scholarly journals The Southern California Extracorporeal Membrane Oxygenation Consortium during the Coronavirus Disease 2019 Pandemic

2021 ◽  
pp. 1-21
Author(s):  
Mazen Odish ◽  
Cassia Yi ◽  
Juliann Eigner ◽  
Amelia Kenner Brininger ◽  
Kristi L. Koenig ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
San Diego ◽  
Southern California ◽  
Limited Resource ◽  
The United States ◽  
San Diego County ◽  
Clinical Practices ◽  
Membrane Oxygenation ◽  
Effective Manner ◽  
Share Data

Abstract In March 2020, at the onset of the coronavirus disease 2019 (COVID-19) pandemic in the United States, the Southern California Extracorporeal Membrane Oxygenation (ECMO) Consortium was formed. The consortium included physicians and coordinators from the four ECMO centers in San Diego County. Guidelines were created to ensure that ECMO was delivered equitably and in a resource effective manner across the county during the pandemic. A biomedical ethicist reviewed the guidelines to ensure ECMO utilization would provide maximal community benefit of this limited resource. The San Diego County Health and Human Services Agency further incorporated the guidelines into its plans for the allocation of scarce resources. The consortium held weekly video conferences to review countywide ECMO capacity (including census and staffing), share data, and discuss clinical practices and difficult cases. Equipment exchanges between ECMO centers maximized regional capacity. From March 1 to November 30, 2020, consortium participants placed 97 patients on ECMO. No eligible patients were denied ECMO due to lack of resources or capacity. The Southern California ECMO Consortium may serve as a model for other communities seeking to optimize ECMO resources during the current COVID-19 or future pandemics.

scholarly journals Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation—A Retrospective International Multicenter Study

Membranes ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 170
Author(s):  
Alexander Supady ◽  
Jeff DellaVolpe ◽  
Fabio Silvio Taccone ◽  
Dominik Scharpf ◽  
Matthias Ulmer ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Survival Prediction ◽  
Study Cohort ◽  
Additional Tool ◽  
Saps Ii ◽  
Membrane Oxygenation ◽  
International Multicenter

The role of veno-venous extracorporeal membrane oxygenation therapy (V-V ECMO) in severe COVID-19 acute respiratory distress syndrome (ARDS) is still under debate and conclusive data from large cohorts are scarce. Furthermore, criteria for the selection of patients that benefit most from this highly invasive and resource-demanding therapy are yet to be defined. In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival. Methods: This is an investigator-initiated retrospective non-interventional international multicenter registry study (NCT04405973, first registered 28 May 2020). In 127 patients treated with V-V ECMO at 15 centers in Germany, Switzerland, Italy, Belgium, and the United States, we calculated the Sequential Organ Failure Assessment (SOFA) Score, Simplified Acute Physiology Score II (SAPS II), Acute Physiology And Chronic Health Evaluation II (APACHE II) Score, Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) Score, Predicting Death for Severe ARDS on V‑V ECMO (PRESERVE) Score, and 30-day survival. Results: In our study cohort which enrolled 127 patients, overall 30-day survival was 54%. Median SOFA, SAPS II, APACHE II, RESP, and PRESERVE were 9, 36, 17, 1, and 4, respectively. The prognostic accuracy for all these scores (area under the receiver operating characteristic—AUROC) ranged between 0.548 and 0.605. Conclusions: The use of scores for the prediction of mortality cannot be recommended for treatment decisions in severe COVID-19 ARDS undergoing V-V ECMO; nevertheless, scoring results below or above a specific cut-off value may be considered as an additional tool in the evaluation of prognosis. Survival rates in this cohort of COVID-19 patients treated with V‑V ECMO were slightly lower than those reported in non-COVID-19 ARDS patients treated with V-V ECMO.

Association of Hospital Safety Net Status With Outcomes and Resource Use for Extracorporeal Membrane Oxygenation in the United States

2021 ◽  
pp. 088506662110070
Author(s):  
Matthew Gandjian ◽  
Catherine Williamson ◽  
Yu Xia ◽  
Carlos Maturana ◽  
Nikhil Chervu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Resource Use ◽  
Safety Net ◽  
The United States ◽  
Infectious Complications ◽  
Membrane Oxygenation ◽  
Hospital Safety ◽  
Hospitalization Costs ◽  
National Cohort ◽  
Multivariable Regression

