We demonstrate that the presence of an altered microbiome in severe OSA is associated with inflammatory markers. Further experimental approaches to explore causal links are needed.

Introduction: Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19), but there has been little evidence of its efficacy.We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID-19.Methods: All adult patients who were placed on ECMO for ARDS due to COVID-19 between April 2020 and June 2020 (during the first wave of COVID-19) were identified. The clinical characteristics and outcomes of these patients were analyzed with a specific focus on the differences between patients who survived to hospital discharge and those who did not.Results: In total, 20 COVID-19 patients were included in this study. All patients were placed on veno-veno ECMO. Comparing survivors and non-survivors, older age was found to be associated with hospital mortality (p = .02). The following complications were observed: renal failure requiring renal replacement therapy (35%, n = 7), bacteremia during ECMO (20%, n = 4), coinfection with bacterial pneumonia (15%, n = 3), cannula site bleeding (15%, n = 3), stroke (10%, n = 2), gastrointestinal bleeding (10%, n = 2), and liver failure (5%, n = 1). The complications associated with patient mortality were culture-positive septic shock (p = .01), culture-negative systemic inflammatory response syndrome (p = .01), and renal failure (p = .01). The causes of death were septic shock (44%, n = 4), culture-negative systemic inflammatory response syndrome (44%, n = 4), and stroke (11%, n = 1).Conclusions: Based on our experience, ECMO can improve refractory ARDS due to COVID-19 in select patients. Proper control of bacterial infections during COVID-19 immunomodulation therapy may be critical to improving survival.

Purpose: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as coronavirus disease 2019 ). We conducted this study to compare the outcomes of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19.Methods: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV-ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed.Results: A total of 28 COVID-19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p = .04). Thirty days survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p = .13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 vs. 12 days; p = .025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy before ECMO initiation (p < .001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%; p = .03) and bacterial pneumonia (36% vs. 6%; p = .024).Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.

Purpose: Extracorporeal membrane oxygenation (ECMO) is a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, also referred to as COVID-19). We conducted this study to compare the outcomes of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19. Materials and Methods: Patients in our institution with ARDS due to COVID-19 or influenza who were placed on ECMO between August 1, 2010 and September 15, 2020 were included in this comparative, retrospective study. To improve homogeneity, only VV -ECMO patients were analyzed. The clinical characteristics and outcomes were extracted and analyzed. Results: 28 COVID-19 patients and 17 influenza patients were identified and included. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p=0.04). 30-day survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p=0.13). COVID-19 patients spent a longer time on ECMO compared to flu patients (21 days vs. 12 days, p=0.025), and more COVID-19 patients (26/28 vs. 2/17) were on immunomodulatory therapy prior to ECMO initiation (p<0.001). COVID-19 patients had higher rates of new infections during ECMO (50% vs. 18%, p=0.03) and bacterial pneumonia (36% vs 6%, p=0.024). Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections.

Introduction Restrictive cardiomyopathy (RCM) and hypertrophic cardiomyopathy (HCM) are two disease processes that are known to progress to heart failure with preserved ejection fraction (HFpEF). Pharmacologic therapies for HFpEF have not improved patient outcomes or reduced mortality in this patient cohort; thus, there continues to be substantial interest in other treatment strategies, including surgical interventions and devices. In this article, we explore and report the current utility of percutaneous therapies and surgically implanted mechanical support in the treatment of patients with HFpEF. Results Treatment strategies include percutaneous interventions with interatrial shunts, left atrial assist devices (LAADs), and ventricular assist devices (VADs) in various configurations. Although VADs have been employed to treat patients with heart failure with reduced ejection fraction, their efficacy is limited in those with RCM and HCM. A left atrial‐to‐aortic VAD has been proposed to directly unload the left atrium, but data is limited. Alternatively, a LAAD could be placed in the mitral position and simultaneously unload the left atrium, while filling the left ventricle. Conclusion A left atrial assist device in the mitral position is a promising solution to address the hemodynamic abnormalities in RCM and HCM; these pumps, however, are still under development.

