During the ongoing COVID-19 pandemic, it is\nimportant for healthcare workers to understand the implications of COVID-19 for\nthe safe provision of cardiac surgery. <\/p>\n\n\n\n
Here, Edwards Lifesciences provides a\nselection of publications that may be of interest to healthcare workers\ninvolved in cardiac surgery at this time. The publications highlight key\nlearnings from prior pandemics, techniques that have been used to support\npatients with respiratory distress and implications for cardiac surgery. For\nconvenience, a short summary of each publication is provided. Please refer to\nthe full publication for detailed information on the techniques used and the\noutcomes achieved. <\/p>\n\n\n\n
We are learning more about COVID-19 every\nday. Therefore, it is important to acknowledge that insights from previous\npandemics might not be directly applicable to the situation we presently face,\nand that treatment for critical COVID-19 patients may differ from previous\npandemics.<\/p>\n\n\n\n
Matt P\n& Maisano F. PCR Online<\/em>, March\n2020.<\/p>\n\n\n\n https:\/\/bit.ly\/3bCPM1N<\/a><\/p>\n\n\n\n Acknowledging that cardiac surgery is not\non the front line of patient care in the COVID-19 outbreak, it is important to\nunderstand the impact the pandemic may have on cardiac surgery, both for\nhealthcare workers and for their patients. The authors highlight the importance\nof strategic decision-making by cardiac surgeons in planning essential\noperations, while also minimising the burden of these procedures on healthcare\nsystems during the pandemic. Surgeons need to assess the risks associated with\ndelaying surgical care against the risks of exposing patients to SARS-CoV-2\nwithin the hospital environment. Additional challenges are also discussed, such\nas limited ICU beds and ventilation facilities, the consequences of postponing\nsurgeries and the protection of healthcare workers. This article, with its\naccompanying references and the articles summarised below may prove useful in\ndeveloping or improving treatment algorithms for currently overwhelmed\nhealthcare systems around the world. <\/p>\n\n\n\n Access details about ongoing COVID-19 trials on ClinicalTrials.gov: https:\/\/clinicaltrials.gov\/ct2\/results?cond=COVID-19<\/a> <\/p>\n\n\n\n Bonow RO\net al.<\/em> JAMA Cardiol<\/em>. 2020; March 27: e1\u20133.<\/p>\n\n\n\n https:\/\/bit.ly\/2xKhhYr<\/a><\/p>\n\n\n\n In this\neditorial, Bonow and colleagues discuss the paucity of information regarding risks\nof COVID-19 for individuals with underlying cardiovascular disease. They highlight\nthe insufficient attention given thus far to understanding the effects of\nCOVID-19 infection in causing or exacerbating cardiovascular injury. The\nauthors discuss early data from several recent publications that aim to help\nfill this knowledge gap, acknowledging that patients with long-term coronary\nartery disease and\/or those with risk factors for atherosclerotic\ncardiovascular disease, prevalent in the elderly, have an increased risk of\ndeveloping acute coronary syndrome upon COVID-19 infections. Such acute\ninfections can place a high demand on myocardial tissue, which would make these\npatients more susceptible to adverse outcomes and death. Severe inflammatory\nstress and haemodynamic decompensation result in an increase in circulating cytokines.\nThis can also increase disease severity and mortality risk. This publication\nhighlights many coordinated efforts by the scientific community in understanding\nthe relationship between COVID-19 infection and cardiovascular disease. <\/p>\n\n\n\n Shi S et al. JAMA Cardiol. <\/em>2020;\nMarch 25: e1\u20138.<\/p>\n\n\n\n https:\/\/bit.ly\/2Ux8iTq<\/a><\/p>\n\n\n\n Presenting data collected during January\nand February this year from a single hospital in Wuhan, China, Shi and\ncolleagues demonstrate a statistically significant association between cardiac\ninjury and mortality in hospitalised COVID-19 patients. To compare outcomes of\npatients with and without cardiac injury, the authors analysed clinical,\nradiological and treatment data. The paper acknowledges that, due to the\nlogistical constraints of collecting data from patients in ICU and isolation,\nmeasures of echocardiography, electrocardiography and cytokine levels were\nlacking. This limits the determination of potential mechanisms of cardiac\ninjury. Another limitation is that, for many patients, clinical endpoints had\nnot been reached as these individuals were still under clinical observation.\nThe authors point to the need for data from larger populations and multiple\ncentres to further understand and manage the outcomes of cardiac injury in\nCOVID-19.<\/p>\n\n\n\n Morens\nDM et al. Crit Care Med<\/em>. 2010; 38:<\/strong> e10\u201320.