Extracorporeal membrane oxygenation (ECMO) has advanced significantly in the last few decades. Although not FDA-approved in the United States for respiratory insufficiency, it is widely used to support cardiac and pulmonary function via Venoarterial (VA) and Venovenous (VV) ECMO, respectively. In the patient with worsening respiratory failure VV-ECMO is considered a salvaging therapy that gives patients’ lungs time to heal or as a bridge to lung transplant. Clinicians use tools like the Murray score to initiate a referral for VV-ECMO using indices like oxygen requirement, pulmonary compliance, and bilateral opacities. Early referral for VV-ECMO within 7 days of intubation has shown better results. Important factors that are considered in ECMO candidacy are patients’ age, comorbid conditions, and chronic conditions that would affect patients’ overall longevity. Extracorporeal life support organization (ELSO) gets data from ECMO centers worldwide and has general recommendations for centers guiding treatment and management. During the COVID pandemic, there was a huge surge in acute respiratory distress syndrome (ARDS) and rampant use of VV-ECMO for COVID-ARDS. Data from various centers have helped us understand the appropriate use of VV-ECMO for ARDS and other causes of hypoxic and hypercapnic respiratory failure. Early referral and careful screening for the patient for ECMO are of paramount importance for a better outcome.

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Background:Trinidad & Tobago is a heterogenous country of 1.3 million in population with people who have diverse ethnic, religious, cultural and socioeconomic activities. Great variations are seen in the prevalence of diabetes among several age and ethnic groups in the country. This study sought to perform molecular characterization of bacterial organisms prevalent among a cross section of diabetic patients with asymptomatic bacteriauria.Methods & Materials: Over a 9 months period, two noncommunicable chronic diseases clinics for adult patients were visited and after obtaining informed consent was obtained diabetic volunteers were recruited to participate in the study. Participants fulfilled study criteria that included absence of urinary symptoms, not catheterized, no history of UTI or any form of uropathy. Their blood samples were processed for Hb1Ac, serum electrolytes and urea values; and urine for microscopy, culture and sensitivity. Enterobacteriaceae from urine culture were subjected to screening for CTX, TEM, SHV, and VIM by amplification of gene fragments by conventional PCR and for KPC, NDM and OXA48 targets by real-time PCR using Sybergreen melting curve analysis.Results: Four hundred and fourteen diabetics were surveyed. Significant bacteriauria was noted in sixty five subjects. Majority, 81.5% (53/65) of the positive urine cultures were in those with high HBA1c values. Enterobacteriaceae recovered most frequently were Escherichia coli 48.57% (34/70) and Klebsiella pneumonia 25.7% (18/70). Most 87.1% (61/70) of the bacteria were recovered in urine samples from female 75.4% (49/65) subjects. Urine samples from males 24.6% (16/65) yielded mostly Staphylococcus epidermidis 14.3% (10/7) and the Staphylococcus aureus 5.7% (4/70) respectively. All Enterobacteriaceae isolates were negative KPC, NDM and OXA-48. Although the blaTEM and bla SHV were detected in both the E. coli and K. pneumoniae isolates these were nothing ununsual.Conclusion: Escherichia coli was the prevalent Enterobacteriaceae among the patients with asymptomatic bacteriauria. Poor diabetic control significantly is strongly associated with bacteriau-ria that was more prevalent among female diabetics. Although none of the antimicrobial resistant targets were encountered among the Enterobacteriaceae, there is still the need to keep an eye on these targets and diabetic subjects in the country.

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