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dc.contributor.authorShah, Aakash
dc.contributor.authorDave, Sagar
dc.contributor.authorGalvagno, Samuel
dc.contributor.authorGeorge, Kristen
dc.contributor.authorMenne, Ashley R
dc.contributor.authorHaase, Daniel J
dc.contributor.authorMcCormick, Brian
dc.contributor.authorRector, Raymond
dc.contributor.authorDahi, Siamak
dc.contributor.authorMadathil, Ronson J
dc.contributor.authorDeatrick, Kristopher B
dc.contributor.authorGhoreishi, Mehrdad
dc.contributor.authorGammie, James S
dc.contributor.authorKaczorowski, David J
dc.contributor.authorScalea, Thomas M
dc.contributor.authorMenaker, Jay
dc.contributor.authorHerr, Daniel
dc.contributor.authorTabatabai, Ali
dc.contributor.authorKrause, Eric
dc.date.accessioned2021-05-05T15:05:39Z
dc.date.available2021-05-05T15:05:39Z
dc.date.issued2021-04-21
dc.identifier.urihttp://hdl.handle.net/10713/15572
dc.description.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.en_US
dc.description.urihttps://doi.org/10.3390/membranes11050306en_US
dc.language.isoenen_US
dc.publisherMDPI AGen_US
dc.relation.ispartofMembranesen_US
dc.subjectCOVID-19en_US
dc.subjectacute respiratory distress syndromeen_US
dc.subjectanticoagulationen_US
dc.subjectextracorporeal membrane oxygenationen_US
dc.subjectmechanical ventilationen_US
dc.subjectpneumothoraxen_US
dc.subjectsedationen_US
dc.subjecttracheostomyen_US
dc.titleA Dedicated Veno-Venous Extracorporeal Membrane Oxygenation Unit during a Respiratory Pandemic: Lessons Learned from COVID-19 Part II: Clinical Managementen_US
dc.typeArticleen_US
dc.identifier.doi10.3390/membranes11050306
dc.identifier.pmid33919390
dc.source.volume11
dc.source.issue5
dc.source.countrySwitzerland


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