Purpose: Safety net hospitals (SNH) have been associated with inferior surgical outcomes and increased resource use. Utilization and outcomes for extracorporeal membrane oxygenation (ECMO), a rescue modality for patients with respiratory or cardiac failure, may vary by safety net status. We hypothesized SNH to be associated with inferior outcomes and costs of ECMO in a national cohort. Materials and Methods: The 2008-2017 National Inpatient Sample was queried for ECMO hospitalizations and safety net hospitals were identified. Multivariable regression was used to perform risk-adjusted comparisons of mortality, complications and resource utilization at safety net and non-safety net hospitals. Results: Of 36,491 ECMO hospitalizations, 28.2% were at SNH. On adjusted comparison SNH was associated with increased odds of mortality (AOR: 1.23), tracheostomy use (AOR: 1.51), intracranial hemorrhage (AOR: 1.39), as well as infectious complications (AOR: 1.21, all P < .05), with NSNH as reference. SNH was also associated with increased hospitalization duration (β=+4.5 days) and hospitalization costs (β=+$32,880, all P < .01). Conclusions: We have found SNH to be associated with inferior survival, increased complications, and higher costs compared to NSNH. These disparate outcomes warrant further studies examining systemic and hospital-level factors that may impact outcomes and resource use of ECMO at SNH.

scholarly journals Extracorporeal Membrane Oxygenation for ARDS: National Trends in the United States 2008–2012

2016 ◽  
Vol 61 (10) ◽  
pp. 1293-1298 ◽  
Author(s):  
Bhupinder S Natt ◽  
Hem Desai ◽  
Nirmal Singh ◽  
Chithra Poongkunran ◽  
Sairam Parthasarathy ◽  
...  
Keyword(s):  
United States ◽  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Membrane Oxygenation ◽  
National Trends

Utilization patterns of extracorporeal membrane oxygenation in neonates in the United States 1997–2012

2017 ◽  
Vol 52 (10) ◽  
pp. 1681-1687 ◽  
Author(s):  
Ashley Y. Song ◽  
Hsuan-Hsiu Annie Chen ◽  
Rachel Chapman ◽  
Ameish Govindarajan ◽  
Jeffrey S. Upperman ◽  
...  
Keyword(s):  
United States ◽  
Extracorporeal Membrane Oxygenation ◽  
The United States ◽  
Membrane Oxygenation ◽  
Utilization Patterns

A Case Study of Planning

2001 ◽  
Author(s):  
Marlon Boarnet ◽  
Randall C. Crane
Keyword(s):  
United States ◽  
Land Use ◽  
Urban Areas ◽  
San Diego ◽  
The United States ◽  
San Diego County ◽  
Light Rail ◽  
Rail Transit ◽  
The South

The facts, figures, and inferences in chapter 7 regarding municipal behavior toward transit-oriented housing opportunities illustrate many points. Still, there is much that even a careful statistical analysis might miss or misunderstand. For that reason, we also explored what we could learn by talking to real planners about these issues. The case of San Diego is interesting and useful for several reasons. First, the San Diego Trolley is the oldest of the current generation of light rail projects in the United States. Unlike many newer systems, the age of San Diego’s rail transit (the South Line opened in 1981) allows time for land use planning to respond to the fixed investment. Second, the San Diego system is no stranger to modern transit-based planning ideas. The San Diego City Council approved a land-use plan for their stations that includes many of the ideas promoted by transit-oriented development (TOD) advocates (City of San Diego, 1992). Third, the light rail transit (LRT) authority in San Diego County, the Metropolitan Transit Development Board (MTDB), is often regarded as one of the more successful municipal LRT agencies. The initial parts of the MTDB rail transit system were constructed strictly with state and local funds, using readily available, relatively low-cost technology (Demoro and Harder, 1989, p. 6). Portions of San Diego’s system have high fare-box recovery rates, including the South Line, which in its early years recovered as much as 90 percent of operating costs at the fare box (Gómez-Ibáñez, 1985). All of these factors make San Diego potentially a “best-case” example of TOD implementation. When generalizing from this case study, it is important to remember that the transit station area development process in San Diego is likely better developed than in many other urban areas in the United States. The results from San Diego County can illustrate general issues that, if they have not already been encountered, might soon become important in other urban areas with rail transit systems. Also, given San Diego County’s longer history of both LRT and TOD when compared with most other regions, any barriers identified in San Diego County might be even more important elsewhere.

scholarly journals Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2055-e2060
Author(s):  
Matthew D Read ◽  
Jason J Nam ◽  
Mauer Biscotti ◽  
Lydia C Piper ◽  
Sarah B Thomas ◽  
...  
Keyword(s):  
Critical Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Demographic Data ◽  
The United States ◽  
Published Data ◽  
Medical Treatment Facility ◽  
Membrane Oxygenation ◽  
Transport Distance ◽  
Primary Indication ◽  
The U.S

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. Materials and methods We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. Results The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. Conclusions Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.

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