics participated in the intubation of human cadavers in three different scenarios: a normal airway at rest without concomitant chest compression (CC) (scenario A), a normal airway with uninterrupted CC (scenario B) and manual in-line stabilization (scenario C). Time and rate of success for intubation, the glottic view scale, and ease-of-use of ETView vs. sETT intubation were assessed for each emergency scenario. RESULTS The median time to intubation using ETView vs. sETT was compared for each of the aforementioned scenarios. For scenario A, time to first ventilation was achieved fastest for ETView, 19.5 [IQR, 16.5-22] sec, when compared to that of sETT at 21.5 [IQR, 20-25] sec (p = .013). In scenario B, the time for intubation using ETView was 21 [IQR, 18.5-24.5] sec (p < .001) and sETT was 27 [IQR, 24.5-31.5] sec. Time to first ventilation for scenario C was 23.5 [IQR, 19-25.5] sec for the ETView and 42.5 [IQR, 35-49.5] sec for sETT. CONCLUSIONS In normal airways and situations with continuous chest compressions, the success rate for intubation of cadavers and the time to ventilation were improved with the ETView. The time to glottis view, tube insertion, and cuff block were all found to be shorter with the ETView. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02733536.
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Affiliation(s)
| | - Paweł Krajewski
- Department of Forensic Medicine, Medical University of Warsaw, Warsaw
| | - Marcin Fudalej
- Department of Forensic Medicine, Medical University of Warsaw, Warsaw
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Kurt Ruetzler
- Departments of Outcomes Research and General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Lukasz Szarpak
- Department of Emergency Medicine
- Correspondence: Lukasz Szarpak, Department of Emergency Medicine, Medical University of Warsaw, Lidleya 4 Str., 02-005 Warsaw, Polamd (e-mail: )
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Szarpak L, Truszewski Z, Czyzewski L, Frass M, Robak O. CPR using the lifeline ARM mechanical chest compression device: a randomized, crossover, manikin trial. Am J Emerg Med 2016; 35:96-100. [PMID: 27756513 DOI: 10.1016/j.ajem.2016.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION European Resuscitation Council as well as American Heart Association guidelines for cardiopulmonary resuscitation (CPR) stress the importance of uninterrupted and effective chest compressions (CCs). Manual CPR decreases in quality of CCs over time because of fatigue which impacts outcome. We report the first study with the Lifeline ARM automated CC device for providing uninterrupted CCs. METHODS Seventy-eight paramedics participated in this randomized, crossover, manikin trial. We compared the fraction of effective CCs between manual CPR and automated CPR using the ARM. RESULTS Using the ARM during resuscitation resulted in a higher percentage of effective CCs (100/min [interquartile range, 99-100]) compared with manual CCs (43/min [interquartile range, 39-46]; P<.001). The number of effective CCs decreased less over time with the ARM (P<.001), more often reached the required depth of 5 cm (97% vs 63%, P<.001), and more often reached the recommended CC rate (P<.001). The median tidal volume was higher and hands-off time was lower when using the ARM. CONCLUSION Mechanical CCs in our study adhere more closely to current guidelines than manual CCs. The Lifeline ARM provides more effective CCs, more ventilation time and minute volume, less hands-off time, and less decrease in effective CCs over time compared with manual Basic Life Support and might therefore impact outcome.
