scholarly journals Safety of healthcare workers undertaking transport and retrieval of patients on extracorporeal membrane oxygenation during the peak of COVID-19 pandemic in the State of Qatar

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ahmed Labib Shehatta ◽  
Brian Racela ◽  
Ian Howard ◽  
Guillaume Alinier ◽  
Hani Jaouni ◽  
...  
Keyword(s):  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Healthcare Workers ◽  
Close Contact ◽  
Well Being ◽  
Clinical Staff ◽  
Clinical Team ◽  
Confined Space ◽  
Membrane Oxygenation ◽  
Increased Risk

Background: Transport and retrieval of patients on extracorporeal membrane oxygenation (ECMO) support can be hazardous to patients and healthcare workers (HCWs). COVID-19 is highly contagious and can be transmitted by contact, droplet, or airborne route. Transport of COVID-19 patients exposes HCWs and the public to infection risks, hence strict measures must be in place to ensure everyone's safety. ECMO cannulation and transportation is considered an aerosol generating procedure and can pose significant risks to HCWs. In addition, close contact with the patient in the confined space of the ambulance may put HCWs at increased risk of exposure and infection. Methods: Between March 1st and September 30th 2020, a total of 32 episodes of COVID-19 ECMO transport were undertaken by the Medical Intensive Care Unit (MICU) and Ambulance Service. We reviewed the incidence of COVID-19 infection among HCWs involved in these missions. The transport clinical team is composed of ECMO consultant, two ECMO nurses, a perfusionist and a Critical Care Paramedic (CCP). Due to staff shortage and clinical needs, a respiratory therapist did not attend to the majority of cases. A crew of two paramedics supports the clinical team with their intensive care ambulance. Results: The number of clinical staff involved in the COVID-19 ECMO transport during that period is shown in . The duration of clinical staff’s exposure to the infected patient in the back of the ambulance is demonstrated in. MICU staff underwent COVID-19 serology tests every 2 weeks as per local policy. None of the clinical staff involved in these transfers and retrievals of COVID-19 positive patients tested positive after 2 weeks of transport. Conclusion: Strict infection prevention and personal protective measures are mandatory to avoid cross-infection and were carefully adhered to during all the missions. They translated into the well-being of the clinical staff involved in the transfer and retrievals of COVID-19 positive patients.

scholarly journals SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study

Thorax ◽  
2020 ◽  
Vol 75 (12) ◽  
pp. 1089-1094 ◽  
Author(s):  
Adrian Shields ◽  
Sian E Faustini ◽  
Marisol Perez-Toledo ◽  
Sian Jossi ◽  
Erin Aldera ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthcare Workers ◽  
Venous Blood ◽  
Cross Sectional Study ◽  
Nasopharyngeal Swab ◽  
Sectional Study ◽  
University Hospitals ◽  
Cross Sectional ◽  
General Internal ◽  
Increased Risk

ObjectiveTo determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DesignA cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SettingUniversity Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.Participants545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded.InterventionParticipants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked.Main outcome measureProportion of participants demonstrating infection and positive SARS-CoV-2 serology.ResultsThe point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02).Conclusions and relevanceWe identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.

Abstract 16543: Severe Thrombocytopenia is Common in Adults Undergoing Venoarterial Extracorporeal Membrane Oxygenation and is Predictive of Hemorrhage

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tia C Kohs ◽  
Vikram Raghunathan ◽  
Patricia Liu ◽  
Ramin Amirsoltani ◽  
Michael Oakes ◽  
...  
Keyword(s):  
Overall Survival ◽  
Logistic Regression ◽  
Platelet Count ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Implications ◽  
Severe Thrombocytopenia ◽  
Multivariate Logistic Regression ◽  
Membrane Oxygenation ◽  
Increased Risk ◽  
Va Ecmo

Introduction: Extracorporeal membrane oxygenation (ECMO) is used to provide circulatory support and facilitate gas exchange via cardiopulmonary bypass. The relationship between ECMO and the incidence of severe thrombocytopenia (platelet count <50 x 10 9 /L) and subsequent clinical consequences are ill defined. We aimed to identify the risk factors for the development of thrombocytopenia and its clinical implications. Methods: This is a single-center retrospective cohort study of adults who received venoarterial (VA) ECMO. We examined consecutive platelet counts while on ECMO. Univariate logistic regression was used to determine if mean platelet count, platelet count range, or severe thrombocytopenia were predictors of overall survival, hemorrhage and thrombosis. A multivariate logistic regression model was used to identify factors that contribute to the development of the aforementioned patient outcomes. Results: In our cohort, 33 patients were included with a mean age of 55 years and duration of ECMO of 5.9 days. All patients received heparin, 33.3% received antiplatelet therapy and 45.5% developed severe thrombocytopenia. In univariate, analysis the development of severe thrombocytopenia increased the odds of major bleeding by 450% (OR 5.500, 95% CI 1.219 - 24.813, P -value 0.027), and the odds of surviving hospitalization decreased 84.1% (OR 0.159, 95% CI 0.033 - 0.773, P -value 0.023). Multivariate logistic regression controlling for additional clinical variables found no significant association between the development of severe thrombocytopenia and rates of thrombosis, hemorrhage, or overall survival. Platelet count decreased over time while on ECMO. Conclusions: Nearly half of the patients requiring VA-ECMO developed severe thrombocytopenia, which was associated with an increased risk of hemorrhage and in-hospital mortality. Additional studies are required to clarify the clinical implications of severe thrombocytopenia in ECMO patients.

