Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19

Shaefi, Shahzad; Brenner, Samantha K.; Gupta, Shruti; O’Gara, Brian; Krajewski, Megan L.; Charytan, David M.; Chaudhry, Sobaata; Mirza, Sara; Peev, Vasil; Anderson, Mark D.; Bansal, Anip; Hayek, Salim S.; Srivastava, Anand; Mathews, Kusum S.; Johns, Tanya S.; Leonberg‐Yoo, Amanda K.; Green, Adam; Arunthamakun, Justin; Wille, Keith; Shaukat, Tanveer; Singh, Harkarandeep; Admon, Andrew J.; Semler, Matthew W.; Hernán, Miguel A.; Mueller, Ariel; Wang, Wei; Leaf, David E.; Investigators, Stop-Covid

doi:10.1007/s00134-020-06331-9

Cited by 176 publications

(252 citation statements)

References 40 publications

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“…Recent retrospective studies have reported that COVID-19 patients with ARDS supported by vv-ECMO overall have favorable outcomes [9][10][11]29 , with 63% of them being alive at 90 days in the ELSO registry 29 . However, the rate of severe bleeding, including intracranial haemorrhage, and fatal bleeding on ECMO was particularly high in these studies.…”

Section: Discussionmentioning

confidence: 99%

“…From October 22, 2019 (8)(9)(10)(11)(12)(13)(14)(15)(16), respectively. The SOFA score tended to be higher in the COVID-19 group [12 (8.5-15.8) versus 9.5 (7.0-17.2) in the non-COVID-19 group).…”

Section: Patientsmentioning

confidence: 99%

“…Positive end-expiratory pressure, cm of water Plateau pressure, cm of water Compliance, ml/cm of water 12 [10][11][12][13][14][15] 30 [28][29][30][31][32][33][34] 20.3 [15.3-30.3] 12 [7][8][9][10][11][12] 29 [19][20][21][22][23][24][25][26][27][28][29][30] 22.5 [21.2-32.9] 14 [10][11][12][13][14][15] 30 [28][29][30][31][32][33][34]…”

Section: Tidal Volume Ml/kgmentioning

confidence: 99%

“…Nevertheless, large cohorts of critically ill COVID-19 patients supported by vv-ECMO recently reported high rates of major bleeding events during hospitalization [9][10][11] , with rates of intracranial haemorrhage up to 40% 12,13 . Some authors suggested that these bleeding events might result from worsening COVID-19 associated coagulopathy during ECMO support, further leading to disseminated intravascular coagulation, enhanced fibrinolysis or acquired von Willebrand syndrome (AVWS), or from heparin overdose 14 .…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation Induces Early Alterations in Coagulation and Fibrinolysis Profiles in COVID-19 Patients with Acute Respiratory Distress Syndrome

et al. 2021

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Hemostatic changes induced by extracorporeal membrane oxygenation (ECMO) support have been yet poorly documented in COVID-19 patients who have a baseline complex hypercoagulable state. In this prospective monocentric study of patients with severe acute respiratory distress syndrome (ARDS) rescued by ECMO, we performed longitudinal measurements of coagulation and fibrinolysis markers throughout the course of ECMO support in 20 COVID-19 and 10 non-COVID-19 patients. Blood was sampled before and then 24 hours, 7 and 14 days after ECMO implantation. Clinical outcomes were prospectively assessed until discharge from the intensive care unit or death. The median age of participants was 47 (35-56) years, with a median body mass index of 30 (27-35) kg/m², and a SOFA score of 12 (8-16). Baseline levels of von Willebrand factor, fibrinogen, factor VIII, prothrombin F1+2, thrombin-antithrombin, D-Dimers and PAI-1 were elevated in both COVID-19 and non-COVID-19 ARDS patients, indicating that endothelial activation, endogenous thrombin generation and fibrinolysis shut-down occur in all ARDS patients before ECMO implantation. From baseline to day 7, thrombin generation (prothrombin F1+2, p<0.01) and fibrin formation markers (fibrin monomers, p<0.001) significantly increased, further resulting in significant decreases in platelet count (p<0.0001) and fibrinogen level (p<0.001). PAI-1 levels significantly decreased from baseline to day 7 (p<0.0001) in all ARDS patients. These changes were more marked in COVID-19 patients, resulting in 14 non-fatal and 3 fatal bleeding. Additional studies are warranted to determine whether monitoring of thrombin generation and fibrinolysis markers might help to early predict bleeding complications in COVID-19 patients supported by ECMO.