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Affiliation(s)
- Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Zenon Truszewski
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Lukasz Czyzewski
- Department of Nephrology Nursing, Medical University of Warsaw, Warsaw, Poland
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
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Frass M, Robak O, Vaida S, Gaitini L. Abstract PR564. Anesth Analg 2016. [DOI: 10.1213/01.ane.0000492945.96452.8b] [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: 11/05/2022]
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Sandhofer MJ, Robak O, Frank H, Kulnig J. Vaccine hesitancy in Austria : A cross-sectional survey. Wien Klin Wochenschr 2016; 129:59-64. [PMID: 27565644 DOI: 10.1007/s00508-016-1062-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 03/27/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Vaccine hesitancy is an emerging phenomenon particularly in industrialized nations. It has led to repeated epidemic outbreaks of otherwise vaccine-preventable, infectious diseases. Compared to other countries very low rates of influenza and measles vaccination rates have been reported in Austria. METHODS We performed a single-center cross-sectional, questionnaire-based survey. A total of 350 adult patients attending our emergency room participated in this survey. We assessed knowledge and attitudes towards vaccination and the associated infectious diseases. RESULTS Out of 350 participants 40 (11.4 %) declared that they deliberately refused vaccinations. Most common reasons for non-vaccination were fear of adverse effects (35.9 %), doubt of effectiveness of vaccines (35.9 %) and distrust towards the pharmaceutical industry (23.1 %). Of all 350 participants only 148 (42.3 %) thought themselves to be sufficiently informed about national vaccination recommendations as stated in the Austrian National Vaccination Program (ANVP). General practitioners (GP) were the primary source of healthcare-related information for 256 (73.1 %) participants. Furthermore, GPs as well as hospital-based physicians achieved the highest level of trust in this study population. CONCLUSIONS The results of our study underline the necessity of comprehensive informational campaigns on the merits of vaccination. A lack of knowledge about the benefits of vaccination, uncertainty and unfounded fears seem to prevent the achievement of recommended vaccination rates. Family GPs enjoyed the highest levels of trust in our study population. We believe that additional information communicated by GPs could help boost the low vaccination rates. This study underlines the important role of primary care practitioners in informing patients about vaccines and healthcare topics.
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Affiliation(s)
- Michael J Sandhofer
- Department of Internal Medicine, University Hospital Tulln, Karl Landsteiner University of Health Sciences, Alter Ziegelweg 10, 3430, Tulln, Austria.
| | - Oliver Robak
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Herbert Frank
- Department of Internal Medicine, University Hospital Tulln, Karl Landsteiner University of Health Sciences, Alter Ziegelweg 10, 3430, Tulln, Austria
| | - Johannes Kulnig
- Department of Pediatrics and Neonatology, University Hospital Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
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Doehn JM, Winkler A, Kuzmina Z, Hladik A, Greinix H, Knapp S, Robak O. Pentraxin-3 levels in graft-versus-host disease during allogeneic hematopoietic stem cell transplantation. Exp Hematol 2016; 44:917-23. [PMID: 27403536 DOI: 10.1016/j.exphem.2016.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/23/2016] [Accepted: 06/29/2016] [Indexed: 01/15/2023]
Abstract
Acute and chronic graft-versus-host-diseases (aGVHD and cGVHD, respectively) are serious complications after hematopoietic stem cell transplantation (HSCT), impairing survival and quality of life. Because the underlying pathomechanism of GVHD is still poorly understood, we investigated the novel inflammatory marker Pentraxin-3 (PTX3) for its potential role in acute and chronic GVHD compared with autologous HSCT and healthy individuals. We collected plasma samples from patients undergoing autologous (n = 12) and allogeneic (n = 28) HSCT and from healthy individuals (n = 15) throughout 7 days before and up to 1 year after HSCT. PTX3 levels in patients with aGVHD were significantly higher (36.4 ± 23.6 ng/mL) than in allogeneic patients without aGVHD (10.4 ± 4.4 ng/mL, p = 0.0001), autologous controls (11.4 ± 6.7 ng/mL, p = 0.001), or healthy individuals (1.9 ± 0.6 ng/mL, p < 0.001). PTX3 levels in patients with cGVHD (13.6 ± 6.3 ng/mL) were significantly lower than in allogeneic patients without cGVHD (25.1 ± 13.8 ng/mL, p = 0.04) and higher than in autologous controls (8.9 ± 7.8 ng/mL, p = 0.07) and healthy individuals (1.9 ± 0.6 ng/mL, p < 0.001). Severity of aGVHD and cGVHD correlated with PTX3 levels. Rising PTX3 levels after HSCT indicated unfavorable outcome. We show that PTX3 levels correlate with the severity of aGVHD, cGVHD, and-with reservations-survival in patients undergoing allogeneic HSCT.