Outcomes of pediatric oncology and hematopoietic cell transplant patients receiving extracorporeal membrane oxygenation

Perfusion ◽  
2019 ◽  
Vol 34 (7) ◽  
pp. 598-604
Author(s):  
Danielle K Maue ◽  
Michael J Hobson ◽  
Matthew L Friedman ◽  
Elizabeth AS Moser ◽  
Courtney M Rowan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Hematopoietic Cell ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Membrane Oxygenation ◽  
Transplant Patients

Background/objectives: There is controversy regarding the utilization of extracorporeal membrane oxygenation in pediatric patients with an underlying oncologic diagnosis or who have undergone hematopoietic cell transplant. We hypothesized that these patients have higher mortality, more bleeding complications, more blood product utilization, and a higher rate of new infections than the general pediatric intensive care unit population supported with extracorporeal membrane oxygenation. Design/methods: This is a retrospective chart review at a single center quaternary care pediatric hospital including all pediatric intensive care unit extracorporeal membrane oxygenation patients from 2011 to 2016. Patients were categorized as either oncology/hematopoietic cell transplant or general pediatric intensive care unit. Patients from the cardiovascular intensive care unit or the neonatal intensive care unit were excluded. Results: A total of 38 patients met inclusion criteria of which 7 were oncology/hematopoietic cell transplant patients. The oncology/hematopoietic cell transplant group had lower platelets at the start of extracorporeal membrane oxygenation (p = 0.02) but other pre-extracorporeal membrane oxygenation characteristics were similar. Extracorporeal membrane oxygenation survival was lower in the oncology/hematopoietic cell transplant group (29% vs 77%, p = 0.02). The incidence of bleeding complications and new infections did not differ. The oncology/hematopoietic cell transplant group received more platelets (median of 15.9 mL/kg/day (interquartile range 8.4, 36.6) vs 7.9 mL/kg/day (3.3, 21.9), p = 0.04) and fresh frozen plasma (14.0 mL/kg/day (3, 15.7) vs 1.8 mL/kg/day (0.5, 5.9), p = 0.04). Conclusion: Oncology and hematopoietic cell transplant patients had a higher mortality and received more blood products while on extracorporeal membrane oxygenation than the general pediatric intensive care unit patients despite similar pre-extracorporeal membrane oxygenation characteristics. Physicians should use caution when deciding whether or not to utilize extracorporeal membrane oxygenation in this population.

scholarly journals Mobile extracorporeal membrane oxygenation service for severe acute respiratory failure – A review of five years of experience

2019 ◽  
Vol 21 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Ada M Krzak ◽  
Jo-Anne Fowles ◽  
Alain Vuylsteke
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Qualitative Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Equipment Failure ◽  
Quality And Safety ◽  
Regular Reflection ◽  
Membrane Oxygenation

Provision of extracorporeal membrane oxygenation as part of support escalation in severe refractory acute respiratory failure in England is provided by five specialist centres that operate within a well-defined quality and safety framework. We conducted a qualitative study of the extracorporeal membrane oxygenation retrieval service provided by one of the five centres. We analysed 176 consecutive debrief reports written between October 2013 and April 2018 by the consultant. Main identified issues were short delays in retrieval predominantly due to insufficient communication or equipment failure. All issues were addressed in subsequent practice. Our results suggest a need for improved communication between the referring intensive care unit and retrieving team. Our findings highlight the value of regular reflection-based evaluation to ensure continued provision of safe and efficient service.

scholarly journals The psychological impacts of COVID-19: a study of frontline physicians and nurses in the Arab world

2020 ◽  
pp. 1-6
Author(s):  
N. Al Mahyijari ◽  
A. Badahdah ◽  
F. Khamis
Keyword(s):  
Perceived Stress ◽  
Healthcare Workers ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Arab World ◽  
Close Contact ◽  
Well Being ◽  
Sultanate Of Oman ◽  
Stress Scale ◽  
Harmful Effects

