Critical care & ECMO in the era of COVID-19: why data matters! ELSO webinar, moderated by Dr. Robert Bartlett & Matt Paden, highlighting the current research underway focused on better understanding the impact of COVID-19, and the role of extracorporeal support and ICU care in patients with SARS-CoV-2 Coronavirus infection. Topics & speakers: ELSO Registry and the live dashboard for COVID-19 Cases: Matt Paden & Ryan Barbaro EuroELSO Survey on ECLS in COVID-19, Roberto Lorusso & Jan Bělohlávek COVID-Critical Care Consortium, John Fraser & Heidi Dalton
Here full replay!
… and some slides:
Barbaro R.: We always know data matters! since H1N1 pandemic: now, more than 10 years later, COVID- 19 presented uncertainty & dynamic understanding, but thanks to community data soon start arriving, through: ELSO Registry COVID-19 addendum and live dashboard COVID critical care consortium EuroELSO survey on ECMO in COVID-19
Lorusso R.: with @jan_belohlavek sharing (preliminary) data but really interesting insights from EuroECMO COVID, the scientific “adventure” of EuroELSO survey, amazing collection of data in really short ime, thanks to EuroELSO & collaborative centers.
Fraser J.: presenting COVID critical care consortium, global collaboration of more than 330 hospital across 50 countries, 1021 patients enrolled to date, aimed to characterize COVID-19 ICU pts, & its subgroups: we need data to get whole picture!
And please take the ongoing related surveys, ie neonatal and pediatric ICU & ECMO survey http://bit.ly/3d7MSmR aimed to acquire basic informations on neonates & pediatric SARS-CoV-2 Coronavirus patients requiring ICU admission/ECMO, or the ethics ECMO & pandemis survey.
ECMO in COVID-19: What we have learned thus far? Lot of interesting topics & points of view discussed during this ELSO webinar, on April 22! Speakers & topics: Christian Bermudez & Holt Murray: regional coordination and collaboration on patients selection, cannulation, transfer, management strategies… Erik Osborn: successful ECMO support experiences, general management & procedures on extracorporeal support Troy Seelhammer & Tim Maul: hypercoagulable state of patients with Coronavirus infection & approaches to anticoagulation; circuits/devices shortage & potential alternatives. Here the slides!
Christian Bermudez, Professor of Surgery and Director of Thoracic Transplantation – Department of Surgery – University of Pennsylvania: ECMO Center Organization and Regional Coordination
Holt Murray, Department of Critical Care Medicine, Chief of Service UPMC Mercy and Assistant Professor, Critical Care Medicine, University of Pittsburgh School of Medicine Regional ECMO Coordination – 10 years in 10 minutes
Timothy M. Maul Perfusionist and Sr. Researcher – Nemours Children’s Hospital and Adjunct Asst. Professor, Biomedical Engineering, University of Pittsburgh Inflammation & Coagulation for SARS-COV-2: Perfusionist’s Perspective
The ECMOCARD Study first steps, trying to understand provide best care to COVID-19 patients who need critical care in ICU, from local outbreaks of Novel Coronavirus, to global pandemics of SARS-CoV-2. December, 26 2019: 4 unusual cases of pneumonia reported at HICWH Hospital in Wuhan, China; on January, 21 2020, first draft: ExtraCorporeal Membrane Oxygenation for 2019 WUhan CORonavirus Infection The ECMOWUCOR Observational trial, with study protocol in Chinese, Korean and Japanese one week later. At the end of January, ECMOWUCOR has been linked with SPRINT-SARI, Short PeRiod IncideNce sTudy of Severe Acute Respiratory Infection, & ISARIC, International Severe Acute Respiratory and Emerging Infection Consortium. On February, 4 2020, study title & acronym changed to ECMOCARD, ExtraCOrporeal Membrane, Oxygenation for novel Coronavlrus Acute Respiratory Disease… Work is in progress!
Collaboration mandatory: join & support ECMOCARD Study involving (to date): 43 Countries 6 Continents 286 Collaborative Centers 15 Recruiting Centers with 265 enrolled Patients All Trial Documents available here. Additional info & graphics available. Any question?? send email to ECMOCARD@ELSO.org
The Extracorporeal Life Support Organization – ELSO COVID-19 Dashboard is now live! We are asking centers Worldwide to support us capture vital informations to assist in the fight against SARS-CoV-2 Coronavirus: here a video with easy step-by-step instructions on how to quickly add data into the Registry! Key takeaways: Non-ELSO Centers contact firstname.lastname@example.org for CenterID and login Remember all red highlighted fields must be completed for your submission to be saved.