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Affiliation(s)
- Jan-Moritz Doehn
- Department of Infectious Diseases and Pneumology, Charité University Medicine Berlin, Berlin, Germany
| | - Andreas Winkler
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Zoya Kuzmina
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anastasiya Hladik
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Hildegard Greinix
- Department of Medicine I, Medical University of Vienna, Vienna, Austria; Division of Hematology, Medical University of Graz, Graz, Austria
| | - Sylvia Knapp
- Department of Medicine I, Medical University of Vienna, Vienna, Austria; CeMM, Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Oliver Robak
- Department of Infectious Diseases and Pneumology, Charité University Medicine Berlin, Berlin, Germany; Department of Medicine I, Medical University of Vienna, Vienna, Austria.
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Robak O, Kuzmina Z, Winkler A, Kalhs P, Rabitsch W, Greinix H. Adiponectin and resistin in acute and chronic graft-vs-host disease patients undergoing allogeneic hematopoietic stem cell transplantation. Croat Med J 2016; 57:255-65. [PMID: 27374827 PMCID: PMC4937231 DOI: 10.3325/cmj.2016.57.255] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim To investigate the association of adiponectin and resistin levels in patients undergoing hematopoietic stem cell transplantation (HSCT) with the clinical outcome, including the occurrence of acute and chronic graft-vs-host disease (GVHD), non-relapse mortality, and overall survival. Methods We prospectively collected serum samples from 40 patients undergoing either autologous (n = 12; 10 male) or allogeneic (n = 28; 11 male) HSCT for up to 12 months post HSCT and determined adiponectin and resistin serum concentrations using enzyme-linked immunosorbent assay. Results There were no significant differences in adiponectin levels (18.5 vs 9.3 µg/mL, P = 0.071) and adiponectin/BMI ratio (0.82 vs 0.39, P = 0.068) between patients with acute GVHD grades 2-4 and autologous controls. However, resistin values were significantly lower in patients with acute GVHD grades 2-4 than in autologous controls (4.6 vs 7.3 ng/mL, P = 0.030). Adiponectin levels were higher in patients with chronic GVHD (n = 17) than in autologous controls (13.5 vs 7.6 µg/mL, P = 0.051), but the difference was not significant. Adiponectin/BMI ratio was significantly higher in patients with chronic GVHD than in autologous controls (0.59 vs 0.25, P = 0.006). Patients dying from relapse also had significantly lower adiponectin levels (8.2 µg/mL) and adiponectin/BMI ratio (0.3) on admission than surviving allogeneic (15.8 µg/mL, P = 0.030 and 0.7, P = 0.004) and surviving autologous patients (19.2 µg/mL, P = 0.031 and 0.7, P = 0.021). Conclusion Adiponectin and resistin levels were altered in patients with acute and chronic GVHD compared to autologous controls and were associated with overall survival and relapse mortality in patients undergoing allogeneic HSCT.
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Affiliation(s)
- Oliver Robak
- Oliver Robak, Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria,
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Thierbach A, Piepho T, Göbler S, Rützler K, Frass M, Kaye AD, Robak O. Comparative study of three different supraglottic airway devices in simulated difficult airway situations. Minerva Anestesiol 2015; 81:1311-1317. [PMID: 25616207] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Supraglottic airway devices (SAD) provide an effective way for managing difficult airways. Numerous SADs have been developed in recent years. We compared three SADs utilizing simulated airways. The major aim of this study was to provide evidence for the efficacy of SADs in the management of simulated difficult airway situations. METHODS The study utilized an airway simulation manikin (Laerdal SimMan® 3G) to assess feasibility and time to final placement of three different airway devices (the classic laryngeal mask airway [LMA], the Laryngeal tube [LT], and the EasyTube® [EzT]). Thirty anesthesiologists inserted each of the SADs under standard physiologic airway conditions (STD) as well as pathological airway conditions, including tongue edema (TE) and trismus combined with limited mobility of the cervical spine (TCS), mimicking a patient with cramps. RESULTS In STD and TE, all participants were able to successfully place the LMA, LT, and EzT correctly. In TCS, one participant failed to place the LMA correctly, whereas six participants failed to place the LT correctly (P=0.031). Under STD and TE conditions, we found a significantly longer time to final placement with the EzT (P=0.001). Under TCS conditions, there was no significant difference between the tested SADs. Under STD conditions, the participants rated the LMA best (P<0.001). Under TE and TCS condition, the EzT was significantly higher rated (P<0.001). CONCLUSION The EzT showed benefits in two difficult airway situations (TE and TCS) in a prospective manikin study amongst anesthesiologists.
