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Constantine L, DeCicco D, Carpenter RD, Pockl S, Seachrist KB, Navia RO. Healthcare Providers' Experiences of Caring for Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation Support. Am J Hosp Palliat Care 2024; 41:568-573. [PMID: 37218036 PMCID: PMC10203850 DOI: 10.1177/10499091231178503] [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] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Coronavirus 19 (COVID-19) affected healthcare workers (HCW) in ways more than increasing the volume of patients needing care. Increased numbers of patients at younger ages required support with extracorporeal membrane oxygenation (ECMO). Providing this care requires an interdisciplinary team. AIM This study explored the experiences of HCW caring for patients with COVID-19 on ECMO. METHODS Face-to-face semi-structured interviews were conducted via videoconferencing, and transcript comparison was used for the analysis. FINDINGS Open coding of the data generated 7 categories including (1) fearing the unknown, (2) confronting challenges in patient and/or family interactions, (3) encountering barriers to providing care, (4) facing moral distress, (5) working through exhaustion, (6) persevering by strengthening teamwork, (7) and acknowledging frustration with non-believers. DISCUSSION HCW balanced pessimism and optimism while caring for patient with COVID-19 on ECMO. They used negative experiences caring for these patients to strength teamwork and bonding among peers. CONCLUSION The practice implications for caring for patients with COVID-19 on ECMO include viligance by clinician and organization to protect the wellbeing of healthcare providers, particularly in ICU and ECMO units were moral distress and burnout can be high.
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Affiliation(s)
- Lori Constantine
- Division of Geriatric, Palliative
Medicine and Hospice, Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
- West Virginia University School of
Nursing, Morgantown, WV, USA
- Dynamic Health, EBSCO Information
Services, Ipswich, MA, USA
| | - Danielle DeCicco
- Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
| | | | - Stephanie Pockl
- Division of Geriatric, Palliative
Medicine and Hospice, Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
- Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
| | - Katherine B. Seachrist
- Division of Geriatric, Palliative
Medicine and Hospice, Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
- Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
| | - R. Osvaldo Navia
- Division of Geriatric, Palliative
Medicine and Hospice, Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
- Department of Medicine, West Virginia University
Hospital, JW Ruby Memorial, Morgantown, WV, USA
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Laskey D, Housman B, Dawodu G, Scheinin S. Intraoperative Extracorporeal Support during Lung Transplantation: Not Just for the High-Risk Patient. J Clin Med 2023; 13:192. [PMID: 38202198 PMCID: PMC10779858 DOI: 10.3390/jcm13010192] [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: 09/24/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The use of intraoperative mechanical support during lung transplantation has traditionally been a controversial topic. Trends for intraoperative mechanical support strategies swing like a pendulum. Historically, cardiopulmonary bypass (CPB) was the modality of choice during transplantation. It provides full hemodynamic support including oxygenation and decarboxylation. Surgical exposure is improved by permitting the drainage of the heart and provides more permissive retraction. CPBs contain drainage reservoirs with hand-held pump suction catheters promoting blood conservation through collection and re-circulation. But CPB has its disadvantages. It is known to cause systemic inflammation and coagulopathy. CPB requires high doses of heparinization, which increases bleeding risks. As transplantation progressed, off-pump transplantation began to trend as a preferable option. ECMO, however, has many of the benefits of CPB with less of the risk. Outcomes were improved with ECMO compared to CPB. CPB has a higher blood transfusion requirement, a higher need for post-operative ECMO support, a higher re-intubation rate, high rates of kidney injury and need for hemodialysis, longer ICU stays, higher incidences of PGD grade 3, as well as overall in-hospital mortality when compared with ECMO use. The focus now shifts to using intraoperative mechanical support to protect the graft, helping to reduce ischemia-reperfusion injury and allowing for lung protective ventilator settings. Studies show that the routine use of ECMO during transplantation decreases the rate of primary graft dysfunction and many adverse outcomes including ventilator time, need for tracheostomy, renal failure, post-operative ECMO requirements, and others. As intraoperative planned ECMO is considered a safe and effective approach, with improved survival and better overall outcomes compared to both unplanned ECMO implementation and off-pump transplantation, its routine use should be taken into consideration as standard protocol.
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Affiliation(s)
- Daniel Laskey
- Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, One Gustave L. Levy Place, Box 1023, New York, NY 10029, USA; (B.H.); (G.D.); (S.S.)
