Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic

Kichloo, Asim; Kumar, Akshay; Amir, Rawan; Aljadah, Michael; Farooqi, Najiha; Albosta, Michael; Singh, Jagmeet P.; Jamal, Shakeel; El-Amir, Zain; Kichloo, Akif Ahmed; Lone, Nazir

doi:10.5492/wjccm.v10.i1.1

Cited by 11 publications

(10 citation statements)

References 30 publications

(59 reference statements)

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“…If oxygen levels fall, respiratory management is required, but spontaneous breathing should be maintained as long as possible and reasonable. A number of approaches to support spontaneous breathing is available and has been comprehensively summarized elsewhere[ 10 ]. A schematic overview of the strategy for respiratory management in COVID-19 patients is presented in Figure 1 .…”

Section: Respiratory Management In Covid-19 Patientsmentioning

confidence: 99%

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

Bellgardt¹,

Özcelik²,

Breuer-Kaiser³

et al. 2021

WJCCM

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Coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS) is a severe complication of infection with severe acute respiratory syndrome coronavirus 2, and the primary cause of death in the current pandemic. Critically ill patients often undergo extracorporeal membrane oxygenation (ECMO) therapy as the last resort over an extended period. ECMO therapy requires sedation of the patient, which is usually achieved by intravenous administration of sedatives. The shortage of intravenous sedative drugs due to the ongoing pandemic, and attempts to improve treatment outcome for COVID-19 patients, drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy. Administration of volatile anesthetics requires an appropriate delivery. Commercially available ones are the anesthetic gas reflection systems AnaConDa ® and MIRUS TM , and each should be combined with a gas scavenging system. In this review, we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS. We focus particularly on the technical details of administration of volatile anesthetics. Furthermore, we describe the advantages of inhaled sedation and volatile anesthetics, and we discuss the limitations as well as the requirements for safe application in the clinical setting.

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Section: Respiratory Management In Covid-19 Patientsmentioning

confidence: 99%

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

Bellgardt¹,

Özcelik²,

Breuer-Kaiser³

et al. 2021

WJCCM

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“…7 El incremento de citocinas puede causar vasodilatación y aumento de la permeabilidad de los vasos que conduce a hipoxemia, aumento del trabajo respiratorio y síndrome de dificultad respiratoria (SDRA]. 8 De ahí que, en la cronología de la enfermedad, parece que después de 10 días de infección, si no se ha controlado, comienza el desarrollo de la hiperinflamación sistémica, ya bien establecida entre los 15 y 28 días del inicio de la infección y con la progresión a fibrosis pulmonar. 5 Las condiciones respiratorias severas son: disnea, frecuencia respiratoria ≥ 30/min, saturación de oxígeno sanguíneo < 93%, razón de la presión parcial de oxígeno/fracción inspirada de oxígeno (PaO 2 /FiO 2 ) < 300 mm Hg, 9 aunque existe un reporte que indica que hipoxemia con saturación de oxígeno < 90%, hasta 88%, a menudo es bien tolerada en pacientes con COVID-19 menores de 60 años.…”

Section: Receptor Eca2unclassified

Tratamiento para la COVID-19 (II) ¿Cuál es la fisiopatología y etapas clínicas?

Sánchez-Rodrı́guez

2021

CyRS

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Boletín de la Evidencia FISIOPATOLOGÍALa infección producida por el SARS-CoV-2, fue denominada por la OMS COVID-19 por el acrónimo de su nombre en inglés Coronavirus Disease of 2019, tiene como principal característica provocar un síndrome respiratorio agudo severo en algunos de los pacientes que han sido infectados. Al ser una enfermedad de reciente aparición, a pesar de que ha surgido mucha información científica y se han realizado investigaciones para caracterizar al virus, establecer la historia natural de la enfermedad, los mecanismos molecu-

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“…The use of ECMO as a therapeutic option for severe respiratory and/or cardiac failure refractory to conventional approaches has increased 4-fold over the past few decades with a paradigm shift from rescue therapy to earlier administration. [1][2][3][4] Although ECMO may improve survival in patients with severe adult respiratory failure compared with conventional therapy, it is associated with significant adverse events including major bleeding, thrombosis, and circuit complications. [5][6][7] Patients requiring ECMO may experience vessel wall injury, hypercoagulability, and circulatory stasis leading to hemostatic changes.…”

Section: Introductionmentioning

confidence: 99%

Correlation between partial thromboplastin time and thromboelastography in adult critically ill patients requiring bivalirudin for extracorporeal membrane oxygenation

et al. 2023

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Study Objective Thromboelastography (TEG) offers a more dynamic assessment of hemostasis over activated partial thromboplastin time (aPTT). However, the clinical utility of TEG in monitoring bivalirudin during extracorporeal membrane oxygenation (ECMO) remains unknown. The purpose of this study was to evaluate the correlation between aPTT and TEG in adult ECMO patients anticoagulated with bivalirudin. Design Multicenter, retrospective, cohort study conducted over a 2‐year period. Setting Two academic university medical centers (Banner University Medical Center) in Phoenix and Tucson, AZ. Patients Adult patients requiring ECMO and bivalirudin therapy with ≥1 corresponding standard TEG and aPTT plasma samples drawn ≤4 h of each other were included. The primary endpoint was to determine the correlation coefficient between the standard TEG reaction (R) time and bivalirudin aPTT serum concentrations. Measurements and Main Results A total of 104 patients consisting of 848 concurrent laboratory assessments of R time and aPTT were included. A moderate correlation between TEG R time and aPTT was demonstrated in the study population (r = 0.41; p < 0.001). Overall, 502 (59.2%) concurrent assessments of TEG R time and aPTT values showed agreement on whether they were sub‐, supra‐, or therapeutic according to the institution's classification for bivalirudin. The 42.2% (n = 271/642) discordant TEG R times among “therapeutic” aPTT were almost equally distributed between subtherapeutic and supratherapeutic categories. Conclusions Moderate correlation was found between TEG R time and aPTT associated with bivalirudin during ECMO in critically ill adults. Further research is warranted to address the optimal test to guide clinical decision‐making for anticoagulation dosing in ECMO patients.

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Utilization of extracorporeal membrane oxygenation during the COVID-19 pandemic

Cited by 11 publications

References 30 publications

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

Extracorporeal membrane oxygenation and inhaled sedation in coronavirus disease 2019-related acute respiratory distress syndrome

Tratamiento para la COVID-19 (II) ¿Cuál es la fisiopatología y etapas clínicas?

Correlation between partial thromboplastin time and thromboelastography in adult critically ill patients requiring bivalirudin for extracorporeal membrane oxygenation

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