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Vigneshwar NG, Masood MF, Vasic I, Krause M, Bartels K, Lucas MT, Bronsert M, Selzman CH, Thompson S, Rove JY, Reece TB, Cleveland JC, Pal JD, Fullerton DA, Aftab M. Venovenous extracorporeal membrane oxygenation support in patients with COVID-19 respiratory failure: A multicenter study. JTCVS Open 2022; 12:211-220. [PMID: 36097635 PMCID: PMC9451935 DOI: 10.1016/j.xjon.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 01/08/2023]
Abstract
Objective The COVID-19 pandemic presents a high mortality rate amongst patients who develop severe acute respiratory distress syndrome (ARDS). The purpose of this study was to evaluate the outcomes of venovenous extracorporeal membrane oxygenation (VV-ECMO) in COVID-19-related ARDS and identify the patients who benefit the most from this procedure. Methods Adult patients with COVID-19 and severe ARDS requiring VV-ECMO support at 4 academic institutions between March and October 2020 were included. Data were collected through retrospective chart reviews. Bivariate and multivariable analyses were performed with the primary outcome of in-hospital mortality. Results Fifty-one consecutive patients underwent VV-ECMO with a mean age of 50.4 years; 64.7% were men. Survival to hospital discharge was 62.8%. Median intensive care unit and hospitalization duration were 27.4 days (interquartile range [IQR], 17-37 days) and 34.5 days (IQR, 23-43 days), respectively. Survivors and nonsurvivors had a median ECMO cannulation time of 11 days (IQR, 8-18) and 17 days (IQR, 12-25 days). The average postdecannulation length of stay was 17.5 days (IQR, 12.4-25 days) for survivors and 0 days for nonsurvivors (IQR, 0-6 days). Only 1 nonsurvivor was able to be decannulated. Clinical characteristics associated with mortality between nonsurviors and survivors included increasing age (P = .0048), hemorrhagic stroke (P = .0014), and postoperative dialysis (P = .0013) were associated with mortality in a bivariate model and retained statistical significance in a multivariable model. Conclusions This multicenter study confirms the effectiveness of VV-ECMO in selected critically ill patients with COVID-19-related severe ARDS. The survival of these patients is comparable to non-COVID-19-related ARDS.
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Affiliation(s)
- Navin G. Vigneshwar
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Muhammad F. Masood
- Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo
| | - Ivana Vasic
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Martin Krause
- Department of Anesthesiology, University of San Diego, San Diego, Calif
| | - Karsten Bartels
- Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Neb
| | - Mark T. Lucas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Michael Bronsert
- Colorado Health Outcomes Program, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, Utah
| | - Shaun Thompson
- Division of Critical Care, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Neb
| | - Jessica Y. Rove
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Thomas B. Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Joseph C. Cleveland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Jay D. Pal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David A. Fullerton
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo,Address for reprints: Muhammad Aftab, MD, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, 12631 E 17th Ave, C-310, Room 6602, Aurora, CO 80045.
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Sen A, Blakeman S, DeValeria PA, Peworski D, Lanza LA, Downey FX, Alwardt CM, Dobberpuhl JG, DeMarco M, Callisen H, Shively J, McKay K, Singbartl K, Sell-Dottin KA, D’Cunha J, Patel BM. Practical Considerations for and Outcomes of Interfacility ECMO Transfer of Patients With COVID-19 During a Pandemic: Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2021; 5:525-531. [PMID: 33686378 PMCID: PMC7927641 DOI: 10.1016/j.mayocpiqo.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Interfacility transport of a critically ill patient with acute respiratory distress syndrome (ARDS) may be necessary for a higher level of care or initiation of extracorporeal membrane oxygenation (ECMO). During the COVID-19 pandemic, ECMO has been used for patients with severe ARDS with successful results. Transporting a patient after ECMO cannulation by the receiving facility brings forth logistic challenges, including availability of adequate personal protective equipment for the transport team and hospital capacity management issues. We report our designated ECMO transport team's experience of 5 patients with COVID-19-associated severe ARDS after cannulation at the referring facility. Focusing on transport-associated logistics, creation of checklists, and collaboration with emergency medical services partners is necessary for safe and good outcomes for patients while maintaining team safety.
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Affiliation(s)
- Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix
| | | | | | | | - Louis A. Lanza
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | | | - Cory M. Alwardt
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | | | | | | | | | - Kelly McKay
- Mayo Clinic Center for Military Medicine, Mayo Clinic Arizona, Phoenix
| | - Kai Singbartl
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | | | - Jonathan D’Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | - Bhavesh M. Patel
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix
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