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Affiliation(s)
- A Thierbach
- Department of Anesthesia, Intensive Care Medicine, Emergency Medicine and Pain Therapy, Klinikum Idar-Oberstein, Germany -
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Robak O, Leonardelli M, Zedtwitz-Liebenstein K, Rützler K, Schuster E, Vaida S, Salem R, Frass M. Feasibility and speed of insertion of seven supraglottic airway devices under simulated airway conditions. CAN J EMERG MED 2015; 14:330-4. [PMID: 23131479 DOI: 10.2310/8000.2012.120658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Endotracheal intubation (ETI) is considered the gold standard for protecting the airway. Alternative devices for airway protection have been developed that can be used by untrained personnel, by those with less experience, and for when ETI is not possible. The main goals of our study were to evaluate the success rate and speed of insertion of different supraglottic airway devices and to determine whether the devices could be properly inserted under simulated critical conditions. METHODS Fifty medical students used an airway simulation trainer (Laerdal SimMan 3G) to assess the success rate and time used to insert seven different supraglottic airway devices under simulated physiologic and pathologic conditions in two different runs. RESULTS Although all airway devices could be inserted without problems, only the Combitube and the EasyTube could be successfully inserted in simulations of trismus, limited mobility of the cervical spine, or a combination of pathologic conditions such as trismus plus limited mobility of the spine and trismus plus tongue edema. The insertion time was significantly longer with LMA Unique, Fastrach, and I-Gel devices in both the first and second runs. CONCLUSION The Combitube and the EasyTube were most easily inserted under simulated conditions such as trismus, limited mobility of the cervical spine, and combined pathologic conditions. Although all devices are useful for establishing an airway by nontrained medical students in standard simulations, we suggest that the Combitube and the EasyTube may offer advantages in difficult airway situations.
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Affiliation(s)
- Oliver Robak
- Department of Medicine I, Intensive Care Unit, Medical University Vienna, Vienna, Austria.
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Hermann A, Riss K, Schellongowski P, Bojic A, Wohlfarth P, Robak O, Sperr WR, Staudinger T. A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal. Intensive Care Med 2015; 41:1773-80. [DOI: 10.1007/s00134-015-3957-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/29/2015] [Indexed: 11/29/2022]
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Szarpak Ł, Kurowski A, Truszewski Z, Robak O, Frass M. Comparison of 4 supraglotttic devices used by paramedics during simulated CPR : a randomized controlled crossover trial. Am J Emerg Med 2015; 33:1084-8. [PMID: 25963675 DOI: 10.1016/j.ajem.2015.04.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ensuring an open airway during cardiopulmonary resuscitation is fundamental. The aim of this study was to determine the success rate of blind intubation during simulated cardiopulmonary resuscitation by untrained personnel. METHODS Four devices were compared in a simulated resuscitation scenario: ILMA (Intavent Direct Ltd, Buckinghamshire, United Kingdom), Cobra PLA (Engineered Medical Systems Inc, Indianapolis, IN), Supraglottic Airway Laryngopharyngeal Tube (SALT) (ECOLAB, St. Paul, MN), and Air-Q (Mercury Medical, Clearwater, FL). A group of 210 paramedics intubated a manikin with continuous chest compressions. RESULTS The mean times to intubation were 40.46 ± 4.64, 33.96 ± 6.23, 17.2 ± 4.63, and 49.23 ± 13.19 seconds (SALT vs ILMA, Cobra PLA, and Air-Q; P < .05). The success ratios of blind intubation for the devices were 86.7%, 85.7%, 100%, and 71.4% (SALT vs ILMA, Cobra PLA, and Air-Q; P < .05). CONCLUSION The study showed that the most efficient device with the shortest blind intubation time was the SALT device.
