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
Hauptverfasser: Karampinis, Ioannis, Al-Shammari, Abdullah, Hartley, Philip, Patel, Mehul, Arachchillage, Deepa R J, Jordan, Simon, Thakuria, Louit, Garfield, Ben, Ledot, Stephane, Buderi, Silviu
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container_end_page 842
container_issue 4
container_start_page 837
container_title Perfusion
container_volume 38
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
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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. 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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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