The power of connection: at a time when social distancing is a universal necessity, connecting as a healthcare community has never been so vitally important to keeping our patients & colleagues safe. This ELSO webinar focused on sharing experiences from around the globe that are currently in the surge phase. Highlights: Pearls from a COVID-19 dedicated WhatsApp chat: popular discussion topics, best practices & advices shared by ECLS experts. Stories from the front lines: preparing for the surge, indication, selection criteria & configuration for ECMO support in SARS-CoV-2 related severe respiratory failure & hemodynamic impairment, with some numbers about extracorporeal support implementation so far: Seattle Experience by Jenelle Badulak New York City Experience by Cara Agerstrand Paris Experience by Matthieu Schmidt.
Here full video
And here the slides!
Tammy Friedrich, MSN, RN, BSN, ECMO Specialist at Mayo Clinic in Rochester, MN Amy Hackmann, MD, FACS, Associate Professor in the Department of Cardiovascular and Thoracic Surgery at UT Southwestern Medical Center Holli Williams, RN, BSN, CCRN,ECMO and VAD Specialist and Preceptor – Innovative ECMO Concepts Inc What Have We Learned from Each Other
Matthieu Schmidt, MD, PhD – Service de Réanimation iCAN, Institute of Cardiometabolism and Nutrition Hôpital Pitié-Salpêtrière, AP-HP, Paris Université Pierre et Marie Curie, Paris 6 ECMO and COVID-19: Experience from Paris
In a time of global crisis, global collaboration is essential: join & support ECMOCARD Study: how to provide best care to COVID-19 patients who need critical care in ICU? In the pictures, some of the international collaborators of ECMOCARD & updated active sites map! All ECMOCARD Trial Documents available on the ELSO website Any question?? send email to ECMOCARD@ELSO.org
Current situation of ECMO use in Japan for COVID-19 associated ARDS: second ELSO webinar focused on the use of ECLS during the SARS-CoV-2 pandemics, run on March 30th. Highlights: case presentation of patient from Diamond Princess cruise ship requiring ECLS transport of patients on extracorporeal support coagulopathy on ECMO & more… Here full video, and the slides, available for download.
Shingo Ichiba, Department of Surgical Intensive Care Medicine, Nippon Medical School Hospital, Tokyo, Japan. ECMO for COVID-19-Experience in Japan
Keibun Liu, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan: An assessment of aerosolization via membranous oxygenator and coagulopathy in COVID-19
Here some suggested readings related to the webinar topic, all full texts are open access: First article report a case of successful implementation of veno-venous ECMO on a cruise passenger tested positive for SARS-CoV-2 Coronavirus https://bit.ly/2UOHFIR
A report describing findings from the initial phase of a cruise ship investigation into COVID-19 cases among crew members during quarantine. Full text
Data about chronology of COVID-19 cases on the cruise ship, with ethical considerations related to infection control, including the reasonable justification for isolation, the psychological fragility and quality of life of the isolated passengers and crew members, the procedural justice inherent in a forced quarantine, and the optimization of control measures. Full text.
First Extracorporeal Life Support Organization webinar dedicated to the role of extracorporeal support in patients with SARS-CoV-2 infection, speakers:
Michael A. Matthay, MD Departments of Medicine & Anesthesia Cardiovascular Research Institute University of California, San Francisco Acute Respiratory Distress Syndrome – with Special Reference to COVID-19
A/Prof Kiran Shekar, Adult Intensive Care Services and Critical Care Research Group – The Prince Charles Hospital, Brisbane, Australia Provision of ECMO During COVID-19 and Other Pandemics
K.R. Ramanathan, Department of Cardiothoracic Intensive Care Unit, Dept of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore. Infection Control Measures during ECMO for CoVID-19
Here full video, and all the slides, available for download.
A global crisis needs a global response and global collaboration. In an unknown disease, ECMOCARD Study Group is coordinating with 26 countries across 4 continents to share data real-time. With these data, we will use Artificial Intelligence to produce machine learning and feed back decision support to clincians who are currently “driving blindfold” in this entirely new and poorly understood condition. Our best current asset is shared experience and global data to guide treatment today and tomorrow. But research needs to be supported!
