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A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management
(1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. W...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143287/ https://www.ncbi.nlm.nih.gov/pubmed/33919390 http://dx.doi.org/10.3390/membranes11050306 |
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author | Shah, Aakash Dave, Sagar Galvagno, Samuel George, Kristen Menne, Ashley R. Haase, Daniel J. McCormick, Brian Rector, Raymond Dahi, Siamak Madathil, Ronson J. Deatrick, Kristopher B. Ghoreishi, Mehrdad Gammie, James S. Kaczorowski, David J. Scalea, Thomas M. Menaker, Jay Herr, Daniel Tabatabai, Ali Krause, Eric |
author_facet | Shah, Aakash Dave, Sagar Galvagno, Samuel George, Kristen Menne, Ashley R. Haase, Daniel J. McCormick, Brian Rector, Raymond Dahi, Siamak Madathil, Ronson J. Deatrick, Kristopher B. Ghoreishi, Mehrdad Gammie, James S. Kaczorowski, David J. Scalea, Thomas M. Menaker, Jay Herr, Daniel Tabatabai, Ali Krause, Eric |
author_sort | Shah, Aakash |
collection | PubMed |
description | (1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients. |
format | Online Article Text |
id | pubmed-8143287 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-81432872021-05-25 A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management Shah, Aakash Dave, Sagar Galvagno, Samuel George, Kristen Menne, Ashley R. Haase, Daniel J. McCormick, Brian Rector, Raymond Dahi, Siamak Madathil, Ronson J. Deatrick, Kristopher B. Ghoreishi, Mehrdad Gammie, James S. Kaczorowski, David J. Scalea, Thomas M. Menaker, Jay Herr, Daniel Tabatabai, Ali Krause, Eric Membranes (Basel) Article (1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients. MDPI 2021-04-21 /pmc/articles/PMC8143287/ /pubmed/33919390 http://dx.doi.org/10.3390/membranes11050306 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Shah, Aakash Dave, Sagar Galvagno, Samuel George, Kristen Menne, Ashley R. Haase, Daniel J. McCormick, Brian Rector, Raymond Dahi, Siamak Madathil, Ronson J. Deatrick, Kristopher B. Ghoreishi, Mehrdad Gammie, James S. Kaczorowski, David J. Scalea, Thomas M. Menaker, Jay Herr, Daniel Tabatabai, Ali Krause, Eric A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management |
title | A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management |
title_full | A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management |
title_fullStr | A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management |
title_full_unstemmed | A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management |
title_short | A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management |
title_sort | dedicated veno-venous extracorporeal membrane oxygenation unit during a respiratory pandemic: lessons learned from covid-19 part ii: clinical management |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143287/ https://www.ncbi.nlm.nih.gov/pubmed/33919390 http://dx.doi.org/10.3390/membranes11050306 |
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