Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome
Objectives: The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical...
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Veröffentlicht in: | Perfusion 2023-05, Vol.38 (4), p.837-842 |
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creator | Karampinis, Ioannis Al-Shammari, Abdullah Hartley, Philip Patel, Mehul Arachchillage, Deepa R J Jordan, Simon Thakuria, Louit Garfield, Ben Ledot, Stephane Buderi, Silviu |
description | Objectives:
The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS.
Methods:
18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March–June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications.
Results:
Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18).
Conclusions:
Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding. |
doi_str_mv | 10.1177/02676591221090618 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9082097</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_02676591221090618</sage_id><sourcerecordid>2800544985</sourcerecordid><originalsourceid>FETCH-LOGICAL-c418t-a6fb78eda4012111d445c20ffb971322cacbde031074ea46f6941278d5e10c853</originalsourceid><addsrcrecordid>eNp1kU1v1DAQhi0EokvhB3BBlrhwSZlx7Di5IKEtH5Uq9VIQN8txJltXSbzYSdX9DfxpvGwpX-LikTXPvDPvDGPPEU4QtX4NotKValAIhAYqrB-wFUqtC0T88pCt9vliDxyxJyldA4CUsnzMjkqlUIJSK_bt8ipE67zjaYkbijvuJ761s6dpTjxM_IamUOyfJXG6nTMb4jZEsgMfaWyjnYiH292GplyU-T5Evr74fHZaYMNtSsF5O1PHrVtm4pHS1kc7h9yo82nO_8TTbupiGOkpe9TbIdGzu3jMPr1_d7n-WJxffDhbvz0vnMR6LmzVt7qmzkpAkZ12UionoO_bRmMphLOu7QhKBC3JyqqvGolC150iBFer8pi9Oehul3akzmWr0Q5mG_1o484E682fmclfmU24MQ3UAhqdBV7dCcTwdaE0m9EnR8OQl5H3ZERVIdSqkmVGX_6FXoclTtmeETWAkrL5MREeKBdDSpH6-2EQzP7U5p9T55oXv7u4r_h52wycHIBkN_Sr7f8VvwMA8rRy</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2800544985</pqid></control><display><type>article</type><title>Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome</title><source>SAGE Complete A-Z List</source><source>MEDLINE</source><creator>Karampinis, Ioannis ; Al-Shammari, Abdullah ; Hartley, Philip ; Patel, Mehul ; Arachchillage, Deepa R J ; Jordan, Simon ; Thakuria, Louit ; Garfield, Ben ; Ledot, Stephane ; Buderi, Silviu</creator><creatorcontrib>Karampinis, Ioannis ; Al-Shammari, Abdullah ; Hartley, Philip ; Patel, Mehul ; Arachchillage, Deepa R J ; Jordan, Simon ; Thakuria, Louit ; Garfield, Ben ; Ledot, Stephane ; Buderi, Silviu</creatorcontrib><description>Objectives:
The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS.
Methods:
18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March–June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications.
Results:
Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18).
Conclusions:
Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding.</description><identifier>ISSN: 0267-6591</identifier><identifier>EISSN: 1477-111X</identifier><identifier>DOI: 10.1177/02676591221090618</identifier><identifier>PMID: 35514055</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Anticoagulants ; Anticoagulants - therapeutic use ; Bleeding ; Complications ; Coronaviruses ; COVID-19 ; COVID-19 - complications ; COVID-19 - therapy ; Extracorporeal membrane oxygenation ; Extracorporeal Membrane Oxygenation - methods ; Humans ; Membranes ; Original Paper ; Ostomy ; Oxygenation ; Pandemics ; Patients ; Respiratory distress syndrome ; Respiratory Distress Syndrome - etiology ; Respiratory Distress Syndrome - therapy ; Retrospective Studies ; Surgery ; Thoracic Surgery ; Thorax ; Thromboembolism ; Tracheostomy ; Tracheotomy</subject><ispartof>Perfusion, 2023-05, Vol.38 (4), p.837-842</ispartof><rights>The Author(s) 2022</rights><rights>The Author(s) 2022 2022 SAGE Publications</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c418t-a6fb78eda4012111d445c20ffb971322cacbde031074ea46f6941278d5e10c853</cites><orcidid>0000-0003-2742-9045</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/02676591221090618$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/02676591221090618$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>230,314,776,780,881,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35514055$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karampinis, Ioannis</creatorcontrib><creatorcontrib>Al-Shammari, Abdullah</creatorcontrib><creatorcontrib>Hartley, Philip</creatorcontrib><creatorcontrib>Patel, Mehul</creatorcontrib><creatorcontrib>Arachchillage, Deepa R J</creatorcontrib><creatorcontrib>Jordan, Simon</creatorcontrib><creatorcontrib>Thakuria, Louit</creatorcontrib><creatorcontrib>Garfield, Ben</creatorcontrib><creatorcontrib>Ledot, Stephane</creatorcontrib><creatorcontrib>Buderi, Silviu</creatorcontrib><title>Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome</title><title>Perfusion</title><addtitle>Perfusion</addtitle><description>Objectives:
The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS.
Methods:
18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March–June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications.
Results:
Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18).
