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Martin AK, Shah SZ, Guru PK, Chaudhary S, Franco PM, Makey I, Fritz AV, Pham SM, Thomas M. Multidisciplinary Approach for Lung Transplantation due to COVID-19. Mayo Clin Proc Innov Qual Outcomes 2022; 6:200-208. [PMID: 35281693 PMCID: PMC8904149 DOI: 10.1016/j.mayocpiqo.2022.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Indexed: 12/26/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), a novel etiology of end-stage lung disease, has resulted in major disruptions to the process of health care delivery worldwide. These disruptions have led to team-based innovations globally, resulting in a broad range of new processes in cardiopulmonary perioperative management. A key intersection of multidisciplinary teamwork and COVID-19 is found in lung transplantation, in which diverse teams collaborate throughout the perioperative period to achieve optimal outcomes. In this article, we describe the multidisciplinary approach taken by Mayo clinic in Florida to manage patients with COVID-19 presenting for lung transplantation.
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Key Words
- ARDS, acute respiratory distress syndrome
- CAD, coronary artery disease
- COVID-19, coronavirus disease 2019
- ECMO, extracorporeal membrane oxygenation
- ESLD, end-stage lung disease
- ICU, intensive care unit
- MCF, Mayo clinic in Florida
- MDT, multidisciplinary team
- OR, operating room
- PCR, polymerase chain reaction
- POD, postoperative day
- PPE, personal protective equipment
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VA, veno-arterial
- VV, veno-venous
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Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic in Florida, Jacksonville, FL
| | - Sadia Z Shah
- Department of Transplantation, Mayo Clinic in Florida, Jacksonville, FL
| | - Pramod K Guru
- Department of Critical Care, Mayo Clinic in Florida, Jacksonville, FL
| | - Sanjay Chaudhary
- Department of Critical Care, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Ian Makey
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic in Florida, Jacksonville, FL
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic in Florida, Jacksonville, FL
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Choudhary M, Chen Y, Friedman O, Cuk N, Ben-Shlomo A. Pheochromocytoma Crisis Presenting With ARDS Successfully Treated With ECMO-Assisted Adrenalectomy. AACE Clin Case Rep 2021; 7:310-314. [PMID: 34522771 PMCID: PMC8426613 DOI: 10.1016/j.aace.2021.03.008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/19/2023] Open
Abstract
Objective Pheochromocytoma (PCC) crisis caused by acute catecholamine release from an adrenal PCC or extra-adrenal paraganglioma can be difficult to diagnose and may require an unconventional management strategy to achieve good outcomes. We describe a case of PCC crisis presenting with acute respiratory distress syndrome (ARDS) that resolved with stabilization on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) during adrenalectomy. Case Description A 30-year-old man with a history of severe alcohol use disorder and a prior hospital admission for alcohol withdrawal syndrome presented with sudden-onset hemoptysis, altered mental status, and severe dyspnea that rapidly deteriorated to ARDS requiring ECMO support. He demonstrated hemodynamic collapse after cannulation for VV-ECMO and stabilized after conversion to veno-arterial-ECMO, but ARDS persisted and he developed acute renal failure. Computed tomography without contrast done as part of work-up for a presumed infection revealed a 6.9 × 6.4 cm right adrenal mass suspicious for pheochromocytoma. Plasma and random urine metanephrine levels were markedly elevated. ARDS persisted despite α- and β-adrenoreceptor blockade, and he underwent laparoscopic right adrenalectomy with VV-ECMO support. Pathology confirmed PCC with intermediate risk for malignancy. Postoperatively, he was weaned off respiratory and renal support within 10 days, showed rapid clinical improvement, and was discharged 1 month later. Conclusion This case highlights diagnostic and management challenges associated with patients with PCC crisis presenting with ARDS. A multidisciplinary team approach is critical to identifying appropriate treatment strategies.
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Affiliation(s)
- Manita Choudhary
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yufei Chen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Oren Friedman
- Women's Guild Lung Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Natasha Cuk
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anat Ben-Shlomo
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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Zern EK, Ramirez PR, Rubin J, Rosenfield K, Manning P, Raz Y, Funamoto M, D'Alessandro D, Crowley JC, Shelton K. Severe Tricuspid Valve Endocarditis: A Tale of 2 Circuits. JACC Case Rep 2021; 3:1343-1349. [PMID: 34505066 PMCID: PMC8414435 DOI: 10.1016/j.jaccas.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 10/31/2022]
Abstract
A 25-year-old woman with severe tricuspid valve endocarditis and septic pulmonary emboli required VA-ECMO for recurrent hypoxemia-induced cardiac arrest. We present the clinical challenges requiring ECMO circuit reconfiguration and a percutaneous approach for vegetation debulking. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Emily K Zern
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paolo R Ramirez
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Jonah Rubin
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Rosenfield
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patrick Manning
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yuval Raz
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Masaki Funamoto
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David D'Alessandro
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jerome C Crowley
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Shelton
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Hennon TR, Yu KOA, Penque MD, Abdul-Aziz R, Chang AC, McGreevy MB, Pastore JV, Prout AJ, Schaefer BA, Alibrahim OS, Gomez-Duarte OG, Hicar MD. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves. Prog Pediatr Cardiol 2021; 62:101407. [PMID: 34121829 PMCID: PMC8179839 DOI: 10.1016/j.ppedcard.2021.101407] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023]
Abstract
Multisystem inflammatory syndrome of children (MIS-C) continues to be a highly concerning diagnosis in those recently infected with SARS-CoV-2. The diagnosis of MIS-C cases will likely become even more challenging as vaccine uptake and natural immunity in previously infected persons leads to lower circulating rates of SARS-CoV-2 infection and will make cases sporadic. Febrile children presenting with cardiac dysfunction, symptoms overlapping Kawasaki disease or significant gastrointestinal complaints warrant a thorough screen in emergency departments, urgent care centers, and outpatient pediatric or family medicine practices. An increased index of suspicion and discussion regarding higher level of care (transferring to pediatric tertiary care centers or to intensive care) continues to be recommended. Herein we outline a broad approach with a multidisciplinary team for those meeting the case definition and believe such an approach is crucial for successful outcomes.
