Extracorporeal membrane oxygenation for coronavirus disease 2019-associated acute respiratory distress syndrome: Report of two cases and review of the literature.

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2, is a worldwide pandemic. Some COVID-19 patients develop severe acute respiratory distress syndrome and progress to respiratory failure. In such cases, extracorporeal membrane oxygenation (ECMO) treatment is a necessary life-saving procedure. CASE SUMMARY: Two special COVID-19 cases-one full-term pregnant woman and one elderly (72-year-old) man-were treated by veno-venous (VV)-ECMO in the Second People's Hospital of Zhongshan, Zhongshan City, Guangdong Province, China. Both patients had developed refractory hypoxemia shortly after hospital admission, despite conventional support, and were therefore managed by VV-ECMO. Although both experienced multiple ECMO-related complications on top of the COVID-19 disease, their conditions improved gradually. Both patients were weaned successfully from the ECMO therapy. At the time of writing of this report, the woman has recovered completely and been discharged from hospital to home; the man remains on mechanical ventilation, due to respiratory muscle weakness and suspected lung fibrosis. As ECMO itself is associated with various complications, it is very important to understand and treat these complications to achieve optimal outcome. CONCLUSION: VV-ECMO can provide sufficient gas exchange for COVID-19 patients with acute respiratory distress syndrome. However, it is crucial to understand and treat ECMO-related complications.

The Prognostic Risk Factors of ECMO in Patients with Cardiogenic Shock: A Retrospective Cohort Analysis.

BACKGROUND: Advances in ECMO have rapidly progressed in recent years; however, the clinical mortality rate remains high. This study aimed to identify the risk factors of ECMO in patients with cardiogenic shock. METHODS: Data of patients with cardiogenic shock who received ECMO from January 2006 to August 2013 at the Affiliated Hospital of Sun Yat-Sen University were retrospectively analyzed. All patients with cardiogenic shock were divided into two groups according to whether death occurred in the hospital. The possible prognostic risk factors of ECMO were first obtained in a univariate analysis of the two groups, and the risk factors that affected the prognosis of patients who underwent ECMO were determined using a logistic regression analysis. RESULTS: This study included 94 cardiogenic shock patients who were treated with ECMO. Overall, 59 patients were successfully weaned from ECMO, which accounted for 62.7% of all patients. The multivariate analysis indicated that the independent risk factors associated with prognosis included ECMO timing (OR = 7.68; 95% CI 1.60-37.01), the occurrence of postoperative MOF (OR = 2,823.09; 95% CI 14.75-540,171.06), and the lactate level at weaning (OR = 493.17; 95% CI: 1.55-156,653.27). CONCLUSION: For patients with refractory cardiogenic shock, the early establishment of ECMO, improvement in perfusion, and the prevention of complications may improve the prognosis.

[Clinical application of extracorporeal membrane oxygenation for treatment of adult refractory cardiogenic shock].

OBJECTIVE: To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult refractory cardiogenic shock. METHODS: From January 2003 to January 2011, patients with refractory cardiogenic shock required veno-arterial ECMO by failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy were retrospectively studied. Patients with severe traumatic brain injury, advanced malignancies and multiple organ failure were excluded. Patients were divided into weaned group (n = 31) and not weaned group (n = 23) according to the ECMO weaning. RESULTS: The duration of ECMO was 24.16 (14.12, 56.75) hours. Twenty-two out of 31 patients in the weaned group survived and were discharged, 9 patients died after successfully weaned from ECMO (5 due to multisystem organ failure, 2 due to reoccurred cardiogenic shock, 1 due to infectious shock and 1 due to disseminated or diffuse intravascular coagulation). Pre-ECMO mean arterial pressure, ejection fraction, the duration of ECMO were significantly higher while pre-ECMO blood lactate [(8.64 ± 3.17) vs. (14.44 ± 2.52) , P < 0.01], the duration of ROSC [ (16.70 ± 5.29) vs. (35.64 ± 5.89), P < 0.01] and multisystem organ failure [0 vs. 17.4% (4/23) , P < 0.05] were lower in weaned group than in not wean group. CONCLUSIONS: ECMO is an effective mechanical assistant therapy strategy for adult refractory cardiogenic shock patients. Timely applying this strategy on suitable patients is crucial for the success of ECMO. Cardiac function and reversibility of heart failure are key factors determine the fate of weaned or not weaned ECMO in adult refractory cardiogenic shock patients.

[Effect of plasmaslyte A on the liver function of patients undergoing cardiac surgery with extracorporeal circulation].

OBJECTIVE: To observe the effect of plasmaslyte A on the liver function of patients receiving cardiac surgery with extracorporeal circulation. METHODS: Sixty patients scheduled for cardiac surgery were randomized to receive plasmaslyte A (group P, n=30) and ringer lactate solution (group R, n=30). The two agents were used in priming heart-lung machine and intra- and postoperative crystal solution. All the patients were examined for the levels of AST, ALT and Lac the day before and at 2 h and 1, 3 and 7 days after the surgery. The time of extubation and length of stay at the ICU were record. RESULTS: The levels of ALT, AST and Lac in group P were significantly lower than those in group R (P<0.05), and the duration of intubation and stay at the ICU was shorter in group P (P<0.05). CONCLUSION: Plasmaslyte A can markedly reduce the level of AST, ALT and Lac and protect the liver function of patients undergoing cardiac surgery with extracorporeal circulation.

[Expression of Rock2 and TGF-ß1 mRNA and glucocorticoid intervention in asthmatic rats].

OBJECTIVE: To study the roles of rhoassociated coiled coil forming protein kinase 2 (Rock2) and transforming growth factor-ß1 (TGF-ß1) mRNA in acute asthma and the effect of glucocorticoid intervention on the Rock2 and TGF-ß1 mRNA expression in rats. METHODS: Forty-eight male rats were randomly divided into 4 groups (n=12 each): asthma, control, dexamethasone treated (DXM) and budesonide treated (BUD). Rat model of asthma was prepared by the ovalbumin (OVA) challenge. The animals were sacrificed 24 hrs after the last challenge. The total cell number and differentiation cell number were counted in bronchoalveolar lavage fluid (BALF). The protein expression of Rock2 was ascertained by immunohistochemistry and the mRNA expression of TGF-ß1 was ascertained by hybridization in situ. RESULTS: The pathological changes in the BUD and the DXM groups were alleviated when compared with the asthma group. The total cell number and the percentage of eosinophil (EOS), polymorphonuclear leukocytes (PMN) and lymphocytes (Lym) in BALF in the asthma group were significantly higher than those in the control group (P<0.01). The percentage of macrophage (Mф) in the asthma group was significantly lower than that in the control group (P<0.01). The total cell number and the percentage of EOS and Lym in BALF in the DXM and the BUD groups decreased, while the percentage of Mф increased significantly compared with those in the asthma group (P<0.01). The Rock2 and TGF-ß1 mRNA expression in lung tissues in the asthma group increased significantly compared with those in the control, BUD and DXM groups, while there were no significant differences in the Rock2 expression and TGF-ß1 mRNA expression between the DXM or BUD group and the control group. CONCLUSIONS: The expression of Rock2 and TGF-ß1 mRNA in lung tissues is increased in rats with acute asthma. Glucocorticoids can significantly decrease the expression of Rock2 and TGF-ß1 in lung tissues, thus alleviates airway inflammation.