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3
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Meng FQ, Wang B, Chen X, Su ML, Wu PL, Wang Y. Case report: Transcatheter edge-to-edge repair with MitraClip for acute mitral regurgitation after myocardial infarction. Medicine (Baltimore) 2023; 102:e36230. [PMID: 38050305 PMCID: PMC10695537 DOI: 10.1097/md.0000000000036230] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION Acute mitral regurgitation (MR) due to papillary muscle rupture (PMR) is a rare but lethal mechanical complication of acute myocardial infarction (MI). The treatment of patients with post-MI PMR, especially those with cardiogenic shock, presents great challenges due to the high surgical risk. PATIENT CONCERNS We report an 80-year-old woman with a history of hypertension and diabetes mellitus, presented with chest pain. Despite an early percutaneous coronary intervention and transfer to the intensive care unit, her general condition and hemodynamic parameters continued to deteriorate rapidly. DIAGNOSIS Evidenced by electrocardiogram, echocardiogram and coronary angiography, the patient was diagnosed with acute lateral and posterior ST-segment elevation MI, cardiogenic shock, PMR, severe MR, and pulmonary edema. INTERVENTIONS The patient received percutaneous mitral valve repair with MitraClip (Abbott Vascular, Santa Clara, CA, USA) supported by extracorporeal membranous oxygenation and intra-aortic balloon pump. OUTCOMES The patient was discharged with relief of heart failure symptoms, reduced MR, and recovery of cardiac function, remaining in a stable condition in New York Heart Association class I after 15-month outpatient follow up. CONCLUSION Transcatheter edge-to-edge repair with MitraClip can serve as a viable alternative to surgery in reducing MR in post-MI PMR patients at high surgical risk.
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Affiliation(s)
- Fan-Qi Meng
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Bin Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Xiang Chen
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Mao-Long Su
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Peng-Long Wu
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian Province, China
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Housman B, Laskey D, Dawodu G, Scheinin S. Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient. J Clin Med 2023; 12:6789. [PMID: 37959256 PMCID: PMC10649201 DOI: 10.3390/jcm12216789] [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: 09/23/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Introduction: The optimal treatment for Secondary Pulmonary Hypertension from End-Stage Lung Disease remains controversial. Double Lung Transplantation is widely regarded as the treatment of choice as it eliminates all diseased parenchyma and introduces a large volume of physiologically normal allograft. By comparison, the role of single lung transplantation for pulmonary hypertension (PAH) is less clear. The remaining diseased lung will limit clinical improvements and permit downstream sequelae; including residual cough, recurrent infection, and continued pulmonary hypertension. But not every patient can undergo DLT. Advanced age, frailty, co-morbid conditions, and limited availability of organs will all affect surgical candidacy and can offset the benefits of double lung procedures. Studies that compare SLT and DLT do not commonly explore the utility of single lung procedures even though multiple theoretical advantages exist; including reduced waiting times, less waitlist mortality, fewer surgical complications, and lower operative mortality. Worse, multiple forms of publication and selection bias may favor DLT in registry-based studies. In this review, we present the prevailing literature on single and double lung transplants in patients with secondary pulmonary hypertension and clarify the potential utility of these procedures. Materials and Methods: A PubMed search for English-language articles exploring single and double lung transplants in the setting of secondary pulmonary hypertension was conducted from 1990 to 2023. Key words included "single lung transplant", "double lung transplant", "pulmonary hypertension", "rejection", "complications", "extracorporeal membranous oxygenation", "death", and all appropriate Boolean operators. We prioritized research from retrospective studies that evaluated clinical outcomes from single centers. Conclusions: The question is not whether DLT is better at resolving lung disease; instead, we must ask if SLT is an acceptable form of therapy in a select group of high-risk patients. Further research should focus on how best to identify recipients that may benefit from each type of procedure, and the clinical utility of perioperative VA ECMO.
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Affiliation(s)
- Brian Housman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY 10029, USA; (D.L.); (G.D.); (S.S.)