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Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

Section: Tidal Volume Ml/kgmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation Induces Early Alterations in Coagulation and Fibrinolysis Profiles in COVID-19 Patients with Acute Respiratory Distress Syndrome

et al. 2021

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“…In a very recent study on the outcome of VV-ECMO in COVID-19, the authors sought to estimate the effect of ECMO on mortality in comparison to conventional therapy. For this purpose, they analyzed data from 190 patients treated with ECMO among a cohort of 5122 critically ill COVID-19 patients in 68 US hospitals [171]. They performed a "target trial emulation", in which only mechanically ventilated patients with an age < 70 y, without malignancy, hospitalized in an ECMO center, and a PaO 2 /FiO 2 ratio < 100 mm Hg between day 1 and day 7, were included.…”

Section: Extracorporeal Membrane Oxygenation (Ecmo)mentioning

confidence: 99%

The Right Ventricle in COVID-19

Bonnemain

Ltaief

Liaudet

2021

JCM

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Infection with the novel severe acute respiratory coronavirus-2 (SARS-CoV2) results in COVID-19, a disease primarily affecting the respiratory system to provoke a spectrum of clinical manifestations, the most severe being acute respiratory distress syndrome (ARDS). A significant proportion of COVID-19 patients also develop various cardiac complications, among which dysfunction of the right ventricle (RV) appears particularly common, especially in severe forms of the disease, and which is associated with a dismal prognosis. Echocardiographic studies indeed reveal right ventricular dysfunction in up to 40% of patients, a proportion even greater when the RV is explored with strain imaging echocardiography. The pathophysiological mechanisms of RV dysfunction in COVID-19 include processes increasing the pulmonary vascular hydraulic load and others reducing RV contractility, which precipitate the acute uncoupling of the RV with the pulmonary circulation. Understanding these mechanisms provides the fundamental basis for the adequate therapeutic management of RV dysfunction, which incorporates protective mechanical ventilation, the prevention and treatment of pulmonary vasoconstriction and thrombotic complications, as well as the appropriate management of RV preload and contractility. This comprehensive review provides a detailed update of the evidence of RV dysfunction in COVID-19, its pathophysiological mechanisms, and its therapy.

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Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Hansford,

Cashin,

Jones

et al. 2023

JAMA Netw Open

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ImportanceObservational (nonexperimental) studies that aim to emulate a randomized trial (ie, the target trial) are increasingly informing medical and policy decision-making, but it is unclear how these studies are reported in the literature. Consistent reporting is essential for quality appraisal, evidence synthesis, and translation of evidence to policy and practice.ObjectiveTo assess the reporting of observational studies that explicitly aimed to emulate a target trial.Evidence ReviewWe searched Medline, Embase, PsycINFO, and Web of Science for observational studies published between March 2012 and October 2022 that explicitly aimed to emulate a target trial of a health or medical intervention. Two reviewers double-screened and -extracted data on study characteristics, key predefined components of the target trial protocol and its emulation (eligibility criteria, treatment strategies, treatment assignment, outcome[s], follow-up, causal contrast[s], and analysis plan), and other items related to the target trial emulation.FindingsA total of 200 studies that explicitly aimed to emulate a target trial were included. These studies included 26 subfields of medicine, and 168 (84%) were published from January 2020 to October 2022. The aim to emulate a target trial was explicit in 70 study titles (35%). Forty-three studies (22%) reported use of a published reporting guideline (eg, Strengthening the Reporting of Observational Studies in Epidemiology). Eighty-five studies (43%) did not describe all key items of how the target trial was emulated and 113 (57%) did not describe the protocol of the target trial and its emulation.Conclusion and RelevanceIn this systematic review of 200 studies that explicitly aimed to emulate a target trial, reporting of how the target trial was emulated was inconsistent. A reporting guideline for studies explicitly aiming to emulate a target trial may improve the reporting of the target trial protocols and other aspects of these emulation attempts.

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Extracorporeal membrane oxygenation in patients with severe respiratory failure from COVID-19

Cited by 176 publications

References 40 publications

Extracorporeal Membrane Oxygenation Induces Early Alterations in Coagulation and Fibrinolysis Profiles in COVID-19 Patients with Acute Respiratory Distress Syndrome

Extracorporeal Membrane Oxygenation Induces Early Alterations in Coagulation and Fibrinolysis Profiles in COVID-19 Patients with Acute Respiratory Distress Syndrome

The Right Ventricle in COVID-19

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

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