Extracorporeal support to treat E-cigarette or vaping product use-associated lung injury (EVALI) during the coronavirus disease 2019 (COVID-19) pandemic

Hayanga, J.W. Awori; Hayanga, Heather K.; Dhamija, Ankit; Fugett, James H.; Cook, Chris C.; Powell, Douglas; McCarthy, Paul; Olfert, Mark; Badhwar, Vinay; Toker, Alper

doi:10.1016/j.xjtc.2020.05.015

Cited by 4 publications

(4 citation statements)

References 9 publications

(9 reference statements)

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“…Several factors made collection of additional cases challenging. First, the peak of EVALI coincided with the beginning of the COVID-19 pandemic, absorbing an incredible amount of bandwidth from the pulmonary, critical care, and ECLS clinical and research infrastructure universally (4, 41). Second, cross-country and cross-institutional collaboration, while extremely valuable, can be difficult from a legal and data-use agreement standpoint, and, unfortunately, a few investigators who were willing to collaborate were unable to gain institutional approval (42).…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Life Support for Respiratory Failure in Patients With Electronic Cigarette or Vaping Product Use–Associated Lung Injury

Gupta

Hayes

Hsu

et al. 2021

Critical Care Medicine

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Electronic cigarette or vaping product use-associated lung injury is a clinical entity that can lead to respiratory failure and death. Despite the severity of electronic cigarette or vaping product use-associated lung injury, the role of extracorporeal life support in its management remains unclear. Our objective was to describe the clinical characteristics and outcomes of patients with electronic cigarette or vaping product use-associated lung injury who received extracorporeal life support. DESIGN:We performed a retrospective review of records of electronic cigarette or vaping product use-associated lung injury patients who received extracorporeal life support. Standardized data were collected via direct contact with extracorporeal life support centers. Data regarding presentation, ventilatory management, extracorporeal life support details, and outcome were analyzed. SETTING:This was a multi-institutional, international case series with patients from 10 different institutions in three different countries. PATIENTS:Patients who met criteria for confirmed electronic cigarette or vaping product use-associated lung injury (based on previously reported diagnostic criteria) and were placed on extracorporeal life support were included. Patients were identified via literature review and by direct contact with extracorporeal life support centers. MEASUREMENTS AND MAIN RESULTS:Data were collected for 14 patients ranging from 16 to 45 years old. All had confirmed vape use within 3 months of presentation. Nicotine was the most commonly used vaping product. All patients had respiratory symptoms and radiographic evidence of bilateral pulmonary opacities. IV antibiotics and corticosteroids were universally initiated. Patients were intubated for 1.9 days (range, 0-6) prior to extracorporeal life support initiation. Poor oxygenation and ventilation were the most common indications for extracorporeal life support. Five patients showed evidence of ventricular dysfunction on echocardiography. Thirteen patients (93%) were placed on venovenous extracorporeal life support, and one patient required multiple rounds of extracorporeal life support. Total extracorporeal life support duration ranged from 2 to 37 days. Thirteen patients survived to hospital discharge; one patient died of septic shock. CONCLUSIONS:Electronic cigarette or vaping product use-associated lung injury can cause refractory respiratory failure and hypoxemia. These data suggest that venovenous extracorporeal life support can be an effective treatment option for profound, refractory respiratory failure secondary to electronic cigarette or vaping product use-associated lung injury.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal Life Support for Respiratory Failure in Patients With Electronic Cigarette or Vaping Product Use–Associated Lung Injury

Gupta

Hayes

Hsu

et al. 2021

Critical Care Medicine

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“…In this issue of the Journal , Hayanga and colleagues 3 reported a complex case of ALI during the early phase of the COVID-19 pandemic. A 30-year-old woman at 33 weeks of gestation, with a high index of suspicion for SARS-CoV-2 infection, presented with a rapidly progressive severe hypoxic ALI refractory to maximal therapy.…”

mentioning

confidence: 99%

“…Amid the new “clinical normal” imposed by the COVID-19 pandemic, the case report by Hayanga and colleagues 3 illustrates that cardiac surgeons, who remain the gatekeepers of mechanical circulatory support in most hospital systems, must remain sensitive to the panoply of causes of severe respiratory failure requiring veno-venous ECMO. An emerging indication, unfortunately obscured by the overwhelming global catastrophe of COVID-19, is vaping and e-cigarette–induced ALI, and must be evaluated in the differential diagnosis of severe refractory respiratory failure, even in patients with a high probability of exposure to SARS-CoV-2.…”

mentioning

confidence: 99%

Commentary: Veno-venous extracorporeal membrane oxygenation in areas with high coronavirus disease 2019 (COVID-19) burden: Other causes must still be ruled out

Kalavrouziotis

Mohammadi

2020

JTCVS Techniques

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“…In their article in this issue of JTCVS Techniques, Hayanga and colleagues 8 apply many of the aforementioned principles, including preparedness drills using high-fidelity scenarios with mock pumps and mannequins. This allowed for a reproducible response of all team members and procedures and also identified holes that otherwise might have been Through preparedness and practice, the ability to expeditiously put COVID patients on extracorporeal membrane oxygenation while keeping staff safe allows for the swift treatment of patients before a diagnosis is known.…”

mentioning

confidence: 99%

Commentary: “Preparedness in the time of COVID”: Implications for engagement of the health care team with acute respiratory failure

Demarest¹,

Tang²

2020

JTCVS Techniques

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E-cigarette, or vaping, products have been available for more than 10 years. These devices emit aerosols containing nicotine, flavoring, and often other additives, including tetrahydrocannabinol. They were initially lauded as lessharmful alternatives to inhalational tobacco products, but in 2019 there was a nationwide outbreak of e-cigarette or vaping product use-associated lung injury (EVALI), with more than 2500 hospitalizations and 60 deaths. 1 Patients with EVALI may present with tachycardia, tachypnea, hypoxia, leukocytosis, and chest computed tomography findings of bilateral ground-glass opacities. 2 EVALI ranges from a mild pneumonitis to lifethreatening acute respiratory distress syndrome (ARDS), with >30% of patients requiring intubation. 3 In cases of rapidly progressive ARDS, swift institution of extracorporeal membrane oxygenation (ECMO) can avoid lung injury associated with high-pressure ventilator settings, and lead to faster recovery. This seems to be particularly true for EVALI, with pulmonary infiltration resolving more expediently than in other etiologies of ARDS. 4 EVALI presentation can be difficult to distinguish from COVID-19, which could lead to diagnostic quandaries during this pandemic. Owing to the nascent experience with COVID-19, there is no strong consensus on the use of ECMO for patients with COVID-19, but the World Health

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Extracorporeal support to treat E-cigarette or vaping product use-associated lung injury (EVALI) during the coronavirus disease 2019 (COVID-19) pandemic

Abstract: See Commentaries on pages 385 and 387.

Cited by 4 publications

References 9 publications

Extracorporeal Life Support for Respiratory Failure in Patients With Electronic Cigarette or Vaping Product Use–Associated Lung Injury

Extracorporeal Life Support for Respiratory Failure in Patients With Electronic Cigarette or Vaping Product Use–Associated Lung Injury

Commentary: Veno-venous extracorporeal membrane oxygenation in areas with high coronavirus disease 2019 (COVID-19) burden: Other causes must still be ruled out

Commentary: “Preparedness in the time of COVID”: Implications for engagement of the health care team with acute respiratory failure

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