Abstract Extracorporeal life support is a rescue therapy when mechanical ventilation is unable to maintain adequate tissue oxygenation in the setting of acute cardiac or respiratory failure. Outcome is influenced not only by factors independent of ECMO but also by the potential complications related to ECMO. The study is designed to understand the outcomes of Extracorporeal membrane oxygenation in the management of Acute Cardio Respiratory failure in adult population. The study is analytical and the data is prospectively collected from a local registry of ECMO patients and ICU clinical database. Further, clinical details were obtained from prospective review of patient medical records. The study period is from November 2013 and November 2015. A total of 30 patients were included in the study 36.7% were weaned off ECLS and 33.3% survived to hospital discharge. Incidence of Heparin Induced Thrombocytopenia was observed in 3 patients. 27 patients went into renal dysfunction. Both ICU duration (p-0.945) and duration of ECMO (0.736) support did not prove to be significant in predicting mortality. No cannula related vascular complications leading to limb ischemia or need for vascular repair were encountered in any patient. Mean number of blood transfusions required during ECMO support were 15.17 units. Infections acquired on ECMO support, p=0.052; 95% CI=0.007-1.707. Our results endorse the use of ECMO as a rescue therapy in adults, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. However, ECMO is still marred by frequent and significant complications such as renal derangement, bleeding and nosocomial infections.
{"title":"Evaluation of Extra Corporeal Membrane Oxygenation Support in Adult Cardio Respiratory Failure-An Observational Study.","authors":"","doi":"10.46940/shfci.01.1001","DOIUrl":"https://doi.org/10.46940/shfci.01.1001","url":null,"abstract":"Abstract Extracorporeal life support is a rescue therapy when mechanical ventilation is unable to maintain adequate tissue oxygenation in the setting of acute cardiac or respiratory failure. Outcome is influenced not only by factors independent of ECMO but also by the potential complications related to ECMO. The study is designed to understand the outcomes of Extracorporeal membrane oxygenation in the management of Acute Cardio Respiratory failure in adult population. The study is analytical and the data is prospectively collected from a local registry of ECMO patients and ICU clinical database. Further, clinical details were obtained from prospective review of patient medical records. The study period is from November 2013 and November 2015. A total of 30 patients were included in the study 36.7% were weaned off ECLS and 33.3% survived to hospital discharge. Incidence of Heparin Induced Thrombocytopenia was observed in 3 patients. 27 patients went into renal dysfunction. Both ICU duration (p-0.945) and duration of ECMO (0.736) support did not prove to be significant in predicting mortality. No cannula related vascular complications leading to limb ischemia or need for vascular repair were encountered in any patient. Mean number of blood transfusions required during ECMO support were 15.17 units. Infections acquired on ECMO support, p=0.052; 95% CI=0.007-1.707. Our results endorse the use of ECMO as a rescue therapy in adults, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. However, ECMO is still marred by frequent and significant complications such as renal derangement, bleeding and nosocomial infections.","PeriodicalId":293101,"journal":{"name":"SunKrist Heart Failure and Cardiology Insights","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116909608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The coronavirus disease-2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has hit the world very hard by affecting millions of people across countries hence posing a major health threat on a global scale. This novel virus is thought to enter and cause infection in its host through the attachment of its structural protein known as the S-glycoprotein to angiotensin-converting enzyme 2 (ACE2). COVID-19 is presented with asymptomatic, mild, or severe pneumonia-like symptoms. During the infection, the cardiovascular system is affected by unknown pathophysiological processes. Among COVID-19 patients, cardiovascular disease (CVD) is resulting into cardiac injury, acute coronary syndrome (ACS), myocardial infarction (MI), arrhythmic infestation and myocarditis. The results of the meta-analysis suggest that CVD and its risk factors are closely related to fatal outcomes in COVID-19 for patients across all ages. Hence, from a cardiovascular standpoint, there are concerns as to whether patients with underlying cardiovascular conditions are at a higher risk of an aggravated COVID-19 infection. Also, as to whether COVID-19 infections induce cardiomyopathies that were not in existence prior to the infection. Nonetheless, much needs to be discovered about the cardiac involvement of this novel coronavirus (nCoV) infection and its relationship with cardiovascular diseases (CVDs). For acute CVD events, the use of antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs) and statins are recommended per practice guidelines. Whether the medications which patients used for cardiovascular disease will interfere with the treatment or the outcome of COVID-19, is still unknown. With the invent of vaccines and as new clinical evidences emerging, the diagnosis and treatment may change. The purpose of this concise review is to discuss CVD and related potential disorders in patients with COVID-19 which involves SARS-CoV-2 infection, pathophysiology, role of ACE2 in cardiac injury, possible mechanism of cardiac complications and clinical manifestations.
{"title":"Review: SARS-CoV-2, Cardiovascular Disease, Pathophysiology and Role of ACE2 in Cardiac Injury","authors":"","doi":"10.46940/shfci.03.1004","DOIUrl":"https://doi.org/10.46940/shfci.03.1004","url":null,"abstract":"The coronavirus disease-2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has hit the world very hard by affecting millions of people across countries hence posing a major health threat on a global scale. This novel virus is thought to enter and cause infection in its host through the attachment of its structural protein known as the S-glycoprotein to angiotensin-converting enzyme 2 (ACE2).\u0000COVID-19 is presented with asymptomatic, mild, or severe pneumonia-like symptoms. During the infection, the cardiovascular system is affected by unknown pathophysiological processes. Among COVID-19 patients, cardiovascular disease (CVD) is resulting into cardiac injury, acute coronary syndrome (ACS), myocardial infarction (MI), arrhythmic infestation and myocarditis. The results of the meta-analysis suggest that CVD and its risk factors are closely related to fatal outcomes in COVID-19 for patients across all ages. Hence, from a cardiovascular standpoint, there are concerns as to whether patients with underlying cardiovascular conditions are at a higher risk of an aggravated COVID-19 infection. Also, as to whether COVID-19 infections induce cardiomyopathies that were not in existence prior to the infection. Nonetheless, much needs to be discovered about the cardiac involvement of this novel coronavirus (nCoV) infection and its relationship with cardiovascular diseases (CVDs). For acute CVD events, the use of antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs) and statins are recommended per practice guidelines. Whether the medications which patients used for cardiovascular disease will interfere with the treatment or the outcome of COVID-19, is still unknown. With the invent of vaccines and as new clinical evidences emerging, the diagnosis and treatment may change.\u0000The purpose of this concise review is to discuss CVD and related potential disorders in patients with COVID-19 which involves SARS-CoV-2 infection, pathophysiology, role of ACE2 in cardiac injury, possible mechanism of cardiac complications and clinical manifestations.","PeriodicalId":293101,"journal":{"name":"SunKrist Heart Failure and Cardiology Insights","volume":"65 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126988102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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