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Key Words
- AP, approved
- ASO, anti-streptolysin O
- BNP, brain-natriuretic peptide
- CDC, Center for Disease Control
- COVID-19
- COVID-19, coronavirus disease 2019
- CRP, C-reactive protein
- CXCL10, C-X-C-motif chemokine ligand 10
- DCBLD2, Discoidin, CUB and LCCL domain-containing protein 2
- E, envelope protein
- E.U., European Union
- ECMO, extracorporeal membrane oxygenation
- EKG, electrocardiogram
- EM, emergency use
- FDA, US Food and Drug Authority
- Fever
- GI, gastrointestinal
- IL, interleukin
- IVIG, intravenous immunoglobulin G
- Inflammation
- KD, Kawasaki disease
- LDH, lactate dehydrogenase
- LFTs, liver function tests
- M, membrane protein
- MIS-C
- MIS-C, Multisystem Inflammatory Syndrome in Children
- Mpred, methylprednisolone
- NP, Nucleoprotein
- PCR, polymerase chain reaction
- PT, prothrombin time
- PTT, partial thromboplastin time
- Pediatric
- RBD, receptor binding domain
- SARS-CoV-2
- TE, thromboembolic events
- TNF, tumor necrosis factor
- TWEAK, TNF-like weak inducer of apoptosis
- U.S., United States of America
- VA, veno-arterial
- VLPs, virus-like particles
- VTE, venous thromboembolic events
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Affiliation(s)
- Teresa R Hennon
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Karl O A Yu
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Michelle D Penque
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Rabheh Abdul-Aziz
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Arthur C Chang
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Megan B McGreevy
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - John V Pastore
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Andrew J Prout
- Wayne State University School of Medicine, Detroit, MI, United States of America.,Children's Hospital of Michigan, Detroit, MI, United States of America
| | - Beverly A Schaefer
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Omar S Alibrahim
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Oscar G Gomez-Duarte
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Mark D Hicar
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.,John R. Oishei Children's Hospital, Buffalo, NY, United States of America
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Hennon TR, Penque MD, Abdul-Aziz R, Alibrahim OS, McGreevy MB, Prout AJ, Schaefer BA, Ambrusko SJ, Pastore JV, Turkovich SJ, Gomez-Duarte OG, Hicar MD. COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach. Prog Pediatr Cardiol 2020; 57:101232. [PMID: 32837142 PMCID: PMC7244417 DOI: 10.1016/j.ppedcard.2020.101232] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Key Words
- ASO, antistreptolysin O
- BNP, brain-natriuretic peptide
- CBC, complete blood count
- CDC, Center for Disease Control
- COVID-19
- COVID-19, severe viral respiratory infection caused by SARS-CoV-2
- CRP, C-reactive protein
- CSS, cytokine storm syndrome
- ECMO, extracorporeal membrane oxygenation
- Fever
- GI, gastrointestinal
- HLH, hemophagocytic lymphohistiocytosis
- ICU, intensive care unit
- IVIG, intravenous immunoglobulin
- Inflammation
- KD, Kawasaki disease
- LDH, lactate dehydrogenase
- LFTs, liver function tests
- MAS, macrophage activation syndrome
- MIS-C
- MIS-C, Multisystem Inflammatory Syndrome in Children
- PCAID, Pediatric COVID-19 Associated Inflammatory Disorder
- PMIS, Pediatric Multisystem Inflammatory Syndrome
- PT, prothrombin Time
- PTT, partial Thromboplastin Time
- Pediatric
- SARS-CoV-2
- TNF, tumor necrosis factor
- VA, veno-arterial
- VTE, venous thromboembolic events
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Affiliation(s)
- Teresa R. Hennon
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Michelle D. Penque
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Rabheh Abdul-Aziz
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Omar S. Alibrahim
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Megan B. McGreevy
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Andrew J. Prout
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Beverly A. Schaefer
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Steven J. Ambrusko
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - John V. Pastore
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Stephen J. Turkovich
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Oscar G. Gomez-Duarte
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States of America
- John R. Oishei Children's Hospital, Buffalo, NY, United States of America
| | - Mark D. Hicar
- Corresponding author at: 1001 Main Street, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, United States of America.
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