Extracorporeal membrane oxygenation (ECMO) is commonly used for refractory cardiac or respiratory failure. There are reported cases of successful use of ECMO in patients with septic shock; however, there is a lack of evidence to prove its overall efficacy. Thus, we conducted this study to analyze the relationship between sepsis and ECMO in our own patients. METHODS: 305 patients who were placed on ECMO between 2010 and 2020 were identified within an IRB-approved database. Their clinical outcomes were analyzed with a specific focus on patients who were septic before and after ECMO, defined as a positive blood culture. Group S was composed of patients who were septic before or during ECMO. Group N was all patients who were non-septic before and during ECMO. The primary outcomes compared between groups were ECMO survival and 30-day post-ECMO survival. RESULTS: Among the 305 patients on ECMO, 58 (19%) were in Group S and 247 (81%) were in Group N. ECMO survival rates were 45% in group S and 62% in Group N (p¼0.017). The 30-day survival rates were 36% and 47%, respectively (p¼0.12) CONCLUSIONS: Of our 305 patients, patients who were septic upon ECMO placement or those who developed sepsis during ECMO had worse ECMO survival rates than non-septic patients. CLINICAL IMPLICATIONS: Ultimately, patients who are septic or have a high probability of becoming septic may not be indicated for ECMO placement, and cautious administration of ECMO to these patients may be necessary.

Extracorporeal membrane oxygenation (ECMO) has historically been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to influenza and is currently being explored as a refractory treatment for ARDS due to COVID-19. We conducted this study to compare the outcomes in our institution of influenza patients treated with veno-venous-ECMO (VV-ECMO) to COVID-19 patients treated with VV-ECMO, during the first wave of COVID-19. Methods: All adult patients who were placed on VV-ECMO between March 1, 2016 and September 15, 2020 (encompassing the first wave of COVID-19) were identified within an IRB-approved database, and any patient with ARDS due to COVID-19 or influenza was included in this study. The clinical characteristics and outcomes of these patients were extracted and analyzed. Results: 28 COVID-19 patients and 17 influenza patients placed on VV-ECMO were identified and included in this study. ECMO survival rates were 68% (19/28) in COVID-19 patients and 94% (16/17) in influenza patients (p=0.04). 30-day survival rates after ECMO decannulation were 54% (15/28) in COVID-19 patients and 76% (13/17) in influenza patients (p=0.13). The COVID-19 patients had lower rates of pre-ECMO acute renal injury (29% vs. 59%, p=0.045), lower rates of coronary artery disease (0% vs. 18%, p=0.021), and a lower average body surface area (2.0 vs. 2.2, p=0.036). They were more likely to have ECMO initiated at an outside hospital (50% vs. 12%, p=0.009) and spend a longer time on ECMO (21 days vs. 12 days, p=0.025). COVID-19 patients had statistically higher complication rates of new infections during ECMO (50% vs. 18%, p=0.03), bacterial pneumonia (36% vs 6%, p=0.024), and blood culture-positive sepsis (32% vs. 6%, p=0.04). Conclusions: COVID-19 patients who were treated in our institution with VV-ECMO had statistically lower ECMO survival rates than influenza patients with the same treatment. It is possible that COVID-19 immunomodulation therapies may increase the risk of other superimposed infections, as COVID-19 patients developed new infections, sepsis, and bacterial pneumonia more frequently than influenza patients. However, more research is needed to better understand the true efficacy rates of ECMO in treating both influenza and COVID-19.

Introduction: Patients on continuous flow left ventricular assist devices (CF-LVADs) often require CF-LVAD exchange. The purpose of this study was to investigate the incidence of infection following CF-LVAD exchange performed for non-infectious indications. Methods: An electronic literature search was performed to identify all studies of patients undergoing CF-LVAD exchange for pump thrombosis or device malfunction. Of 2,698 articles identified, 6 studies with 81 total patients met the inclusion criteria. Cohort-level data were pooled for meta-analysis. Results: Mean patient age was 60 years (95% CI: 41–78), and 74% were male (95% CI: 61–84). Pump thrombosis was the most common indication for exchange in 70% of patients (95% CI: 47–86). Other indications were driveline fracture and electrical malfunction in 21% (95% CI: 5–56) and 12% (95% CI: 4–33) of patients, respectively. Prior to exchange, 95% of patients were on HeartMate II (HM2) LVADs (95% CI: 86–98) and average duration of support for these patients was 27.1 months (95% CI: 9.3–44.8). The majority were placed on a HM2 following exchange (88% (95% CI: 45–98)) versus HM3 (12% (95% CI: 2–55)). Follow-up was an average of 16.4 months (95% CI: 6.8–26.0). Following exchange, 16 of 81 patients developed infection, with pooled mean incidence of 24% (95% CI: 14–38). 30-day mortality was 14% (95% CI: 7–26). Survival at follow-up was 65% (95% CI: 52–76). Conclusions: Infection following CF-LVAD exchange can occur at rates higher than those observed with primary implantation; therefore, effective strategies need to implemented early and consistently to help lower infections rates and help improve outcomes following exchange.