Objectives: The COVID-19 (SARS-CoV2) pandemic is wreaking havoc on healthcare systems and causing serious economic, social, and psychological anguish around the globe. Healthcare workers (HCWs) who diagnose and care for COVID-19 patients have been shown to suffer burnout, stress, and anxiety. Methods: In this study, we collected data from 150 frontline HCWs who had close contact with COVID-19 patients at several health facilities in the Sultanate of Oman. The participants completed an online survey that included the Perceived Stress Scale, the Generalized Anxiety Disorder Scale, and the WHO-5 Well-Being Index. Results: The study found that a substantial number of healthcare professionals experienced relatively high levels of stress and anxiety, as well as suboptimal levels of well-being. Perceived stress and anxiety were significant predictors of HCWs’ well-being. Conclusions: This study adds to the increasing literature indicating harmful effects of COVID-19 on the mental health of HCWs.

scholarly journals Central Airway Obstruction due to Mediastinal Malignant Lymphoma Requiring Venovenous-Extracorporeal Membrane Oxygenation

2019 ◽  
Vol 2 (2) ◽  
pp. 42-47 ◽  
Author(s):  
Yoshihiro Ueda ◽  
Ichiro Hirayama ◽  
Ryohei Horie ◽  
Kent Doi ◽  
Naoto Morimura
Keyword(s):  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Airway Obstruction ◽  
Malignant Lymphoma ◽  
Hematological Malignancy ◽  
Central Airway Obstruction ◽  
Membrane Oxygenation ◽  
Life Threatening ◽  
Central Airway ◽  
Ecmo Therapy

Extracorporeal membrane oxygenation (ECMO) therapy might be controversial when patients with advanced malignant disease develop heart or lung failure refractory to conventional management. Especially as for the hematological malignancy patients, the induction of ECMO therapy must be considered carefully, since it is often associated with bleeding complications or infectious diseases. Here, we report a case of life-threatening airway obstruction requiring ECMO. The trachea of the patient was narrowed by an anterior mediastinal tumor too highly to ventilate both lungs, so she had to be connected to venovenous-ECMO (VV-ECMO) before pathological examination and radical treatment were planned. During the intensive care with ECMO, she was diagnosed with malignant lymphoma and the chemotherapy was started. The chemotherapy brought such an immediate result that the trachea regained its patency and ECMO was disconnected 9 days after the initiation of the chemotherapy. Then, the patient was able to leave the intensive care unit with no sequelae. Central airway obstruction is a life-threatening situation, in which prompt decisions are essential. On the other hand, if the airway is impaired by hematological malignancy, it might be generally challenging to consider ECMO as a bridge until the chemotherapy takes an effect. The prognosis of hematological malignancy differs according to its subtype or stage, so it may be reasonable to take ECMO therapy into consideration for some population.

Cost-effectiveness of Argatroban Versus Heparin Anticoagulation in Adult Extracorporeal Membrane Oxygenation Patients

2019 ◽  
pp. 001857871989009
Author(s):  
Angelina E. Cho ◽  
Kathleen Jerguson ◽  
Joy Peterson ◽  
Deepa V. Patel ◽  
Asif A. Saberi
Keyword(s):  
Cost Effectiveness ◽  
Extracorporeal Membrane Oxygenation ◽  
Average Cost ◽  
P Value ◽  
Bleeding Events ◽  
Membrane Oxygenation ◽  
Increased Risk ◽  
Heparin Anticoagulation ◽  
Ischemic Events ◽  
Ecmo Therapy

Purpose: The purpose of this study was to evaluate the cost effectiveness of argatroban compared to heparin during extracorporeal membrane oxygenation (ECMO) therapy. Methods: This was a retrospective study of patients who received argatroban or heparin infusions with ECMO therapy at a community hospital between January 1, 2017 and June 30, 2018. Adult patients who received heparin or argatroban for at least 48 hours while on venovenous (VV) or venoarterial (VA) ECMO were included. Patients with temporary mechanical circulatory assist devices were excluded. Each continuous course of anticoagulant exposure that met the inclusion criteria was evaluated. The primary endpoint was the total cost of anticoagulant therapy for heparin versus argatroban, including all administered study drugs, blood or factor products, and associated laboratory tests. Secondary endpoints included safety and efficacy of anticoagulation with each agent during ECMO. Documentation of bleeding events, circuit clotting, and ischemic events were noted. Partial thromboplastin time (PTT) values were evaluated for time to therapeutic range and percentage of therapeutic PTTs. Results: A total of 11 courses of argatroban and 24 courses of heparin anticoagulation were included in the study. The average cost per course of argatroban was less than the average cost per course of heparin ($7,091.98 vs $15,323.49, respectively; P value = 0.15). Furthermore, argatroban was not associated with an increased incidence of bleeding, thrombotic, or ischemic events. Conclusion: Argatroban may be more cost-effective during ECMO therapy in patients with low antithrombin III levels without increased risk of adverse events.

Sign in / Sign up

Export Citation Format

Share Document