scholarly journals Vascular Endothelial Damage in the Pathogenesis of Organ Injury in Severe COVID-19

2021 ◽  
Author(s):  
Annabelle Dupont ◽  
Antoine Rauch ◽  
Senna Staessens ◽  
Mouhamed Moussa ◽  
Mickael Rosa ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Liver Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Multiorgan Failure ◽  
Neutrophil Extracellular Traps ◽  
Endothelial Damage ◽  
Extracellular Traps ◽  
Membrane Oxygenation ◽  
Pai 1

Objective: Whether endotheliopathy only mirrors coronavirus disease 2019 (COVID-19) severity or plays an intrinsic role in microvascular thrombosis and organ failure remains unanswered. We assessed whether markers of endothelial damage and immune dysregulation were associated with organ failure, thrombus formation, and death. Approach and Results: Markers of endothelial damage (VWF:Ag [von Willebrand factor antigen], PAI-1 [plasminogen activator inhibitor-1], syndecan-1, TFPI [tissue factor pathway inhibitor], and soluble thrombomodulin), complement activation (C5a and C5b-9), cytokines (IL [interleukin]-6, TNF [tumor necrosis factor]-α, and IL-2R), and neutrophil extracellular traps (cell-free DNA, nucleosomes, and myeloperoxidase-DNA) were measured at intensive care unit admission in 82 patients with COVID-19. We also analyzed the histological composition of thrombi collected in critically ill living patients successfully weaned from extracorporeal membrane oxygenation. Beside respiratory failure, VWF:Ag, PAI-1, TFPI, and syndecan-1 were independently associated with liver injury and multiorgan failure development, underlining the direct role of endotheliopathy in organ failure. Nucleosomes were also associated with liver injury, multiorgan failure, and death which occurred in 38%, 60%, and 27% of patients, respectively. Moreover, dysregulated immune response including cytokines, complement, and neutrophil extracellular traps was associated with markers of endothelial damage, respiratory failure, and liver injury. COVID-19 thrombi retrieved from extracorporeal membrane oxygenation circuitry contained accumulation of neutrophils, VWF, and significantly higher amount of neutrophil extracellular traps when compared with non-COVID-19 thrombi. Conclusions: We provide new associative data supporting that endotheliopathy and dysregulated immune responses are involved in respiratory and liver failure through microvascular damage in patients with severe COVID-19.

scholarly journals Extracorporeal Membrane Oxygenation in Cardiac Intensive Care Unit

2017 ◽  
Vol 01 (01) ◽  
pp. 010-014
Author(s):  
Venkat Goyal ◽  
Pranay Oza
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Organ Failure ◽  
Multiorgan Failure ◽  
Tissue Perfusion ◽  
Critical Care Units ◽  
Membrane Oxygenation ◽  
Mechanical Assist Device ◽  
Mechanical Assist ◽  
Single Organ

AbstractIn critical care units, doctors usually witness patients coming with single organ failure and subsequently suffer multiorgan failure before they succumb to the destiny. It is well-known that hardly a few patients die of single organ failure, and with addition of every organ, the risk of mortality increases by 10%. The multiorgan failure is secondary to inadequate organ function, tissue perfusion, and oxygenation or due to iatrogenic causes. Extracorporeal membrane oxygenation (ECMO) is not a treatment by itself but a mechanical assist device or rather a replacement therapy to sustain life, to give rest to the organs, and to maintain adequate perfusion and oxygenation. There are various articles discussing the outcomes of ECMO in cardiogenic shock with varied etiology. ECMO support can rescue 40% of patients with otherwise fatal cardiogenic shock (mortality without ECMO is > 80%). As per ELSO data January 2017, 10,982 patients were reported in adult cardiac ECMO, out of whom 56% survived ECLS and 40% survived to discharge. The newer scoring system named SAVE score (its online calculator [www.save-score.com]) offers a validated tool to predict survival for patients receiving ECMO for refractory cardiogenic shock.

