Cannulate, extubate, ambulate approach for extracorporeal membrane oxygenation for COVID-19

Hayanga, J.W. Awori; Kakuturu, Jahnavi; Dhamija, Ankit; Asad, Fatima; McCarthy, Paul; Sappington, Penny L.; Badhwar, Vinay

doi:10.1016/j.jtcvs.2022.02.049

Cited by 8 publications

(6 citation statements)

References 38 publications

(15 reference statements)

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“…Of these, 22 were excluded due to their focus on veno-arterial ECMO (V-A ECMO) or extracorporeal cardiopulmonary resuscitation (ECPR) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Fourteen studies were excluded for lack or scarcity of data on CytoSorb© use [ 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], four because of the lack of specific data for the ECMO subgroup [ 67 , 68 , 69 , 70 ], four because CytoSorb© was not used concomitantly with ECMO therapy [ 71 , 72 , 73 , 74 ], two because outcomes of interest for the simultaneous use of CytoSorb© and ECMO were not reported [ 75 , 76 ], and one because it focused on a different device [ 77 ]. One study was excluded because it only reported preliminary findings from other articles [ 78 ].…”

Section: Resultsmentioning

confidence: 99%

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Akil¹,

Napp

Rao

et al. 2022

JCM

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Acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Adjunct hemoadsorption is increasingly utilized to target underlying hyperinflammation derived from ARDS. This article aims to review available data on the use of CytoSorb© therapy in combination with V-V ECMO in severe ARDS, and to assess the effects on inflammatory, laboratory and clinical parameters, as well as on patient outcomes. A systematic literature review was conducted and reported in compliance with principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. When applicable, a before-and-after analysis for relevant biomarkers and clinical parameters was carried out. CytoSorb© use was associated with significant reductions in circulating levels of C-reactive protein and interleukin-6 (p = 0.039 and p = 0.049, respectively). Increases in PaO2/FiO2 reached significance as well (p = 0.028), while norepinephrine dosage reductions showed a non-significant trend (p = 0.067). Mortality rates in CytoSorb© patients tended to be lower than those of control groups of most included studies, which, however, were characterized by high heterogeneity and low power. In an exploratory analysis on 90-day mortality in COVID-19 patients supported with V-V ECMO, the therapy was associated with a significantly reduced risk of death. Based on the reviewed data, CytoSorb© therapy is able to reduce inflammation and potentially improves survival in ARDS patients treated with V-V ECMO. Early initiation of CytoSorb© in conjunction with ECMO might offer a new approach to enhance lung rest and promote recovery in patients with severe ARDS.

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Section: Resultsmentioning

confidence: 99%

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Akil¹,

Napp

Rao

et al. 2022

JCM

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“…Table 2 lists the cannulation criteria set by the ECMO team. 18 These criteria evolved during the course of the COVID-19 pandemic but reflect characteristics of patients most likely to survive to full recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Our program achieved the nation's highest published ECMO survival rate of COVID-19-infected patients (70%) during 2020 to 2021. 18 Those who survived were cannulated for a mean of 19 days, had an ICU length of stay averaging 23 days, and total hospital stay of 29 days on average. Most patients (51%) were able to be ambulatory while cannulated.…”

Section: Discussionmentioning

confidence: 99%

Cannulate, Extubate, Ambulate: How the Pandemic Accelerated Development and Implementation of Early Mobility for Patients Requiring Extracorporeal Membrane Oxygenation

DiVito,

Swisher,

Hayanga

2023

Cardiopulm Phys Ther J

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Objective: Extracorporeal membrane oxygenation (ECMO) is a lifesaving modality that was in great demand for persons with severe COVID-19 infection. Although mobility of these patients has previously been safely reported anecdotally, there were no established guidelines to implement in a greatly expanded patient population, as occurred in the pandemic period. We describe the development and implementation of a program (Cannulate, Extubate, Ambulate) for team-based safe mobilization. Methods: The 3-phase protocol advances based on patient alertness/ability to actively participate. A physical therapist determined initial stage and progression and recommended mobility activities for carryover by nurses and/or ECMO specialists between skilled sessions. Results: The mobility program has been successfully implemented for 104 patients with severe COVID-19 without significant adverse events. Most patients (51%) ambulated while cannulated, and 60% were able to discharge directly home after hospitalization. Conclusions: This safe, effective program allowed extension of physical therapy goals in a highly complex patient population during a time of very high demand. Making early mobility a team goal enhanced buy-in, instead of relying exclusively on rehabilitation providers for mobilization. Utilization of the Cannulate, Extubate, Ambulate program may assist other programs to minimize complications of immobility in the ECMO population.

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“…Anesthesiologists rose to the challenge as leaders in disaster response. 29,30 American Society of Anesthesiologists (ASA) leadership were invited to participate in the White House Coronavirus Task Force at the beginning of the pandemic (personal communication from Mary Dale Peterson, MD). According to the ASA 2020 Annual Report, "The White House publicly acknowledged ASA for leading efforts to convert anesthesia machines to ventilators.…”

Section: Anesthesiologists' Capacity As MCI Leadersmentioning

confidence: 99%

A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents

Gangadharan,

Hayanga,

Greenberg

et al. 2023

Anesthesia &Amp; Analgesia

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Disasters, both natural and man-made, continue to increase. In Spring 2023, a 3-hour workshop on mass casualty incidents was conducted at the Society for Pediatric Anesthesia-American Academy of Pediatrics Annual conference. The workshop used multiple instructional strategies to maximize knowledge transfer and learner engagement including minididactic sessions, problem-based learning discussions in 3 tabletop exercises, and 2 30-minute disaster scenarios with actors in a simulated hospital environment. Three themes became evident: (1) disasters will continue to impact hospitals and preparation is imperative, (2) anesthesiologists are extensively and comprehensively trained and their value is often underestimated as mass casualty incident responders, and (3) a need exists for longitudinal disaster preparedness education and training over the course of a career. In this special article, we have sought to further define the problem and evidence, the capacity of anesthesiologists as leaders in disaster preparedness, and the rationale for preparation with current best practices to guide how best to move forward.

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Cannulate, extubate, ambulate approach for extracorporeal membrane oxygenation for COVID-19

Cited by 8 publications

References 38 publications

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Use of CytoSorb© Hemoadsorption in Patients on Veno-Venous ECMO Support for Severe Acute Respiratory Distress Syndrome: A Systematic Review

Cannulate, Extubate, Ambulate: How the Pandemic Accelerated Development and Implementation of Early Mobility for Patients Requiring Extracorporeal Membrane Oxygenation

A Call to Action: Why Anesthesiologists Must Train, Prepare, and Be at the Forefront of Disaster Response for Mass Casualty Incidents

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