Outcomes of Extubated COVID and Non-COVID Patients Receiving Awake Venovenous Extracorporeal Membrane Oxygenation
Payal Gurnani
- Vol. 68, Iss: 4, pp 478-485
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TLDR
In this article , the authors evaluated outcomes associated with an awake ECMO strategy in patients with acute respiratory distress syndrome (ARDS) receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO).Abstract:
Cessation of continuous analgesia and sedation in patients with acute respiratory distress syndrome (ARDS) receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO) facilitates early extubation, family, patient and provider engagement, and mobility. Outcomes associated with an awake ECMO strategy have not been well described in the literature. The purpose of this study was to evaluate outcomes in patients receiving this strategy. This was a retrospective review of ARDS patients receiving awake VV ECMO. The primary outcome was survival to hospital discharge. Secondary outcomes included days requiring ECMO, time from cannulation to extubation, complications, patients requiring tracheostomy, hospital and intensive care unit (ICU) length of stay (LOS), and discharge disposition. In a subgroup analysis, outcomes were compared between non-COVID and COVID ECMO patients. Sixty-two patients were included with a survival to hospital discharge of 85.5%. Days requiring ECMO was 33.0 (0.0-75.0) and cannulation to extubation was 6.0 (4.0-11.0). Three patients received a tracheostomy (4.8%). Bleeding and infection were reported in 80.6% and 82.3% of patients, respectively. Intensive care unit length of stay was 46.0 days (29.0-90.0) and hospital LOS was 51.0 days (32.0-91.0). Over half of the patients (51.6%) were discharged to an acute rehabilitation facility and 27.4% were discharged home. There was similar survival to hospital discharge between the COVID and non-COVID awake ECMO patients (85% in both groups, p = 1.000). This study highlights the impact of an awake ECMO approach on survival to hospital discharge. Future studies are needed to evaluate this approach as compared to current practice to determine if this should become the standard. read more
Citations
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Extracorporeal Membrane Oxygenation for COVID-19: A Systematic Review
TL;DR: It is suggested that ECMO remains a viable option for the management of COVID-19-associated acute respiratory distress syndrome for selected patients andMeta-analyses are warranted to obtain more conclusive results and assess the risk.
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Comparison of Sedation and Analgesia Requirements in Patients With SARS-CoV-2 Versus Non-SARS-CoV-2 Acute Respiratory Distress Syndrome on Veno-Venous ECMO
Mariah I Sigala,Diane Dreucean,Jesse E. Harris,Kevin R. Donahue,Fariedeh Bostan,Prakruthi Voore,Jose F Cuevas,Celia Morton +7 more
TL;DR: In this paper , the authors compared the analgosedation requirements in patients with acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO) support due to unique pharmacokinetic challenges.
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Developing Cardiothoracic Surgical Critical Care Intensivists: A Case for Distinct Training
TL;DR: In this paper , the shortcomings of the contemporary cardiothoracic surgical intensivist training standards are discussed and a list of desirable competencies that a trainee should develop to become a successful intensivist is presented.
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Extracorporeal Membrane Oxygenation Then and Now; Broadening Indications and Availability.
Blythe E Pollack,Roxanne Kirsch,Rachel L. Chapman,Robert Hyslop,Graeme MacLaren,Ryan P. Barbaro +5 more
TL;DR: Extracorporeal membrane oxygenation (ECMO) is a life support technology provided to children to support respiratory failure, cardiac failure, or cardiopulmonary resuscitation after failure of conventional management as discussed by the authors .
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TL;DR: In patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or hospital discharge were less than 40%.
Journal ArticleDOI
Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients.
Richard Cheng,Rory Hachamovitch,Michelle M. Kittleson,Jignesh Patel,Francisco A. Arabia,Jaime Moriguchi,Fardad Esmailian,Babak Azarbal +7 more
TL;DR: Although ECMO can improve survival of patients with advanced heart disease, there is significant associated morbidity with performance of this intervention.