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Performing bedside tracheostomy on COVID patient. Appropriate PPE is critical for any contact with patients with confirmed or suspected COVID-19. During the tracheostomy, ECMO flow and sweep are increased and the ventilator is intermittently paused when the airway is open to help prevent aerosolization. COVID, coronavirus disease; ECMO, extracorporeal membrane oxygenation; PPE, personal protective equipment.
Context in source publication
Context 1
... to ensure correct donning and doffing procedures. The additional time necessary to comply with these procedures should also be considered, as time-sensitive encounters may be complicated by correct PPE application. Similarly, when procedures such as bronchoscopy or tracheostomy are being performed, appropriate PPE and practices must be utilized (Figs. 2, Fig. ...
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Citations
... Currently, the usage time of ALs with membrane-type oxygenators is limited to several hours in clinical use due to the poor durability; however, long-term durability is required to apply as a bridge for the transplantation of lungs (Duy Nguyen et al., 2021). Furthermore, there has been an increasing demand for the continuous use of oxygenators because of the Covid-19 pandemic (Sanford et al., 2020;Raasveld et al., 2021), recently. ...
Surface modification of hemocompatible copolymers on silicone elastomers (SEs) is crucial for the long-term use of medical devices. Both physical adsorption and chemical conjugation are important for modification of SE. Oxygen plasma treatment is widely used to produce silanol groups on SE for silane coupling. However, the plasma reaction is difficult to apply to the surface modification of three-dimensional complex devices. This study demonstrated an appropriate and efficient method with alkaline solution for producing silanol groups on SE for modifying phosphorylcholine-based copolymer with organosilane (cross-MPC copolymer). A 2.5 wt% aqueous solution of potassium hydroxide (KOH) was effective in producing silanol groups and for coating the cross-MPC copolymer. Additionally, we successfully modified the cross-MPC copolymer on the inner surface of SE tubes after pretreatment with the 2.5 wt% KOH aqueous solution, and the copolymer film was coated homogeneously. The cross-MPC copolymer film on SE was stable for one month under fluidic condition with a shear stress of 3.2 Pa. The hollow fiber membrane with the polymer coating inhibited blood coagulation after one week implantation with extracorporeal circulation device using a goat. Therefore, pretreatment of SE using an alkaline solution is an appropriate method for producing silanol groups for coating the cross-MPC copolymer by silane-coupling reaction.
... For instance, a study conducted in 2020 found that patients initially receiving venous support from ECMO can be treated with hybrid strategies if they develop complications such as myocarditis and thrombotic events. 5 Finally, more studies should be carried out on critically ill COVID-19 patients based on different ages, ethnicity, and comorbidities as it has caused an increase in morbidity and mortality of the patients. ...
... Regarding respiratory failure in COVID-19 patients, VV-ECMO is recommended as a therapeutic method. It allows ultraprotective ventilation by decreasing tidal volume and respiratory rate as well as increasing patient oxygenation as evidenced by an increase and decrease in the PaO₂/FiO₂ ratio and oxygenation index respectively [7]. Previously, a study conducted on Middle East Respiratory Syndrome (MERS) patients with refractory ARDS, showed that ECMO is successfully used as rescue therapy. ...
... ECMO use in respiratory failure for COVID-19 patients has been reported with variable survival rates [15,[19][20][21][22][23]. Reports from retrospective studies have suggested variable use, ranging from 1 to 52%, an observation that may reflect varying availability of ECMO equipment and experienced personnel [15,[19][20][21][22][23]. ...
... ECMO use in respiratory failure for COVID-19 patients has been reported with variable survival rates [15,[19][20][21][22][23]. Reports from retrospective studies have suggested variable use, ranging from 1 to 52%, an observation that may reflect varying availability of ECMO equipment and experienced personnel [15,[19][20][21][22][23]. Patients included in the present study were among the first ones who have been treated with ECMO therapy for COVID-19-related ARDS in Saudi Arabia. ...
... In our study, septic shock was the primary cause of death in 18 (19.6%) of 92 patients but only three of them were converted to venoarterial or venoarterial-venous ECMO for cardiovascular support. Although relatively rare, conversion of VV ECMO to VA ECMO may be appropriate in selected COVID-19 patients [15,21]. Use of these types of ECMO is sproposed in patients with septic shock with severe myocardial dysfunction and decreased cardiac index [51,52]. ...
Background
Extracorporeal membrane oxygenation (ECMO) has been used as a rescue strategy in patients with severe with acute respiratory distress syndrome (ARDS) due to SARS-CoV-2 infection, but there has been little evidence of its efficacy.