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Affiliation(s)
- Łukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Andrzej Kurowski
- Department of Anesthesiology, Institute of Cardiology, Warsaw, Poland
| | - Zenon Truszewski
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Oliver Robak
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Michael Frass
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
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Hermann A, Riss K, Schellongowski P, Bojic A, Wohlfarth P, Robak O, Sperr W, Staudinger T. Determinants of gas exchange during extracorporeal CO2 removal using a novel pump-driven venovenous gas exchange system in a minimally invasive setting. Crit Care 2015. [PMCID: PMC4470462 DOI: 10.1186/cc14354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wohlfarth P, Ullrich R, Staudinger T, Bojic A, Robak O, Hermann A, Lubsczyk B, Worel N, Fuhrmann V, Schoder M, Funovics M, Rabitsch W, Knoebl P, Laczika K, Locker GJ, Sperr WR, Schellongowski P. Extracorporeal membrane oxygenation in adult patients with hematologic malignancies and severe acute respiratory failure. Crit Care 2014; 18:R20. [PMID: 24443905 PMCID: PMC4055976 DOI: 10.1186/cc13701] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 12/27/2013] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Acute respiratory failure (ARF) is the main reason for intensive care unit (ICU) admissions in patients with hematologic malignancies (HMs). We report the first series of adult patients with ARF and HMs treated with extracorporeal membrane oxygenation (ECMO). METHODS This is a retrospective cohort study of 14 patients with HMs (aggressive non-Hodgkin lymphoma (NHL) n = 5; highly aggressive NHL, that is acute lymphoblastic leukemia or Burkitt lymphoma, n = 5; Hodgkin lymphoma, n = 2; acute myeloid leukemia, n = 1; multiple myeloma, n = 1) receiving ECMO support because of ARF (all data as medians and interquartile ranges; age, 32 years (22 to 51 years); simplified acute physiology score II (SAPS II): 51 (42 to 65)). Etiology of ARF was pneumonia (n = 10), thoracic manifestation of NHL (n = 2), sepsis of nonpulmonary origin (n = 1), and transfusion-related acute lung injury (n = 1). Diagnosis of HM was established during ECMO in four patients, and five first received (immuno-) chemotherapy on ECMO. RESULTS Before ECMO, the PaO2/FiO2 ratio was 60 (53 to 65), (3.3 to 3.7). Three patients received venoarterial ECMO because of acute circulatory failure in addition to ARF; all other patients received venovenous ECMO. All patients needed vasopressors, and five needed hemofiltration. Thrombocytopenia occurred in all patients (lowest platelet count was 20 (11 to 21) G/L). Five major bleeding events were noted. ECMO duration was 8.5 (4 to 16) days. ICU and hospital survival was 50%. All survivors were alive at follow-up (36 (10 to 58) months); five patients were in complete remission, one in partial remission, and one had relapsed. CONCLUSIONS ECMO therapy is feasible in selected patients with HMs and ARF and can be associated with long-term disease-free survival.
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Robak O, Frass M. The Reviewers were Thinking Wisely. CAN J EMERG MED 2014; 16:9. [DOI: 10.2310/8000.2013.131233] [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: 11/18/2022]
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Zedtwitz-Liebenstein K, Robak O, Burgmann H, Frass M. Retrospective evaluation of antibody index of human parvovirus B19 as a prognostic factor in patients with dilated and ischemic cardiomyopathy. J Med Virol 2013; 85:1111-4. [DOI: 10.1002/jmv.23516] [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] [Accepted: 12/05/2012] [Indexed: 11/08/2022]
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Robak O, Schellongowski P, Bojic A, Laczika K, Locker GJ, Staudinger T. Short-term effects of combining upright and prone positions in patients with ARDS: a prospective randomized study. Crit Care 2011; 15:R230. [PMID: 21955757 PMCID: PMC3334777 DOI: 10.1186/cc10471] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 08/17/2011] [Accepted: 09/29/2011] [Indexed: 11/24/2022] Open
Abstract