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Ishisaka Y, Watanabe A, Takagi H, Takayama H, Wiley J, Kuno T. Use of Perioperative Extracorporeal Membranous Oxygenation in Pulmonary Endarterectomy Cases: A Systematic Review and Meta-Analysis. J Intensive Care Med 2023; 38:785-796. [PMID: 37226426 DOI: 10.1177/08850666231178262] [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] [Indexed: 05/26/2023]
Abstract
Introduction: Pulmonary endarterectomy (PEA) is known to be a curative intervention for chronic thromboembolic pulmonary hypertension (CTEPH). Its complications include endobronchial bleeding, persistent pulmonary arterial hypertension, right ventricular failure, and reperfusion lung injury. Extracorporeal membranous oxygenation (ECMO) is a perioperative salvage method for PEA. Although risk factors and outcomes have been reported in several studies, overall trends remain unknown. We performed a systematic review and study-level meta-analysis to understand the outcomes of ECMO utilization in the perioperative period of PEA. Methods: We performed a literature search with PubMed and EMBASE on 11/18/2022. We included studies including patients who underwent perioperative ECMO in PEA. We collected data including baseline demographics, hemodynamic measurements, and outcomes such as mortality and weaning of ECMO and performed a study-level meta-analysis. Results: Eleven studies with 2632 patients were included in our review. ECMO insertion rate was 8.7% (225/2,625, 95% CI 5.9-12.5) in total, VV-ECMO was performed as the initial intervention in 1.1% (41/2,625, 95% CI 0.4-1.7) (Figure 3), and VA-ECMO was performed as an initial intervention in 7.1% (184/2,625, 95% CI 4.7-9.9). Preoperative hemodynamic measurements showed higher pulmonary vascular resistance, mean pulmonary arterial pressure, and lower cardiac output in the ECMO group. Mortality rates were 2.8% (32/1238, 95% CI: 1.7-4.5) in the non-ECMO group and 43.5% (115/225, 95% CI: 30.8-56.2) in the ECMO group. The proportion of patients with successful weaning of ECMO was 72.6% (111/188, 95% CI: 53.4-91.7). Regarding complications of ECMO, the incidence of bleeding and multi-organ failure were 12.2% (16/79, 95% CI: 13.0-34.8) and 16.5% (15/99, 95% CI: 9.1-28.1), respectively. Conclusion: Our systematic review showed a higher baseline cardiopulmonary risk in patients with perioperative ECMO in PEA, and its insertion rate was 8.7%. Further studies that compare the use of ECMO in high-risk patients who undergo PEA are anticipated.
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Affiliation(s)
- Yoshiko Ishisaka
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth, Israel
| | - Atsuyuki Watanabe
- Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Hisato Takagi
- Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Hiroo Takayama
- Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Jose Wiley
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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Sklienka P, Frelich M, Burša F. Patient Self-Inflicted Lung Injury-A Narrative Review of Pathophysiology, Early Recognition, and Management Options. J Pers Med 2023; 13:593. [PMID: 37108979 PMCID: PMC10146629 DOI: 10.3390/jpm13040593] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
Patient self-inflicted lung injury (P-SILI) is a life-threatening condition arising from excessive respiratory effort and work of breathing in patients with lung injury. The pathophysiology of P-SILI involves factors related to the underlying lung pathology and vigorous respiratory effort. P-SILI might develop both during spontaneous breathing and mechanical ventilation with preserved spontaneous respiratory activity. In spontaneously breathing patients, clinical signs of increased work of breathing and scales developed for early detection of potentially harmful effort might help clinicians prevent unnecessary intubation, while, on the contrary, identifying patients who would benefit from early intubation. In mechanically ventilated patients, several simple non-invasive methods for assessing the inspiratory effort exerted by the respiratory muscles were correlated with respiratory muscle pressure. In patients with signs of injurious respiratory effort, therapy aimed to minimize this problem has been demonstrated to prevent aggravation of lung injury and, therefore, improve the outcome of such patients. In this narrative review, we accumulated the current information on pathophysiology and early detection of vigorous respiratory effort. In addition, we proposed a simple algorithm for prevention and treatment of P-SILI that is easily applicable in clinical practice.
