Dataset Information

Eleven years of VV ECMO for ARDS: from H1N1 to SARS-COV-2. Experience and perspectives of a national referral center

ABSTRACT:

Objective

Despite growing expertise and wide application of venovenous extracorporeal membrane oxygenation (VV ECMO) treatment for acute respiratory distress syndrome (ARDS) of different origin and during pandemics (H1N1 Influenza A virus and SARS-CoV2), large reports are few and pertain mostly to multicentre registries, while randomized trials are difficult to perform. The aim of this study was to report outcomes, trends and innovations of VV ECMO treatment over the last eleven years.

Design, setting and participants

Observational study on 142 patients treated at the IRCCS San Raffaele Hospital in Milan from June 2009 (year of the H1N1 pandemic) to May 2020 (SARS-CoV-2 pandemic).

Interventions

None.

Measurements and main results

The main causes of ARDS were H1N1 pneumonia in 36% of patients, bacterial pneumonia in 17% and Sars-CoV-2 in 9%. Seventy-two percent of patients were centralized from remote hospitals, of which 33% had implanted VV ECMO before transport. The most common cannulation strategy was the dual lumen catheter cannulation system (55%) and anticoagulation was performed with bivalirudin in most patients (79%). Refractory hypoxia was treated with iv beta-blockers (64%), nitric oxide (20%) and pronation (8%). Almost one third of patients (32%) were extubated while on ECMO. Forty-nine percent of patients were discharged from intensive care unit and hospital discharge was 46%: survival was lower in patients requiring VV ECMO for more than 3 weeks compared to lower support duration (23% vs 56%, p=0.007). Anticoagulation with bivalirudin was associated with higher survival compared to heparin (55% vs 31%, p=0.03) and lower thrombocytopenia incidence (69% vs 35%, p=0.003).

Conclusion

VV ECMO is the pivotal rescue treatment for refractory ARDS: timely treatment and optimal care are needed to optimize therapy, since duration of support is associated with outcome. Anticoagulation with bivalirudin may improve outcome.

SUBMITTER: Pieri M

PROVIDER: S-EPMC8461266 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:OBJECTIVE:To describe our experience with office removal of nonpalpable contraceptive implants at our referral center. METHODS:We performed a retrospective cohort study by reviewing the charts of patients referred to our family planning specialty center for nonpalpable or complex contraceptive implant removal from January 2015 through December 2018. We localized nonpalpable implants using high-frequency ultrasonography and skin mapping in radiology, followed by attempted removal in the office using local anesthesia and a modified vasectomy clamp. We abstracted information on demographics, implant location, and outcomes. RESULTS:Of 61 referrals, 55 patients attended their scheduled appointments. Seven patients had palpable implants; six elected removal. The other 48 patients had ultrasound localization, which identified 47 (98%) of the implants; the remaining patient had successful localization with computed tomography imaging. Nonpalpable implants were suprafascial (n=22), subfascial (n=25) and intrafascial (n=1); four of these patients opted to delay removal. Of 50 attempted office removals, all palpable (n=6), all nonpalpable suprafascial (n=21 [100%, 95% CI 83-100%]), and 19 out of 23 (83%, 95% CI 67-98%) subfascial implants were successful. Three of the four patients with failed subfascial implant office removal had successful operating room removal with a collaborative orthopedic surgeon; the other patient sought removal elsewhere. Transient postprocedure neuropathic complaints were noted in 7 out of 23 (30%, 95% CI 12-49%) subfascial and 1 out of 21 (5%, 95% CI 0-13%) suprafascial removals (P=.048). Nonpalpable implants were more likely to be subfascial in nonobese patients (24/34, 71%) as compared with obese (1/13, 8%) patients (P<.001). Seven (28%) of the 25 subfascially located implants had been inserted during a removal-reinsertion procedure through the same incision. CONCLUSION:Most nonpalpable contraceptive implants can be removed in the office by an experienced subspecialty health care provider after ultrasound localization. Some patients may experience transient postprocedure neuropathic pain. Nonpalpable implants in thinner women are more likely to be in a subfascial location.