ECMO for COVID-19 patients in Europe and Israel.
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ABSTRACT:
SUBMITTER: Lorusso R
PROVIDER: S-EPMC7796689 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesThis study aimed at estimating the real-life impact of vaccination on COVID-19 mortality, with adjustment for SARS-CoV-2 variants spread and other factors across Europe and Israel.Study designTime series analysis.MethodsTime series analysis of the daily number of COVID-19 deaths was performed using non-linear Poisson mixed regression models. Variables such as variants' frequency, demographics, climate, health, and mobility characteristics of thirty-two countries between January 2020 and April 2021 were considered as potentially relevant adjustment factors.ResultsThe analysis revealed that vaccination efficacy in terms of protection against deaths was 72%, with a lower reduction of the number of deaths for B.1.1.7 vs non-B.1.1.7 variants (70% and 78%, respectively). Other factors significantly related to mortality were arrivals at airports, mobility change from the prepandemic level, and temperature.ConclusionsOur study confirms a strong effectiveness of COVID-19 vaccination based on real-life public data, although lower than expected from clinical trials. This suggests the absence of indirect protection for non-vaccinated individuals. Results also show that vaccination effectiveness against mortality associated with the B.1.1.7 variant is slightly lower than that with other variants. Lastly, this analysis confirms the role of mobility reduction, within and between countries, as an effective way to reduce COVID-19 mortality and suggests the possibility of seasonal variations in COVID-19 incidence.
| S-EPMC8413007 | biostudies-literature
Project description:OBJECTIVE:To analyze the survival rates of patients with COVID-19 supported with extracorporeal membrane oxygenation (ECMO) and compare the survival rates of patients with COVID-19 supported with ECMO to patients with influenza supported with ECMO. DESIGN:A systematic review and meta-analysis to assess the impact of ECMO as supportive therapy of COVID-19. SETTING:The authors performed a search through the Cochrane, EMBASE, and MEDLINE/PubMed databases from inception to February 19, 2021, for studies reporting hospitalized patients with COVID-19 managed with ECMO. PARTICIPANTS:A total of 134 studies were selected, including 6 eligible for the comparative meta-analysis of COVID-19 versus influenza. INTERVENTIONS:The authors pooled the risk ratio and random effects model. MEASUREMENTS AND MAIN RESULTS:The primary endpoint was the overall mortality of patients with COVID-19 receiving ECMO. Of the total number of 58,472 patients with COVID-19 reported, ECMO was used in 4,044 patients. The analysis suggested an overall in-hospital mortality of 39% (95% CI 0.34-0.43). In the comparative analysis, patients with COVID-19 on ECMO had a higher risk ratio (RR) for mortality when compared to influenza patients on ECMO: 72/164 (44%) v 71/186 (38%) RR 1.34; 95% CI 1.05-1.71; p = 0.03. CONCLUSIONS:ECMO could be beneficial in patients with COVID-19, according to the authors' meta-analysis. The reported mortality rate was 39%. This systematic analysis can provide clinical advice in the current era and ongoing pandemic.
| S-EPMC8585556 | biostudies-literature
Project description:Epidemic control measures that aim to introduce social distancing help to decelerate the spread of the COVID-19 pandemic. However, their consequences in terms of mental well-being might be negative, especially for older adults. While existing studies mainly focus on the time during the first lockdown, we look at the weeks afterward in order to measure the medium-term consequences of the first wave of the pandemic. Using data from the SHARE Corona Survey, we include retired respondents aged 60 and above from 25 European countries plus Israel. Combining SHARE data with macro-data from the Oxford COVID-19 Government Response Tracker allows us to include macro-indicators at the country level, namely the number of deaths per 100,000 and the number of days with stringent epidemic control measures, in addition to individual characteristics. The findings show that both macro-indicators are influential for increased feelings of sadness/depression, but that individual factors are crucial for explaining increased feelings of loneliness in the time after the first lockdown. Models with interaction terms reveal that the included macro-indicators have negative well-being consequences, particularly for the oldest survey participants. Additionally, the results reveal that especially those living alone had a higher risk for increased loneliness in the time after the first COVID-19 wave.Supplementary informationThe online version contains supplementary material available at 10.1007/s10433-021-00640-8.