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Affiliation(s)
- Peter Sklienka
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 17. listopadu 1790, 70800 Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
- Institute of Physiology and Pathophysiology, Department of Intensive Care Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Michal Frelich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 17. listopadu 1790, 70800 Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
| | - Filip Burša
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 17. listopadu 1790, 70800 Ostrava, Czech Republic
- Department of Intensive Medicine, Emergency Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
- Institute of Physiology and Pathophysiology, Department of Intensive Care Medicine and Forensic Studies, Faculty of Medicine, University of Ostrava, Syllabova 19, 70300 Ostrava, Czech Republic
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7
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Kim H, Song J, Kang IS. Percutaneous coronary intervention in a 4-month-old infant for stenosis of both coronary arteries after arterial switch operation for transposition of the great arteries. Cardiol Young 2021; 31:2019-21. [PMID: 33998432 DOI: 10.1017/S1047951121001876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present a case of percutaneous coronary intervention in a 4-month-old infant with both severe coronary stenosis and acute heart failure after arterial switch operation for transposition of the great arteries. Under extracorporeal membrane oxygenation, balloon angioplasty of the left coronary artery with a 2.0 × 15-mm balloon and stent implantation on the right coronary artery with a 2.25 × 26-mm stent were performed successfully. Echocardiography after the intervention showed recovered cardiac function and no complications.
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8
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Alam L, Lasam G, Fishberg R, Powell D. Acute Severe Mitral Regurgitation Secondary to Ischemic Papillary Muscle Rupture: A Case Report. Cureus 2021; 13:e13996. [PMID: 33880313 PMCID: PMC8053317 DOI: 10.7759/cureus.13996] [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] [Indexed: 11/24/2022] Open
Abstract
Mitral valve rupture secondary to ischemic papillary muscle necrosis is rare in the contemporary era due to improved revascularization techniques. However, when it does occur, prompt diagnosis and urgent surgical intervention can be lifesaving. A 69-year-old male with morbid obesity, hypothyroidism, and a family history of coronary artery disease presented to the hospital with chest pain and dyspnea that began five hours prior. He had an acute infero-postero-lateral myocardial infarction due to total occlusion of the left circumflex artery that was revascularized with the deployment of a drug-eluting stent. Two days after the myocardial infarction, the patient had an episode of ventricular tachycardia. He subsequently went into respiratory distress from flash pulmonary edema and developed cardiogenic shock due to acute mitral valve rupture. The patient underwent surgical mitral valve replacement, extracorporeal membranous oxygenation (ECMO), and hemodialysis. His course was complicated by an acute lower gastrointestinal bleed that progressed into multiorgan failure and eventually his demise. This case highlights the need to include papillary muscle rupture high on the differential when evaluating a hemodynamically unstable patient in the setting of an acute myocardial infarction (MI). Rapid diagnosis by urgent bedside echocardiogram and surgical intervention is crucial.
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Affiliation(s)
- Loba Alam
- Internal Medicine, Overlook Medical Center, Summit , USA
| | | | | | - David Powell
- Cardiology, Overlook Medical Center, Summit , USA
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Meers JB, Nanda NC, Watts TE, Prejean S, Hoopes CW, Lenneman A, Ahmed MI. Utility of transesophageal echocardiography to assess real time left atrial pressure changes and dynamic mitral regurgitation following placement of transseptal multistage venous cannula for systemic venous drainage and indirect left ventricular venting in venoarterial extracorporeal membrane oxygenation. Echocardiography 2021; 38:493-499. [PMID: 33619808 DOI: 10.1111/echo.14990] [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: 11/07/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 11/28/2022] Open
Abstract
A patient with heart failure due to nonischemic cardiomyopathy presented as a transfer to our institution following peripheral (femoral) venoarterial (VA) extracorporeal membrane oxygenation (ECMO) placement. With peripheral VA ECMO cannulation, the patient continued to have unstable ventricular tachyarrhythmias. Echocardiography demonstrated left ventricular (LV) dilation and severe mitral regurgitation (MR) with clinical and chest X-ray evidence of pulmonary edema. To provide venous drainage and simultaneous decompression of the left atrium (LA) and thereby indirect LV venting, a single multistage venous cannula was placed across the inter-atrial septum (IAS) using the previously described left atrial venoarterial (LA-VA) ECMO cannulation technique. Two- and three-dimensional (3D) transesophageal echocardiography (TEE) demonstrated utility in guiding cannula placement into the appropriate position and providing real time assessment of ventricular decompression and MR severity. There was subsequent improvement in pulmonary edema. This case is thought to be the first demonstration of real time resolution of pulmonary venous flow reversal in a patient undergoing LA-VA ECMO cannulation. This demonstration offers important mechanistic insight into some of the potential benefits of such an approach.