Objectives
To describe the effect of ECMO rescue therapy on patient-important outcomes in patients with severe SARS-CoV-2.
Methods
A case series study was conducted for the laboratory-confirmed SARS-CoV-2 patients who were admitted to the ICUs of 22 Saudi hospitals, between March 1, 2020, and October 30, 2020, by reviewing patient’s medical records prospectively.
Results
ECMO use was associated with higher in-hospital mortality (40.2% vs. 48.9%; p = 0.000); lower COVID-19 virological cure (41.3% vs 14.1%, p = 0.000); and longer hospitalization (20.2 days vs 29.1 days; p = 0.000), ICU stay (12.6 vs 26 days; p = 0.000) and mechanical ventilation use (14.2 days vs 22.4 days; p = 0.000) compared to non-ECMO group. Also, there was a high number of patients with septic shock (19.6%) and multiple organ failure (10.9%); and more complications occurred at any time during hospitalization [pneumothorax (5% vs 29.3%, p = 0.000), bleeding requiring blood transfusion (7.1% vs 38%, p = 0.000), pulmonary embolism (6.4% vs 15.2%, p = 0.016), and gastrointestinal bleeding (3.3% vs 8.7%, p = 0.017)] in the ECMO group. However, PaO2 was significantly higher in the 72-h post-ECMO initiation group and PCO2 was significantly lower in the 72-h post-ECMO start group than those in the 12-h pre-ECMO group (62.9 vs. 70 mmHg, p = 0.002 and 61.8 vs. 51 mmHg, p = 0.042, respectively).
Conclusion
Following the use of ECMO, the mortality rate of patients and length of ICU and hospital stay were not improved. However, these findings need to be carefully interpreted, as most of our cohort patients were relatively old and had multiple severe comorbidities. Future randomized trials, although challenging to conduct, are highly needed to confirm or dispute reported observations.
... For severe and critically ill patients, invasive ventilator and ECMO (Extra-Corporeal Membrane Oxygenation, ECMO) that can replace self-breathing are "life-saving machines" [7] to patients with respiratory failure. After a patient is infected with the coronavirus, the lungs will be invaded with fibrosis, leading to respiratory failure. ...
In severe COVID-19-related respiratory failure, extracorporeal membrane oxygenation (ECMO) is a useful modality that is used to provide effective oxygenation and ventilation to the patient. This descriptive study aimed to investigate and compare the outcomes between COVID-19-infected patients and patients who were not infected and required ECMO support. A retrospective study was undertaken on a cohort of 82 adult patients ([Formula: see text]18-year-old) who required venoarterial (VA-ECMO) and venovenous (VV-ECMO) ECMO between January 2019 and December 2022 in a single academic center. Patients who were cannulated for COVID-19-related respiratory failure (C-group) were compared to patients who were cannulated for non-COVID etiologies (non-group). Patients were excluded if data were missing regarding cannulation, decannulation, presenting diagnosis, and survival status. Categorical data were reported as counts and percentages, and continuous data were reported as means with 95% confidence intervals. Out of the 82 included ECMO patients, 33 (40.2%) were cannulated for COVID-related reasons, and 49 (59.8%) were cannulated for reasons other than COVID-19 infection. Compared to the non-group, the C-group had a higher in-hospital (75.8% vs. 55.1%) and overall mortality rate (78.8% vs. 61.2%). The C-group also had an average hospital length of stay (LOS) of 46.6 ± 13.2 days and an average intensive care unit (ICU) LOS of 44.1 ± 13.3 days. The non-group had an average hospital LOS of 24.8 ± 6.6 days and an average ICU LOS of 20.8 ± 5.9 days. Subgroup analysis of patients only treated with VV-ECMO yielded a greater in-hospital mortality rate for the C-group compared to the non-group (75.0% vs. 42.1%). COVID-19-infected patients may experience different morbidity and mortality rates as well as clinical presentations compared to non-COVID-infected patients when requiring ECMO support.
Extracorporeal membrane oxygenation (ECMO) is a life-sustaining therapy that has been used as a means of rescue treatment for severe hypoxemia. Survival benefit has also been demonstrated with the use of ECMO for ARDS related to other viral infections, and the use of veno-venous ECMO is recommended for COVID-19-associated respiratory failure by organizations including the Extracorporeal Life Support Organization (ELSO), the World Health Organization (WHO), and the Surviving Sepsis Campaign COVID-19 panel. In general, ECMO can afford time to allow other treatments to take effect. Transfer to an ECMO center should be considered when the morbidity and mortality of the underlying conditions outweigh the anticipated morbidity or mortality associated with ECMO.