Conclusions:
Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding.</description><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Bleeding</subject><subject>Complications</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - therapy</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Extracorporeal Membrane Oxygenation - methods</subject><subject>Humans</subject><subject>Membranes</subject><subject>Original Paper</subject><subject>Ostomy</subject><subject>Oxygenation</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory Distress Syndrome - etiology</subject><subject>Respiratory Distress Syndrome - therapy</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Thorax</subject><subject>Thromboembolism</subject><subject>Tracheostomy</subject><subject>Tracheotomy</subject><issn>0267-6591</issn><issn>1477-111X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1v1DAQhi0EokvhB3BBlrhwSZlx7Di5IKEtH5Uq9VIQN8txJltXSbzYSdX9DfxpvGwpX-LikTXPvDPvDGPPEU4QtX4NotKValAIhAYqrB-wFUqtC0T88pCt9vliDxyxJyldA4CUsnzMjkqlUIJSK_bt8ipE67zjaYkbijvuJ761s6dpTjxM_IamUOyfJXG6nTMb4jZEsgMfaWyjnYiH292GplyU-T5Evr74fHZaYMNtSsF5O1PHrVtm4pHS1kc7h9yo82nO_8TTbupiGOkpe9TbIdGzu3jMPr1_d7n-WJxffDhbvz0vnMR6LmzVt7qmzkpAkZ12UionoO_bRmMphLOu7QhKBC3JyqqvGolC150iBFer8pi9Oehul3akzmWr0Q5mG_1o484E682fmclfmU24MQ3UAhqdBV7dCcTwdaE0m9EnR8OQl5H3ZERVIdSqkmVGX_6FXoclTtmeETWAkrL5MREeKBdDSpH6-2EQzP7U5p9T55oXv7u4r_h52wycHIBkN_Sr7f8VvwMA8rRy</recordid><startdate>20230501</startdate><enddate>20230501</enddate><creator>Karampinis, Ioannis</creator><creator>Al-Shammari, Abdullah</creator><creator>Hartley, Philip</creator><creator>Patel, Mehul</creator><creator>Arachchillage, Deepa R J</creator><creator>Jordan, Simon</creator><creator>Thakuria, Louit</creator><creator>Garfield, Ben</creator><creator>Ledot, Stephane</creator><creator>Buderi, Silviu</creator><general>SAGE Publications</general><general>Sage Publications Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2742-9045</orcidid></search><sort><creationdate>20230501</creationdate><title>Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome</title><author>Karampinis, Ioannis ; Al-Shammari, Abdullah ; Hartley, Philip ; Patel, Mehul ; Arachchillage, Deepa R J ; Jordan, Simon ; Thakuria, Louit ; Garfield, Ben ; Ledot, Stephane ; Buderi, Silviu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-a6fb78eda4012111d445c20ffb971322cacbde031074ea46f6941278d5e10c853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>Bleeding</topic><topic>Complications</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - complications</topic><topic>COVID-19 - therapy</topic><topic>Extracorporeal membrane oxygenation</topic><topic>Extracorporeal Membrane Oxygenation - methods</topic><topic>Humans</topic><topic>Membranes</topic><topic>Original Paper</topic><topic>Ostomy</topic><topic>Oxygenation</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory Distress Syndrome - etiology</topic><topic>Respiratory Distress Syndrome - therapy</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Thorax</topic><topic>Thromboembolism</topic><topic>Tracheostomy</topic><topic>Tracheotomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karampinis, Ioannis</creatorcontrib><creatorcontrib>Al-Shammari, Abdullah</creatorcontrib><creatorcontrib>Hartley, Philip</creatorcontrib><creatorcontrib>Patel, Mehul</creatorcontrib><creatorcontrib>Arachchillage, Deepa R J</creatorcontrib><creatorcontrib>Jordan, Simon</creatorcontrib><creatorcontrib>Thakuria, Louit</creatorcontrib><creatorcontrib>Garfield, Ben</creatorcontrib><creatorcontrib>Ledot, Stephane</creatorcontrib><creatorcontrib>Buderi, Silviu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Perfusion</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karampinis, Ioannis</au><au>Al-Shammari, Abdullah</au><au>Hartley, Philip</au><au>Patel, Mehul</au><au>Arachchillage, Deepa R J</au><au>Jordan, Simon</au><au>Thakuria, Louit</au><au>Garfield, Ben</au><au>Ledot, Stephane</au><au>Buderi, Silviu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome</atitle><jtitle>Perfusion</jtitle><addtitle>Perfusion</addtitle><date>2023-05-01</date><risdate>2023</risdate><volume>38</volume><issue>4</issue><spage>837</spage><epage>842</epage><pages>837-842</pages><issn>0267-6591</issn><eissn>1477-111X</eissn><abstract>Objectives:
The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS.
Methods:
18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March–June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications.
Results:
Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18).
Conclusions:
Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>35514055</pmid><doi>10.1177/02676591221090618</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-2742-9045</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Anticoagulants Anticoagulants - therapeutic use Bleeding Complications Coronaviruses COVID-19 COVID-19 - complications COVID-19 - therapy Extracorporeal membrane oxygenation Extracorporeal Membrane Oxygenation - methods Humans Membranes Original Paper Ostomy Oxygenation Pandemics Patients Respiratory distress syndrome Respiratory Distress Syndrome - etiology Respiratory Distress Syndrome - therapy Retrospective Studies Surgery Thoracic Surgery Thorax Thromboembolism Tracheostomy Tracheotomy |
title | Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome |
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