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Affiliation(s)
- Jacob Bradley Meers
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Navin C Nanda
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Thomas Evan Watts
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Shane Prejean
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Charles W Hoopes
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Andrew Lenneman
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Mustafa I Ahmed
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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Yun JH, Hong SB, Jung SH, Kang PJ, Sung H, Kim MN, Kim SH, Lee SO, Choi SH, Woo JH, Kim YS, Chong YP. Epidemiology and Clinical Characteristics of Bloodstream Infection in Patients Under Extracorporeal Membranous Oxygenation. J Intensive Care Med 2020; 36:1053-1060. [PMID: 33375874 DOI: 10.1177/0885066620985538] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bloodstream infection (BSI) is an important complication of extracorporeal membranous oxygenation (ECMO) and a major cause of mortality. This study evaluated the epidemiological and clinical characteristics of BSI that occur during ECMO application according to microbial etiology. METHODS Adult patients who underwent ECMO from January 2009 to December 2016 were retrospectively analyzed for BSI episodes at a 2,700-bed, tertiary center. Epidemiological and clinical characteristics and outcomes of BSI were evaluated and were compared for etiologic groups (gram-positive cocci, gram-negative rods, and fungi groups). Risk factors for 14-day mortality were analyzed. RESULTS A total of 1,100 patients underwent ECMO during the study period, and 65 BSI episodes occurred in 61 patients. The BSI incidence was 8.3 episodes/1,000 ECMO days, which significantly decreased over time (P = 0.03), primarily in gram-positive cocci BSI. Gram-positive cocci, gram-negative rods, and fungi accounted for 38%, 40%, and 22% of the 73 blood isolates, respectively. Baseline characteristics were comparable between groups. Catheter-related infection (CRI) and pneumonia were the most common sources of BSI; 52% of gram-positive cocci BSIs and 79% of fungi BSIs were caused by CRI, and 75% of gram-negative BSIs by pneumonia. Patients with gram-negative rods BSI died more frequently and earlier than those with other BSIs. Independent risk factors for 14-day mortality were older age and gram-negative rods BSI. CONCLUSIONS The decreased BSI incidence during ECMO was mainly because of the decrease of gram-positive cocci BSI. The high early mortality of gram-negative rods BSI makes prevention and adequate treatment necessary.
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Affiliation(s)
- Ji Hyun Yun
- Department of Infectious Diseases, 119754Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.,Department of Infectious Diseases, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Bum Hong
- Department of Pulmonary and Critical Care Medicine, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Pil Je Kang
- Department of Thoracic and Cardiovascular Surgery, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Infectious Diseases, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, 65526Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Zimmermann M, Vallier S, Sanchez BG, Agossou M, Venissac N. Tracheal obstruction due to tumour: use of veno-venous extracorporeal membrane oxygenation during rigid bronchoscopy. Anaesth Rep 2020; 8:120-122. [PMID: 33089217 DOI: 10.1002/anr3.12064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2020] [Indexed: 12/19/2022] Open
Abstract
Tracheal tumour is rare but can lead to upper airway obstruction and acute respiratory distress. Its management includes surgical resection, radiotherapy or interventional bronchoscopy. Ventilation or difficulties with tracheal intubation can occur during the peri-operative course resulting in serious adverse consequences. We report the case of an 83-year-old man with an obstructive tracheal chondrosarcoma resected by rigid bronchoscopy undergoing veno-venous extracorporeal membrane oxygenation. Such support should be considered when the patient's airway patency cannot be ensured by conventional methods.
