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SARS-CoV-2 and ECMO: early results and experience
INTRODUCTION: In this paper, we describe our experience and early outcomes with critically unwell severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients who required extracorporeal membrane oxygenation (ECMO). We present our standard practices around ECMO decision-making, retrieval, c...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Singapore
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683277/ https://www.ncbi.nlm.nih.gov/pubmed/33250591 http://dx.doi.org/10.1007/s12055-020-01084-y |
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author | Akhtar, Waqas Olusanya, Olusegun Baladia, Marta Montero Young, Harriet Shah, Sachin |
author_facet | Akhtar, Waqas Olusanya, Olusegun Baladia, Marta Montero Young, Harriet Shah, Sachin |
author_sort | Akhtar, Waqas |
collection | PubMed |
description | INTRODUCTION: In this paper, we describe our experience and early outcomes with critically unwell severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients who required extracorporeal membrane oxygenation (ECMO). We present our standard practices around ECMO decision-making, retrieval, cannulation, ventilation, anticoagulation, tracheostomy, imaging and steroids. METHODS: A retrospective cohort study using data from the hospital notes on all SARS-CoV-2 patients who required extracorporeal support at St Bartholomew’s Hospital between 1 March 2020 and 31 July 2020. In total, this included 18 patients over this time period. RESULTS: In total, 18 patients were managed with extracorporeal support and of these 14 survived (78%) with 4 deaths (22%). The mean duration from hospital admission to intubation was 4.1 ± 3.4 days, mean time from intubation to ECMO 2.3 ± 2 days and mean run on ECMO 17.7 ± 9.4 days. Survivor mean days from intubation to extubation was 20.6 ± 9.9 days and survivor mean days from intubation to tracheostomy decannulation 46.6 ± 15.3 days. Time from hospital admission to discharge in survivors was a mean of 57.2 ± 25.8 days. Of the patients requiring extracorporeal support, the initial mode was veno-venous (VV) in 15 (83%), veno-arterial (VA) in 2 (11%) and veno-venous-arterial (VVA) in 1 (6%). On VV extracorporeal support, 2 (11%) required additional VVA. Renal replacement therapy was required in 10 (56%) of the patients. Anticoagulation target anti-Xa of 0.2–0.4 was set, with 10 (56%) patients having a deep vein thrombosis or pulmonary embolism detected and 2 (11%) patients suffering an intracranial haemorrhage. Tracheostomy was performed in 9 (50%) of the patients and high-dose methylprednisolone was given to 7 (39%) of the patients. CONCLUSION: In our cohort of patients with severe SARS-CoV-2 respiratory failure, a long period of invasive ventilation and extracorporeal support was required but achieving good outcomes despite this. There was a significant burden of thromboembolic disease and renal injury. A significant proportion of patients required tracheostomy and steroids to facilitate weaning. |
format | Online Article Text |
id | pubmed-7683277 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Singapore |
record_format | MEDLINE/PubMed |
spelling | pubmed-76832772020-11-24 SARS-CoV-2 and ECMO: early results and experience Akhtar, Waqas Olusanya, Olusegun Baladia, Marta Montero Young, Harriet Shah, Sachin Indian J Thorac Cardiovasc Surg Original Article INTRODUCTION: In this paper, we describe our experience and early outcomes with critically unwell severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients who required extracorporeal membrane oxygenation (ECMO). We present our standard practices around ECMO decision-making, retrieval, cannulation, ventilation, anticoagulation, tracheostomy, imaging and steroids. METHODS: A retrospective cohort study using data from the hospital notes on all SARS-CoV-2 patients who required extracorporeal support at St Bartholomew’s Hospital between 1 March 2020 and 31 July 2020. In total, this included 18 patients over this time period. RESULTS: In total, 18 patients were managed with extracorporeal support and of these 14 survived (78%) with 4 deaths (22%). The mean duration from hospital admission to intubation was 4.1 ± 3.4 days, mean time from intubation to ECMO 2.3 ± 2 days and mean run on ECMO 17.7 ± 9.4 days. Survivor mean days from intubation to extubation was 20.6 ± 9.9 days and survivor mean days from intubation to tracheostomy decannulation 46.6 ± 15.3 days. Time from hospital admission to discharge in survivors was a mean of 57.2 ± 25.8 days. Of the patients requiring extracorporeal support, the initial mode was veno-venous (VV) in 15 (83%), veno-arterial (VA) in 2 (11%) and veno-venous-arterial (VVA) in 1 (6%). On VV extracorporeal support, 2 (11%) required additional VVA. Renal replacement therapy was required in 10 (56%) of the patients. Anticoagulation target anti-Xa of 0.2–0.4 was set, with 10 (56%) patients having a deep vein thrombosis or pulmonary embolism detected and 2 (11%) patients suffering an intracranial haemorrhage. Tracheostomy was performed in 9 (50%) of the patients and high-dose methylprednisolone was given to 7 (39%) of the patients. CONCLUSION: In our cohort of patients with severe SARS-CoV-2 respiratory failure, a long period of invasive ventilation and extracorporeal support was required but achieving good outcomes despite this. There was a significant burden of thromboembolic disease and renal injury. A significant proportion of patients required tracheostomy and steroids to facilitate weaning. Springer Singapore 2020-11-24 2021-01 /pmc/articles/PMC7683277/ /pubmed/33250591 http://dx.doi.org/10.1007/s12055-020-01084-y Text en © Indian Association of Cardiovascular-Thoracic Surgeons 2020 |
spellingShingle | Original Article Akhtar, Waqas Olusanya, Olusegun Baladia, Marta Montero Young, Harriet Shah, Sachin SARS-CoV-2 and ECMO: early results and experience |
title | SARS-CoV-2 and ECMO: early results and experience |
title_full | SARS-CoV-2 and ECMO: early results and experience |
title_fullStr | SARS-CoV-2 and ECMO: early results and experience |
title_full_unstemmed | SARS-CoV-2 and ECMO: early results and experience |
title_short | SARS-CoV-2 and ECMO: early results and experience |
title_sort | sars-cov-2 and ecmo: early results and experience |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683277/ https://www.ncbi.nlm.nih.gov/pubmed/33250591 http://dx.doi.org/10.1007/s12055-020-01084-y |
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