Introduction Prone position is known to improve oxygenation in patients with acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS). Supine upright (semirecumbent) position also exerts beneficial effects on gas exchange in this group of patients. We evaluated the effect of combining upright and prone position on oxygenation and respiratory mechanics in patients with ALI or ARDS in a prospective randomized cross-over study. Methods After turning them prone from a supine position, we randomized the patients to a prone position or combined prone and upright position. After 2 hours, the position was changed to the other one for another 6 hours. The gas exchange and static compliance of the respiratory system, lungs, and chest wall were assessed in the supine position as well as every hour in the prone position. Results Twenty patients were enrolled in the study. The PaO2/FiO2 ratio improved significantly from the supine to the prone position and further significantly increased with additional upright position. Fourteen (70%) patients were classified as responders to the prone position, whereas 17 (85%) patients responded to the prone plus upright position compared with the supine position (P = n.s.). No statistically significant changes were found with respect to compliance. Conclusions Combining the prone position with the upright position in patients with ALI or ARDS leads to further improvement of oxygenation. Trial registration Clinical Trials No. NCT00753129
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Affiliation(s)
- Oliver Robak
- Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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Boehm A, Rabitsch W, Locker GJ, Worel N, Robak O, Laczika KF, Staudinger T, Bojic A, Siersch V, Valent P, Sperr WR. Successful allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia during respiratory failure and invasive mechanical ventilation. Wien Klin Wochenschr 2011; 123:354-8. [DOI: 10.1007/s00508-011-1590-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 04/14/2011] [Indexed: 11/28/2022]
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Ruetzler K, Roessler B, Potura L, Priemayr A, Robak O, Schuster E, Frass M. Performance and skill retention of intubation by paramedics using seven different airway devices--a manikin study. Resuscitation 2011; 82:593-7. [PMID: 21353364 DOI: 10.1016/j.resuscitation.2011.01.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 01/07/2011] [Accepted: 01/11/2011] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Endotracheal intubation (ETI) is the most widespread method for emergency airway management. Several studies reported that ETI requires considerable skill and experience and if performed incorrectly, may result in serious adverse events. Unrecognized tube misplacement or oesophageal intubation is associated with high prehospital morbidity. This study investigates the usability of supraglottic airway devices compared to ETI and the skill retention of 41 previously inexperienced paramedics following training using a manikin model. METHODS 41 paramedics participated in this study. None had prior experience in airway management, apart from bag-valve ventilation. After a standardised audio-visual lecture lasting 45min, the paramedics participated in a practical demonstration using the advanced patient simulator SimMan(®) (Laerdal Medical, Stavanger, Norway). Afterwards, paramedics were instructed to perform airway-management using seven different techniques to secure the airway (ETI, Laryngeal mask unique [LMA], Proseal, Laryngeal tube disposable [LT-D(®)], I-Gel(®), Combitube(®), and EasyTube(®)) following a randomized sequence. Participants underwent reassessment after 3 months without any further training or practice in airway-management. RESULTS During the initial training session, ETI was successfully performed in 78% of cases, while 3 months later the success rate was 58%. For the supraglottic airway devices, five out of six were successfully used by all paramedics at both time points, the exception being Proseal(®). Our data show successful skill retention (success rate: 100%) after 3 months for five out of six supraglottic airway devices. Time to ventilation (T3) was significantly less for LMA, LT-D(®) and I-Gel(®) at all time points compared to ETI. CONCLUSION ETI performed by inexperienced paramedics is associated with a low success rate. In contrast, supraglottic airway devices like LMA, LT-D(®), I-Gel(®), Combitube(®) and EasyTube(®) are fast, safe and easy-to-use. Within the limitations of a manikin-study, this study suggests that inexperienced medical staff might benefit from using supraglottic airway devices for emergency airway management.
