학술논문
Triage of V-V ECMO referrals for COVID-19 respiratory failure.
Document Type
Academic Journal
Author
Niles E; Critical Care Resuscitation Unit, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.; Haase DJ; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Tran Q; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Gerding JA; Critical Care Resuscitation Unit, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.; Esposito E; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Dahi S; Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Galvagno SM Jr; Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Boswell K; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Rector R; Perfusion Services, University of Maryland Medical Center, Baltimore, Maryland, USA.; Pearce R; University of Maryland Access Center, Linthicum Heights, Maryland, USA.; Abdel-Wahab M; University of Maryland School of Medicine, Research Assistant Program, Baltimore, Maryland, USA.; Singh A; University of Maryland School of Medicine, Research Assistant Program, Baltimore, Maryland, USA.; Pirzada S; University of Maryland School of Medicine, Research Assistant Program, Baltimore, Maryland, USA.; Tabatabai A; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Powell EK; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.; Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Source
Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 7802778 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1594 (Electronic) Linking ISSN: 0160564X NLM ISO Abbreviation: Artif Organs Subsets: MEDLINE
Subject
Language
English
Abstract
Background: As the pandemic progressed, the use of extracorporeal membrane oxygenation (ECMO) for COVID-19-related acute respiratory distress syndrome increased, and patient triage and transfer to ECMO centers became important to optimize patient outcomes. Our objectives are to identify predictors of patient transfer for veno-venous extracorporeal membrane oxygenation (V-V ECMO) evaluation as well as to describe the outcomes of accepted patients.
Methods: This is a single-center, retrospective analysis of V-V ECMO transfer requests for adult patients with known or suspected COVID-19 and respiratory failure from March 2020 until March 2021. Data were collected prospectively during the triage process for transfer requests as part of clinical patient care at our institution.
Results: Of 341 referred patients, 112 (33%) were accepted for transfer to our facility, whereas 229 (67%) patients were declined for transfer. The Classification and Regression Tree analysis showed that patients' high pressure during airway pressure release ventilation (APRV) and age were the variables most significantly associated with the decision to accept or decline patients for transfer.
Conclusions: Our triage process enabled one-third of referred patients to be transferred for evaluation, with nearly 70% of those patients ultimately receiving ECMO support. High ventilator settings on APRV and young age were associated with acceptance for transfer. Accepted patients also had a higher incidence of adjunctive therapies (proning and paralysis) prior to transfer request, less cardiac or renal dysfunction, and a shorter duration of mechanical ventilation. Further research is warranted to investigate the outcomes of nontransferred patients.
(© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)
Methods: This is a single-center, retrospective analysis of V-V ECMO transfer requests for adult patients with known or suspected COVID-19 and respiratory failure from March 2020 until March 2021. Data were collected prospectively during the triage process for transfer requests as part of clinical patient care at our institution.
Results: Of 341 referred patients, 112 (33%) were accepted for transfer to our facility, whereas 229 (67%) patients were declined for transfer. The Classification and Regression Tree analysis showed that patients' high pressure during airway pressure release ventilation (APRV) and age were the variables most significantly associated with the decision to accept or decline patients for transfer.
Conclusions: Our triage process enabled one-third of referred patients to be transferred for evaluation, with nearly 70% of those patients ultimately receiving ECMO support. High ventilator settings on APRV and young age were associated with acceptance for transfer. Accepted patients also had a higher incidence of adjunctive therapies (proning and paralysis) prior to transfer request, less cardiac or renal dysfunction, and a shorter duration of mechanical ventilation. Further research is warranted to investigate the outcomes of nontransferred patients.
(© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)