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Affiliation(s)
- M Zimmermann
- Department of Thoracic and Cardiovascular Surgery University Hospital of Martinique Fort-De-France France
| | - S Vallier
- Department of Anaesthesiology and Reanimation University Hospital of Martinique Fort-De-France France
| | - B G Sanchez
- Department of Thoracic and Cardiovascular Surgery University Hospital of Martinique Fort-De-France France
| | - M Agossou
- Pneumology University Hospital of Martinique Fort-De-France France
| | - N Venissac
- Department of Thoracic and Cardiovascular Surgery University Hospital of Martinique Fort-De-France France
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12
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Iwashita M, Waqanivavalagi S, Merz T, Jones P. Eligibility criteria for extracorporeal cardiopulmonary resuscitation at Auckland City Hospital: A retrospective cohort study. Emerg Med Australas 2020; 32:960-966. [PMID: 33021065 DOI: 10.1111/1742-6723.13649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising adjunct to routine advanced cardiac life support. Growing worldwide interest in ECPR-use has seen more tertiary centres offering ECPR programmes. New Zealand's nationwide extracorporeal membranous oxygenation service is provided at Auckland City Hospital (ACH). Despite the potential benefits of ECPR, it is currently only offered on an ad hoc basis. It remains unknown whether ACH would manage sufficient numbers of patients to warrant an ECPR programme. METHODS A 12-month retrospective cohort study of the medical records of patients who were managed for cardiac arrest in the resuscitation room of the ED was conducted. Patient characteristics and clinical outcomes were analysed descriptively and audited against a unique set of criteria for a hypothetical ECPR programme. RESULTS Between 1 July 2018 and 30 June 2019, 286 patients died or had a cardiac arrest for which they were managed at ACH. Sixty-five of these patients had an in-hospital cardiac arrest in the ED. Seven (10.8%) of these patients were deemed eligible for hypothetical ECPR. Only one of these seven patients survived to hospital discharge with full neurological recovery. CONCLUSIONS An ECPR programme at ACH using standardised and agreed criteria may benefit a small number of patients and improve rates of survival to hospital discharge with preservation of neurological function. An ECPR guideline would help clarify for referring services cases that are appropriate for extracorporeal membranous oxygenation consideration, rather than discussing on an ad hoc basis.
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Affiliation(s)
- Michael Iwashita
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Steve Waqanivavalagi
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Tobias Merz
- Cardiothoracic and Vascular Intensive Care Unit, Auckland District Health Board, Auckland, New Zealand
| | - Peter Jones
- School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,Adult Emergency Department, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
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Sato H, Kyan R, Uemura S, Toyo Y, Wada K, Nomura K, Bunya N, Narimatsu E. Usefulness of venoarterial extracorporeal membranous oxygenation for fatal cibenzoline succinate poisoning. Acute Med Surg 2020; 7:e507. [PMID: 32431847 PMCID: PMC7231569 DOI: 10.1002/ams2.507] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/21/2020] [Accepted: 03/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The effect of venoarterial extracorporeal membranous oxygenation (V‐A ECMO), plasma exchange (PE), and direct hemoperfusion (DHP) for fatal cibenzoline succinate poisoning is unclear. We report a rare case of severe cibenzoline succinate poisoning along with cardiac arrest, wherein the patient was managed with V‐A ECMO, PE, and DHP. We also measured the blood levels of cibenzoline succinate frequently. Case Presentation A 51‐year‐old woman had a refractory cardiac arrest after cibenzoline succinate ingestion. We initiated V‐A ECMO, PE, and DHP. Plasma exchange did not improve clinical manifestations. Her clinical condition improved during DHP, but there was no evidence about removal of drugs. On day 3, DHP and ECMO were terminated. On day 9, she was transferred to another hospital without arrhythmia recurrence. Conclusion Venoarterial ECMO is effective in cases of cibenzoline succinate poisoning‐related cardiac dysfunction or cardiac arrest. No evidence was obtained for the effects of PE and DHP.