Here a letter to the Political Leaders of Australia, signed by Professor John Fraser, Professor Robert Bartlett and by by all the regional Leads of the study (full list in the dedicated picture). “The Covid-19 pandemic is an unprecedented global situation. The WHO calculates that between 60 and 80 per cent of the world population will be infected. This will place an overwhelming burden on hospitals in general, but specifically on intensive care resources. Never before have we seen this disease, nor its magnitude. We have no data on how best to care for our patients – specifically your parents. Without data, we are driving blindfold at 100 Km/h – with your relatives ir the vehicle. Australian medical leaders realised the urgent necessity to gather key treatment information They stood up to this challenge – and created “ECMOCARD ” – the only global study to gather data or the ICU management of the sickest and most vulnerable patients. It is a great example of the globa medical community working as one- for the good of the global patients. In representing the global ICU community, we respectfully and humbly ask the Australiar Government to align themselves with their medical leaders and take the leap. Support of the ECMOCARD global collaboration can assist the global community. Australian Political Leaders should stand shoulder to shoulder with their Medical Leaders – for the sake of us all.
In these pictures, a list of the International ECMOCARD Study regional Leads (all of the have co-signed the letter), and a map with the active sites: the list is continuously updated, as more and more centers, in more Countries, are being involved, and join the study group.
We currently have 104 collaborating centres, and a further 7 sites anticipated to come on board in the near future. This is a fantastic effort on behalf of all collaborating sites and speaks volumes of the importance and clinical relevance of the data we are collecting (Sites map is superimposed to the online dashboard for tracking worldwide spread of the Coronavirus has been built & is regularly updated by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University; the map is freely available and constantly updated link).
Recently Professor John Fraser released an interview to Norman Swan for ABC’s Health Report and, discussing how intensive care specialists will deal with the influx of patients with SARS-CoV-2 infection. “We’ve got a global responsibility for our global community,” Professor Fraser said. Details about interview & full video here.
Managing airways in confirmed/suspected COVID-19 patients
Patients infected by SARS-CoV-2 Coronavirus may develop severe pneumonia induced by COVID-19, eventually requiring invasive mechanical ventilation to support gas exchange; in these subjects, endotracheal intubation needs to be performed. Given the potential for aereosol/droplets generation, this procedure is one of the highest-risk moments for spreading the disease, and any effort should be made to minimize this risk, maximizing safety of any of the healthcare providers performing intubation, or involved in, and patients’ safety too. Here a collections of free open access checklists, algorithms & infographics focused on this current & complex topic. All of these are reproduced with permission (random order!). Note: given continuously evolving evidence about this topic, as more data are continuously collected/published, these advices may potentially need to be updated in the near future.
This the algorithm for airways management in COVID-19 patients proposed by SIAARTI, Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (Italian Society of Anesthesia, Analgesia and Intensive Care) available for download, along with other interesting documents on the SIAARTI website. This document include: double check for indications for endotracheal intubation team preparation PPE donning/doffing clinical checklist airway instrumentation tube position control and protective ventilation transport. Authors: M. Sorbello, I. Di Giacinto, F. Bressan, R. Cataldo, G. Cortese, C. Esposito, S. Falcetta, G. Merli , F. Petrini SIAARTI airways management study group.
Department of Anaesthesia and Intensive Care – The Chinese University of Hong Kong
Here an amazing graphics with principles of airway management in suspected or confirmed COVID-19 patients which may apply to Operative Room, Intensive Care Unit, Emergency Department and, eventually, ward; similar principles may be applied at extubation, by Albert Chan (@gaseousXchange on twitter) realized for the Department of Anaesthesia and Intensive Care – The Chinese University of Hong Kong, and proposed in lot of different languages (English, French, Spanish, Italian, German, Japanese, Portuguese, and simplified Chinese), with the purpose to try helping clinicians around the world; all versions are available for download here (high resolution) .
Criticalcarenorthampton & Propofology
The following represent a proposal of checklists when considering or performing airway intervention in suspected (& confirmed) COVID-19 patients, with pre-intubation, intubation and post-intubation approach , made by a collaborative group including (random order): Dr Jonny Wilkinson, Dr David Lyness, The ICS – Intensive Care Society, and the Midlands Coronavirus ITU Group. Proposed in different styles… First one by Jonny Wilkinson (follow him on twitter @Wilkinsonjonny) available for download at Criticalcarenorthampton.com, with lot of COVID-19 resources including an intubation COVID trolley set up checklist. The other two amazing ones by David Lyness: check COVID-19 dedicated page on his blog, Propofology blog (full resolution infographics & tons of other educational stuff related to SARS-CoV-2 infection), and follow him on twitter @Gas_Craic.
An update of the Alfred ICU guidelines for intubation of critically ills to include an appendix with specific considerations for SARS-CoV-2, outlining modifications for suspected COVID19 has been published by Julia Coull & Chris Nickson (follow them on twitter, @julia_coull & @precordialthump) check & download full document on Intensive Blog.
In the last infographics, emerging best practices for performing tracheal intubation in this population, based on current evidence from China and prior understanding of SARS. Focus on what to do/avoid in this setting! By Patrick Boreskie and published on CanadiEM website!