Evaluation of Bivalirudin as the Primary Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation for SARS-CoV-2–Associated Acute Respiratory Failure

2021 ◽  
pp. 106002802110361
Author(s):  
Brittany D. Bissell ◽  
Taylor Gabbard ◽  
Erica A. Sheridan ◽  
Maher A. Baz ◽  
George A. Davis ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Retrospective Chart Review ◽  
Venous Thromboembolic Event ◽  
Membrane Oxygenation ◽  
Published Report ◽  
Starting Dose ◽  
Venous Thromboembolic ◽  
Polymerase Chain

Background Extracorporeal membrane oxygenation (ECMO) is a potential option for the management of severe acute respiratory failure secondary to COVID-19. Conflicting the use of this therapy is the known coagulopathy within COVID-19, leading to an incidence of venous thrombotic events of 25% to 49%. To date, limited guidance is available on optimal anticoagulation strategies in this population. Objective The purpose of this study was to evaluate the utilization of a pharmacist-driven bivalirudin dosing protocol for anticoagulation in the setting of ECMO for COVID-19–associated respiratory failure. Methods This was a single-center retrospective chart review over a 9-month period of patients receiving bivalirudin while on ECMO. All patients with acute respiratory failure requiring ECMO with a positive SARS-CoV-2 polymerase chain reaction were included. Bivalirudin was dosed via aPTT monitoring after a starting dose of 0.2 or 0.3 mg/kg/h. Results There were 33 patients included in this study, all receiving mechanical ventilation. The most common starting dose of bivalirudin was 0.2 mg/kg/h, with an average time to therapeutic range of 20 hours. Compared to previous reports, rates of bleeding were low at 15.1%, and 6.1% of patients developed a new venous thromboembolic event while on ECMO. ECMO survival was 51.5%, with an ICU mortality rate of 48.5%. Conclusion and Relevance In the first published report of its use within this population, bivalirudin was found to be a viable choice for anticoagulation in those patients on ECMO for severe respiratory failure secondary to COVID-19.

scholarly journals The Evolution of the Use of Extracorporeal Membrane Oxygenation in Respiratory Failure

Membranes ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 491
Author(s):  
Danielle Feldhaus ◽  
Daniel Brodie ◽  
Philippe Lemaitre ◽  
Joshua Sonett ◽  
Cara Agerstrand
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Influenza A ◽  
Distress Syndrome ◽  
Rapid Expansion ◽  
Membrane Oxygenation ◽  
Influenza A H1n1 ◽  
Large Randomized Clinical Trial ◽  
Ventilator Management ◽  
Large Randomized Trial

Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support patients with acute respiratory failure, most commonly, and severe forms of acute respiratory distress syndrome (ARDS). The marked increase in the global use of ECMO followed the publication of a large randomized trial in 2009 and the experience garnered during the 2009 influenza A (H1N1) pandemic, and has been further supported by the release of a large, randomized clinical trial in 2018, confirming a benefit from using ECMO in patients with severe ARDS. Despite a rapid expansion of ECMO-related publications, optimal management of patients receiving ECMO, in terms of patient selection, ventilator management, anticoagulation, and transfusion strategies, is evolving. Most recently, ECMO is being utilized for an expanding variety of conditions, including for cases of severe pulmonary or cardiac failure from coronavirus disease 2019 (COVID-19). This review evaluates modern evidence for ECMO for respiratory failure and the current challenges in the field.

scholarly journals Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tak Kyu Oh ◽  
Hyoung-Won Cho ◽  
Hun-Taek Lee ◽  
In-Ae Song
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Disease ◽  
Respiratory Disease ◽  
Chronic Respiratory Disease ◽  
Newly Diagnosed ◽  
Membrane Oxygenation ◽  
Obstructive Sleep ◽  
All Cause Mortality ◽  
Ecmo Therapy

Abstract Background Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. Methods We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. Results A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. Conclusions At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions.

Sign in / Sign up

Export Citation Format

Share Document