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Affiliation(s)
- Hiroki Sato
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Ryoko Kyan
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Shuji Uemura
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Yoshitake Toyo
- Division of Hospital Pharmacy Sapporo Medical University Sapporo Japan
| | - Kenshiro Wada
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Kazuhito Nomura
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Naofumi Bunya
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine Sapporo Medical University Sapporo Japan
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14
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Rollo D, Atkinson P, Mekwan J, Lutchmedial S, Middleton J, French J, Chanyi S, Gould J, Kovacs G, Légaré JF, Tutschka M, Fraser J, Howlett M. How Feasible is Extracorporeal Cardiopulmonary Resuscitation in a Medium Urban Population Centre? Cureus 2019; 11:e6324. [PMID: 31938615 PMCID: PMC6946035 DOI: 10.7759/cureus.6324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/23/2022] Open
Abstract
Background Patients suffering from out-of-hospital cardiac arrest (OHCA) experience poor survival and neurological outcomes, with rates remaining relatively unchanged despite advancements. Extracorporeal membrane oxygenation (ECMO), termed extracorporeal cardiopulmonary resuscitation (ECPR) in arrests, may offer improved outcomes. We developed local screening criteria for ECPR and then estimated the frequency of use by applying those criteria retrospectively to a cardiac arrest database. The purpose was to determine if an ECPR program is feasible in a medium urban population centre in Atlantic Canada. Methods A three-round modified Delphi survey, building upon data from a literature review, was conducted in collaboration with external experts. The resulting selection criteria for potential ECPR candidates were applied to a pre-existing local cardiac arrest database, supplemented by health records review, identifying potential candidates eligible for ECPR. Results Consensus inclusion criteria included witnessed cardiac arrest, age <70, refractory arrest, no-flow time <10min, total downtime <60min, and presumed cardiac or selected non-cardiac etiologies. Consensus exclusion criteria were an unwitnessed arrest, asystole, and select etiologies and comorbidities. Simplified criteria were developed to facilitate emergency medical services transport. Historically, 20.0% (95% CI 16.2-24.3%) of OHCA would be transported to the Emergency Department (ED), with 4.9% (95% CI 3.0% to 7.6%) qualifying for ECPR. Conclusion Despite conservative estimates based upon historically small numbers of select cardiac arrest patients meeting eligibility for transport and initiation of ECPR, a dedicated program may be feasible in our regional hospital setting. Patient care volumes suggest it would not be resource intensive yet would be sufficiently busy to maintain competency.
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Affiliation(s)
- Derek Rollo
- Family Medicine, Saint John Regional Hospital, Saint John, CAN
| | - Paul Atkinson
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
| | - Jay Mekwan
- Emergency Medicine, Horizon Health Network, Saint John, CAN
| | - Sohrab Lutchmedial
- Cardiology, New Brunswick Heart Centre, Saint John Regional Hospital / Dalhousie University, Saint John, CAN
| | - Joanna Middleton
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
| | - James French
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
| | - Steve Chanyi
- Cardiac/Thoracic/Vascular Surgery, Saint John Regional Hospital, Saint John, CAN
| | - James Gould
- Emergency Medicine, Queen Elizabeth II Health Science Center / Dalhousie University, Halifax, CAN
| | - George Kovacs
- Emergency Medicine, Dalhousie University, Halifax, CAN
| | - Jean-François Légaré
- Cardiac Surgery, Saint John Regional Hospital / Dalhousie University, Saint John, CAN
| | - Mark Tutschka
- Critical Care Medicine, Saint John Regional Hospital / Dalhousie University, Saint John, CAN
| | | | - Michael Howlett
- Emergency Medicine, Saint John Regional Hospital, Saint John, CAN
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Abstract
RATIONALE H7N9 infection causes acute respiratory distress syndrome with high mortality. The use of glucocorticoids in the acute phase lessened inflammatory responses. Some case reports suggested that secondary organizing pneumonia (SOP) could occur at the recovery stage of the influenza virus infection, and the treatment with glucocorticoid was effective. However, the reports of organizing pneumonia after H7N9 infection are lacking. This study reported a patient with H7N9 virus infection who presented a suspected SOP during the recovery stage. PATIENT CONCERN A 68-year-old woman who was diagnosed with H7N9 viral pneumonia. After standard antiviral treatment, venous-venous extracorporeal membranous oxygenation (VV-ECMO) and other supportive treatment, the antigen in the alveolar lavage fluid turned negative, and the shadow in the lung was partially absorbed. However, the imaging manifestations were deteriorated at 3 weeks after disease onset, presented as exudation and consolidation shadow distributed under the pleura and along the bronchial vascular bundles. The oxygenation could not be improved. Repeated sputum, alveolar lavage fluid, and blood pathogen examinations showed negative results. Broad-spectrum anti-infective treatment was ineffective. However, the autoantibodies (ANA, anti-SSA/Ro60, anti-SSA/Ro52) were detected. DIAGNOSIS SOP was considered. INTERVENTIONS Glucocorticoid treatment begun at week 4 from the disease onset. The regimen was methylprednisolone at an initial dose of 40 mg twice a day for 1 week, tapering within 70 days until total withdrawal. OUTCOMES The oxygenation was rapidly improved after initiation of methylprednisolone. The shadow in the lung gradually resolved, and the patient was discharged after improvement of the disease condition. The clinical disease course, imaging findings, and treatment effects in the previous cases of SOP after influenza virus infection were similar to those in this case, suggesting the occurrence of SOP after H7N9 virus infection. LESSONS Organizing pneumonia might occur during the recovery stage of influenza virus infection. When the clinical symptoms do not improve and the shadow in the lung shows no obvious absorption after elimination of the H7N9 influenza virus, or the clinical symptoms are aggravated again after improvement, the probability of transforming into the organizing pneumonia should be taken into consideration.
