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    A Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Management

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    Author
    Shah, Aakash
    Dave, Sagar
    Galvagno, Samuel
    George, Kristen
    Menne, Ashley R
    Haase, Daniel J
    McCormick, Brian
    Rector, Raymond
    Dahi, Siamak
    Madathil, Ronson J
    Deatrick, Kristopher B
    Ghoreishi, Mehrdad
    Gammie, James S
    Kaczorowski, David J
    Menaker, Jay
    Herr, Daniel
    Tabatabai, Ali
    Krause, Eric
    Scalea, Thomas
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    Date
    2021-04-21
    Journal
    Membranes
    Publisher
    MDPI AG
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.3390/membranes11050306
    Abstract
    (1) Background: COVID-19 acute respiratory distress syndrome (CARDS) has several distinctions from traditional acute respiratory distress syndrome (ARDS); however, patients with refractory respiratory failure may still benefit from veno-venous extracorporeal membrane oxygenation (VV-ECMO) support. We report our challenges caring for CARDS patients on VV-ECMO and alterations to traditional management strategies. (2) Methods: We conducted a retrospective review of our institutional strategies for managing patients with COVID-19 who required VV-ECMO in a dedicated airlock biocontainment unit (BCU), from March to June 2020. The data collected included the time course of admission, VV-ECMO run, ventilator length, hospital length of stay, and major events related to bleeding, such as pneumothorax and tracheostomy. The dispensation of sedation agents and trial therapies were obtained from institutional pharmacy tracking. A descriptive statistical analysis was performed. (3) Results: Forty COVID-19 patients on VV-ECMO were managed in the BCU during this period, from which 21 survived to discharge and 19 died. The criteria for ECMO initiation was altered for age, body mass index, and neurologic status/cardiac arrest. All cannulations were performed with a bedside ultrasound-guided percutaneous technique. Ventilator and ECMO management were routed in an ultra-lung protective approach, though varied based on clinical setting and provider experience. There was a high incidence of pneumothorax (n = 19). Thirty patients had bedside percutaneous tracheostomy, with more procedural-related bleeding complications than expected. A higher use of sedation was noted. The timing of decannulation was also altered, given the system constraints. A variety of trial therapies were utilized, and their effectiveness is yet to be determined. (4) Conclusions: Even in a high-volume ECMO center, there are challenges in caring for an expanded capacity of patients during a viral respiratory pandemic. Though institutional resources and expertise may vary, it is paramount to proceed with insightful planning, the recognition of challenges, and the dynamic application of lessons learned when facing a surge of critically ill patients.
    Keyword
    COVID-19
    acute respiratory distress syndrome
    anticoagulation
    extracorporeal membrane oxygenation
    mechanical ventilation
    pneumothorax
    sedation
    tracheostomy
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/15572
    ae974a485f413a2113503eed53cd6c53
    10.3390/membranes11050306
    Scopus Count
    Collections
    UMB Open Access Articles
    UMB Coronavirus Publications

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