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10.1007/s12055-020-01084-y

http://scihub22266oqcxt.onion/10.1007/s12055-020-01084-y
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33250591!7683277!33250591
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suck abstract from ncbi

pmid33250591      Indian+J+Thorac+Cardiovasc+Surg 2021 ; 37 (1): 53-60
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  • SARS-CoV-2 and ECMO: early results and experience #MMPMID33250591
  • Akhtar W; Olusanya O; Baladia MM; Young H; Shah S
  • Indian J Thorac Cardiovasc Surg 2021[Jan]; 37 (1): 53-60 PMID33250591show ga
  • INTRODUCTION: In this paper, we describe our experience and early outcomes with critically unwell severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients who required extracorporeal membrane oxygenation (ECMO). We present our standard practices around ECMO decision-making, retrieval, cannulation, ventilation, anticoagulation, tracheostomy, imaging and steroids. METHODS: A retrospective cohort study using data from the hospital notes on all SARS-CoV-2 patients who required extracorporeal support at St Bartholomew's Hospital between 1 March 2020 and 31 July 2020. In total, this included 18 patients over this time period. RESULTS: In total, 18 patients were managed with extracorporeal support and of these 14 survived (78%) with 4 deaths (22%). The mean duration from hospital admission to intubation was 4.1 +/- 3.4 days, mean time from intubation to ECMO 2.3 +/- 2 days and mean run on ECMO 17.7 +/- 9.4 days. Survivor mean days from intubation to extubation was 20.6 +/- 9.9 days and survivor mean days from intubation to tracheostomy decannulation 46.6 +/- 15.3 days. Time from hospital admission to discharge in survivors was a mean of 57.2 +/- 25.8 days. Of the patients requiring extracorporeal support, the initial mode was veno-venous (VV) in 15 (83%), veno-arterial (VA) in 2 (11%) and veno-venous-arterial (VVA) in 1 (6%). On VV extracorporeal support, 2 (11%) required additional VVA. Renal replacement therapy was required in 10 (56%) of the patients. Anticoagulation target anti-Xa of 0.2-0.4 was set, with 10 (56%) patients having a deep vein thrombosis or pulmonary embolism detected and 2 (11%) patients suffering an intracranial haemorrhage. Tracheostomy was performed in 9 (50%) of the patients and high-dose methylprednisolone was given to 7 (39%) of the patients. CONCLUSION: In our cohort of patients with severe SARS-CoV-2 respiratory failure, a long period of invasive ventilation and extracorporeal support was required but achieving good outcomes despite this. There was a significant burden of thromboembolic disease and renal injury. A significant proportion of patients required tracheostomy and steroids to facilitate weaning.
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