Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus.

BACKGROUND: Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS-CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies. METHODS: We collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay. RESULTS: Thirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05). CONCLUSIONS: ECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.

Comparison of Saudi Arabian hemodialysis and peritoneal dialysis patients' illness perceptions.

The clinical outcome of patients with end-stage renal disease (ESRD) may differ according to their beliefs concerning their illness and its treatment. Both the disease itself and negative perceptions of the illness may increase patients' morbidity and mortality. This study aims to compare hemodialysis (HD) and peritoneal dialysis (PD) patients' illness perceptions and their related factors. This cross-sectional comparative study was conducted in five dialysis centers. After excluding patients with psychiatric comorbidities, 342 stable dialysis patients (HD, n = 267; PD, n = 75) completed a demographic questionnaire and the Revised Illness Perception Questionnaire (IPQ-R). The data were analyzed using t-tests and ANOVAs. Out of the 342 patients, 53.8% were male and 46.2% were female. Their mean age was 46.1 ± 16.5 years. Compared to the HD patients, the PD patients perceived their illness to be significantly less chronic (p = .029) and more controllable, whether through personal or treatment control (p = .012, p = .017). Patients' most common cause of attributions were stress, worry, or poor past medical care. PD showed an advantage over HD in terms of perceptions of ESRD chronicity and controllability. Intervention programs targeting illness perception are needed to support dialysis patients.

Quality of healthcare for hemodialysis patients in various health sectors in Jeddah, Saudi Arabia.

BACKGROUND AND OBJECTIVE: We compared the adequacy of the management of hemodialysis patients in different health sectors in a major city in Saudi Arabia. DESIGN AND SETTINGS: Cross-sectional analytic study conducted in three different health sectors in Jeddah, Saudi Arabia. METHODS: Data was collected from nine hemodialysis centers, which represent three sectors: Ministry of Health, governmental (but not health ministry) hospitals, and charity centers. A simple random sampling tech.nique was employed for gathering data from the participating centers. Medical records were reviewed and all the relevant data were retrieved using a pre-designed form. RESULTS: In the 587 subjects, hypertension, diabetes mellitus and an idiopathic etiology accounted for 85.3% of end-stage renal disease. Only 25.4% of the patients had a hemoglobin level of 110-120 g/L and 12.1% achieved target levels of ferritin and transferrin saturation. The percentage of patients meeting targeted levels of calcium (2.1-2.38 mmol/L), phosphorous (1.13-1.78 mmol/L) and albumin (>=40 g/L) were 54.2%, 38.7% and 23.5%, respectively. The variation between different health sectors was statistically significant (P < .001). Arteriovenous fistula was used for 84% of the patients and catheter for 15.7%. CONCLUSION: The quality of healthcare for hemodialysis patients in Jeddah needs improvement to meet the recommendations of the Kidney Disease Outcomes Quality Initiative guidelines.