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Affiliation(s)
| | | | | | - Jiahao Su
- Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan, China
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Kiamanesh O, Vu EN, Webber DL, Lau E, Kapeluto JE, Stuart H, Wood DA, Wong GC. Pheochromocytoma-Induced Takotsubo Syndrome Treated With Extracorporeal Membrane Oxygenation: Beware of the Apical Sparing Pattern. JACC Case Rep 2019; 1:85-90. [PMID: 34316755 PMCID: PMC8301256 DOI: 10.1016/j.jaccas.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/06/2019] [Revised: 06/16/2019] [Accepted: 06/19/2019] [Indexed: 12/01/2022]
Abstract
A 45-year-old female presents with suspected acute myocardial infarction with cardiogenic shock requiring mechanical circulatory support. Pheochromocytoma-induced atypical Takotsubo syndrome is diagnosed. Clinicians should suspect high catecholamine states as a cause of the basal subtype of atypical Takotsubo syndrome. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Omid Kiamanesh
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Erik N. Vu
- Division of Critical Care Medicine, University of British Columbia, Vancouver, Canada
| | - Douglas L. Webber
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Edgar Lau
- Department of Medicine, Richmond General Hospital, Richmond, Canada
| | | | - Heather Stuart
- Division of General Surgery, University of British Columbia, Vancouver, Canada
| | - David A. Wood
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Graham C. Wong
- Division of Cardiology, University of British Columbia, Vancouver, Canada
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de St Maurice AM, Bridges BC, Rycus PT, Fonnesbeck CJ, Fleming GM, Halasa NB. Global Trends in Extracorporeal Membranous Oxygenation Use and Survival of Patients With Influenza-Associated Illness. Pediatr Crit Care Med 2016; 17:876-83. [PMID: 27427879 DOI: 10.1097/PCC.0000000000000843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To determine the overall use of extracorporeal membranous oxygenation for influenza-associated illness and describe risk factors associated with mortality in these patients. DESIGN Retrospective multicenter cohort analysis. SETTING The international Extracorporeal Life Support Organization database was queried for patients with influenza-associated illness on extracorporeal membranous oxygenation from 1992 to 2014. PATIENTS In total, 1,654 patients with influenza-associated illness on extracorporeal membranous oxygenation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Demographic and clinical data collected included age, type of support, duration of support, type of microbial codetection, complications, and survival status at discharge. The primary outcome of interest was survival to hospital discharge. From 1992 to 2014, 1,688 (3%) of the 61,336 extracorporeal membranous oxygenation runs were due to influenza-associated illness reflecting 1,654 unique patients: 30 (2%) were neonates, 521 (31%) were pediatric patients, and 1,103 (67%) were adults. Extracorporeal membranous oxygenation use for influenza-associated illness increased from 1992 to 2014, with a marked increase in use after the 2009 H1N1 pandemic. Survival to hospital discharge of patients with influenza-associated illness on extracorporeal membranous oxygenation was 63% and was not affected by bacterial codetection. However, when patients with Staphylococcus aureus codetection were compared with those with another bacterial codetection, their survival to hospital discharge was significantly lower (52% vs 67%; p < 0.01). In a logistic regression model, the effect of S. aureus on in-hospital mortality varied by age group, with younger patients with S. aureus having increased in-hospital mortality. CONCLUSIONS Extracorporeal membranous oxygenation use for individuals with influenza increased over time, particularly after the 2009 H1N1 pandemic, most notably among older adults. Survival to hospital discharge for patients with influenza on extracorporeal membranous oxygenation was slightly higher than survival to hospital discharge for respiratory illness due to any cause. Bacterial codetection was common among patients with influenza on extracorporeal membranous oxygenation and was associated with increased days on extracorporeal membranous oxygenation but not increased mortality. Only S. aureus codetection in children was associated with increased in-hospital mortality.
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