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Affiliation(s)
- Kurt Ruetzler
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Austria
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Schellongowski P, Staudinger T, Kundi M, Laczika K, Locker GJ, Bojic A, Robak O, Fuhrmann V, Jäger U, Valent P, Sperr WR. Prognostic factors for intensive care unit admission, intensive care outcome, and post-intensive care survival in patients with de novo acute myeloid leukemia: a single center experience. Haematologica 2010; 96:231-7. [PMID: 21071501 DOI: 10.3324/haematol.2010.031583] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute myeloid leukemia is a life-threatening disease associated with high mortality rates. A substantial number of patients require intensive care. This investigation analyzes risk factors predicting admission to the intensive care unit in patients with acute myeloid leukemia eligible for induction chemotherapy, the outcome of these patients, and prognostic factors predicting their survival. DESIGN AND METHODS A total of 406 consecutive patients with de novo acute myeloid leukemia (15-89 years) were analyzed retrospectively. Markers recorded at the time of diagnosis included karyotype, fibrinogen, C-reactive protein, and Charlson comorbidity index. In patients requiring critical care, the value of the Simplified Acute Physiology Score II, the need for mechanical ventilation, and vasopressor support were recorded at the time of intensive care unit admission. The independent prognostic relevance of the parameters was tested by multivariate analysis. RESULTS Sixty-two patients (15.3%) required intensive care, primarily due to respiratory failure (50.0%) or life-threatening bleeding (22.6%). Independent risk factors predicting intensive care unit admission were lower fibrinogen concentration, the presence of an infection, and comorbidity. The survival rate was 45%, with the Simplified Acute Physiology Score II being the only independent prognostic parameter (P<0.05). Survival was inferior in intensive care patients compared to patients not admitted to an intensive care unit. However, no difference between intensive care and non-intensive care patients was found concerning continuous complete remission at 6 years or survival at 6 years in patients who survived the first 30 days after diagnosis (non-intensive care patients: 28%; intensive care patients: 20%, P>0.05). CONCLUSIONS Ongoing infections, low fibrinogen and comorbidity are predictive for intensive care unit admission in acute myeloid leukemia. Although admission was a risk factor for survival, continuous complete remission and survival of patients alive at day 30 were similar in patients who were admitted or not admitted to an intensive care unit.
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Affiliation(s)
- Peter Schellongowski
- Division of Hematology & Hemostaseology, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Abstract
We report the case of a 55-year-old male European who became septic after he returned from a four-week holiday to Uganda. Soon after, he was diagnosed with severe falciparum malaria and developed multi-organ failure. Due to the worsening condition of the patient, drotrecogin alfa (activated) was started, soon after which the patient's condition significantly improved. He returned home on day 36 after admission, without neurologic sequelae. Looking at those few cases of severe forms of malaria where drotrecogin alfa (activated) was successfully used, it should at least be considered for administration in patients with severe falciparum malaria with disseminated intravascular coagulation and cerebral involvement who do not respond to or deteriorate during standard treatment.
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Affiliation(s)
- O. Robak
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
- Resident, Intensive Care Unit
| | - A. Bojic
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
- Resident, Intensive Care Unit
| | - G. J. Locker
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
| | - K. Laczika
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
| | - M. Ramharter
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
- Resident, Division of Infectious Diseases and Tropical Medicine
| | - T. Staudinger
- Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria
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Haugk M, Robak O, Sterz F, Uray T, Kliegel A, Losert H, Holzer M, Herkner H, Laggner AN, Domanovits H. High acceptance of a home AED programme by survivors of sudden cardiac arrest and their families. Resuscitation 2006; 70:263-74. [PMID: 16828958 DOI: 10.1016/j.resuscitation.2006.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 01/19/2006] [Accepted: 03/16/2006] [Indexed: 11/15/2022]
Abstract
PURPOSE The feasibility and acceptance of providing sudden cardiac arrest survivors with life supporting first aid training and automated external defibrillators (AEDs) at their homes is unknown. Preliminary experiences are reported here. METHODS Trained medical students provided life supporting first aid courses including AED training to cardiac arrest survivors. Patients were asked to invite relatives and friends to such training sessions at their home. Laerdal Little Anne and Heartstart AED Trainer were used. An AED was placed at the patients' disposal. A refresher course took place 1 year later. Questionnaires were used to evaluate the project. RESULTS Since 1999, 88 families have been trained and provided with an AED. Immediately after the training 90% (66% "agree", 24% "maybe yes") believed they would perform first aid correctly, 1 year later 98% did so (68% "agree", 29% "maybe yes") (p=0.03). Families considered feeling much safer having an AED at home. The handling of an AED was regarded to be easy and AEDs would even be used on strangers. Only on one occasion an AED was used in a real emergency situation. CONCLUSION Providing patients and relatives with life support first aid and AED training at their homes is feasible and has raised no major objections by the family members. All have considered handling of an AED much simpler than providing basic life support and therefore none think that it would be a major problem to use it in case of an emergency. This still has to be proven.
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Affiliation(s)
- Moritz Haugk
- Department of Emergency Medicine, Medical University of Vienna, Austria
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