| S-EPMC8383247 | biostudies-literature
Project description: Not available
| S-EPMC8613977 | biostudies-literature
Project description: Not available
| S-EPMC7546264 | biostudies-literature
Project description:IntroductionThe main manifestation of COVID-19 pneumonia is acute respiratory distress syndrome (ARDS), which in some cases can be more severe, requiring Veno-venous extracorporeal membrane oxygenation (VV-ECMO) to ensure hemostasis. Despite support from Veno-venous extracorporeal membrane oxygenation, some patients may remain hypoxemic. One possible therapeutic procedure for these patients is the application of the prone position (PP).ObjectiveThe aim of this study was to investigate the effect of VV-ECMO on arterial oxygenation and compliance of the respiratory system in mechanically ventilated patients with refractory hypoxemia. The secondary objective was to evaluate the safety and feasibility of prone position for ECMO.MethodsWe retrospectively reviewed the electronic records of all 23 COVID-19 patients on ECMO who were placed for the first time in prone position with an average duration of 16 h. Patient characteristics, pre-ECMO characteristics, changes in ventilator/ECMO settings and blood gas analysis before and after PP.ResultsA total of 23 position changes to prone position were performed. Oxygenation and respiratory compliance improved 16 h after adoption of prone position without any accidents during PP.ConclusionsThe use of prone position during Veno-venous extracorporeal membrane oxygenation demonstrated an improvement in oxygenation as well as lung compliance. It is a safe and reliable technique.
| S-EPMC8403004 | biostudies-literature
Project description: Not available
| S-BSST416 | biostudies-other
Project description:BackgroundThe role of ECMO in the management of patients with COVID-19 continues to evolve. The purpose of this manuscript is to review a multi-institutional clinical experience in 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO.MethodsThis analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 9, 2020. Differences by mortality group were assessed using chi-square tests for categorical variables and Kruskal-Wallis rank sum tests and Welch's ANOVA for continuous variables.ResultsMedian ECMO time was 15 days (IQR=9-28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with veno-venous ECMO was 87 of 188 patients (46.3%), while survival with veno-arterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, p<0.001) and shorter median time interval from diagnosis to ECMO cannulation (8 days versus 12 days, p=0.003).In the 90 survivors, adjunctive therapies on ECMO included: intravenous steroids (64), Remdesivir (49), convalescent plasma (43), anti-interleukin-6 receptor blockers (39), prostaglandin (33), and hydroxychloroquine (22).ConclusionsECMO facilitates survival of select critically ill patients with COVID-19. Survivors tend to be younger and have a shorter duration from diagnosis to cannulation. Substantial variation exists in drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.
| S-EPMC8259045 | biostudies-literature
Project description: Not available
| S-EPMC8121532 | biostudies-literature
Project description:BackgroundPatients with Coronavirus disease 2019 (COVID-19)-related acute respiratory disease (ARDS) increasingly receive extracorporeal membrane oxygenation (ECMO) support. While ECMO has been shown to increase risk of stroke, few studies have examined this association in COVID-19 patients.ObjectiveWe conducted a systematic review to characterise neurological events during ECMO support in COVID-19 patients.DesignSystematic review of cohort and large case series of COVID-19 patients who received ECMO support.Data sourcesStudies retrieved from PubMed, EMBASE, Cochrane, Cochrane COVID-19 Study Register, Web of Science, Scopus, Clinicaltrials.gov, and mdRxiv from inception to November 11, 2020.Eligibility criteriaInclusion criteria were a) Adult population (>18 year old); b) Positive PCR test for SARS-CoV-2 with active COVID-19 disease; c) ECMO therapy due to COVID-19 ARDS; and d) Neurological events and outcome described while on ECMO support. We excluded articles when no details of neurologic events were available.Results1,322 patients from 12 case series and retrospective cohort studies were included in our study. The median age was 49.2, and 75% (n=985) of the patients were male. Diabetes mellitus and dyslipidaemia were the most common comorbidities (24% and 20%, respectively). Most (95%, n=1,241) patients were on venovenous ECMO with a median P:F ratio at the time of ECMO cannulation of 69.1. The prevalence of intracranial haemorrhage (ICH), ischaemic stroke, and hypoxic ischaemic brain injury (HIBI) was 5.9% (n=78), 1.1% (n=15), and 0.3% (n=4), respectively. The overall mortality of the 1,296 ECMO patients in the 10 studies that reported death was 36% (n=477), and the mortality of the subset of patients who had a neurological event was 92%.ConclusionsNeurological injury is a concern for COVID-19 patients who receive ECMO. Further research is required to explore how neuromonitoring protocols can inform tailored anticoagulation management and improve survival in COVID-19 patients with ECMO support.
| S-EPMC8553269 | biostudies-literature