<\/p>\n\n\n\n https:\/\/bit.ly\/2WWJ5nd<\/a><\/p>\n\n\n\n This paper provides a history of the\n1918\u20131919 H1N1 influenza pandemic and discusses whether knowledge of its\ncharacteristics, epidemiology and spread can help us to predict and manage\nother respiratory pandemics. The paper explains how, in the case of similar\noutbreaks, a strategic combination of pharmaceuticals, technology and treatment\nalgorithms can identify and\/or treat high-risk or severely ill patients. This\nstrategy may include rapid antigen testing and timely availability of imaging\nand laboratory data to allow healthcare workers to assess a patient\u2019s risk of\ncomplications. Mechanical ventilation methods, such as ECMO, are also useful to\nsupport the most severely ill. The 1918 influenza pandemic has provided a\nwealth of information, and the authors recommend using this knowledge to\nprepare for future pandemics by doing targeted research in prevention,\ncontainment and treatment. Dalton\nHJ & MacLaren G. Crit Care Med. <\/em>2010;\n38:<\/strong> 1484\u20131485.<\/p>\n\n\n\n https:\/\/bit.ly\/343sEqO<\/a><\/p>\n\n\n\n During the 2009\u20132010 H1N1 influenza pandemic,\npatients with severe influenza required mechanical ventilation to prevent organ\nfailure. In some severely ill patients, early antiviral treatment and intensive\ncare failed in stopping ongoing organ failure and ineffective gas exchange. In\nthese cases, rescue therapies were employed to save lives. Dalton and MacLaren\nsummarise the use of ECMO, one of several rescue therapies employed by\nclinicians across the world during the pandemic. The authors cite several case\nseries, review articles and a systematic review of the evidence for ECMO use in\nadult patients. They highlight technological advances that have helped\nclinicians use ECMO across all patients. The authors also recommend using a\nframework to coordinate ECMO use by clinicians around the world. <\/p>\n\n\n\n Winiszewski H et al.<\/em> J Intensive Care<\/em> 2018; 6:<\/strong> 36. <\/p>\n\n\n\n https:\/\/bit.ly\/2WVy8SH<\/a><\/p>\n\n\n\n Highlighting the potential of ECCO2<\/sub>R\nfor patients with ARDS and COPD in critical care settings, the authors of this\nretrospective study found that ECCO2<\/sub>R was associated with decreased\ntidal volume and driving pressure in patients with ARDS. ECCO2<\/sub>R use\nin patients with COPD improved minute ventilation, PaCO2<\/sub> and pH\nnormalisation. Although the authors recommend caution for potential\nanticoagulation events, they found that ECCO2<\/sub>R was well-tolerated. <\/p>\n\n\n\n Aokage T et al.<\/em> J Intensive Care<\/em> 2015; 3:<\/strong> 17.<\/p>\n\n\n\n https:\/\/bit.ly\/2UvLraN<\/a><\/p>\n\n\n\n In this review, the authors discuss the\npotential of ECMO as a lifesaving therapy for patients with refractory severe\nrespiratory failure or cardiac failure. In recent years, use of ECMO for\nrespiratory failure has been increasing. ECMO may reduce the high mortality\nrate associated with severe ARDS, with advantages including the stabilisation\nof gas exchange and haemodynamic compromise, thereby preventing additional\nhypoxic organ damage. This study highlights the potential benefit of using ECMO\nin adult patients with ARDS, when adequate oxygenation cannot be maintained\nusing conventional methods. The authors also highlight, however, that ECMO is a\ncomplicated and high-risk therapy that can only be administered by adequately\ntrained medical staff.<\/p>\n\n\n\n Combes A\net al<\/em>. Intensive Care Med<\/em> 2019; 45:<\/strong>\n592\u2013600.<\/p>\n\n\n\n https:\/\/bit.ly\/2UPrdrD<\/a><\/p>\n\n\n\n This study presents results from SUPERNOVA,\na prospective Phase 2 trial. The trial assessed the feasibility and safety of\nECCO2<\/sub>R to facilitate ultra-protective ventilation in 95 patients\nwith moderate ARDS. In this study, 82% of patients achieved ultra-protective\nventilation at 24 hours. ECCO2<\/sub>R was maintained for 3\u20138 days, with\n78% patient survival at day 28. The authors highly recommend a randomised\nclinical trial to fully assess the risks and benefits of ECCO2<\/sub>R in\npatients with moderate ARDS. This study demonstrates that ECCO2<\/sub>R is\na feasible intervention in moderate ARDS patients, whose potential must be\nfurther explored.<\/p>\n\n\n\n Menon N et al<\/em>. Rev Bras Ter Intensiva<\/em> 2017; 29:\n<\/strong>271\u2013278.<\/p>\n\n\n\n https:\/\/bit.ly\/3bATA3q<\/a><\/p>\n\n\n\n This study of 10 patients with severe\nH1N1-associated ARDS observed favourable outcomes with ECMO intervention. The\nmedian age of patients was 40 years. Typically, patients received mechanical\nventilation for 22 days and spent 29.1 days in hospital (with 27 days in\nintensive care). Six patients experienced minor bleeding as a complication.\nEight patients survived and were discharged with good functional status. The\nauthors demonstrate that ECMO may result in excellent outcomes by helping a\nvulnerable but relatively young patient population to achieve good functional\nstatus. <\/p>\n\n\n\n Grasselli\nG et al.<\/em> Ann Intensive Care<\/em> 2017; 7:<\/strong>\n98.<\/p>\n\n\n\n https:\/\/bit.ly\/2xGYf5a<\/a><\/p>\n\n\n\n A recently recognised autoimmune syndrome,\nIPAF is characterised by the presence of interstitial lung disease and\nautoantibodies, but absence of a specific connective tissue disease or\nalternative aetiology. In this study, patients with IPAF in the ICU had\ncomparable survival compared to patients with ARDS who had a known risk factor.\nAll patients required prolonged mechanical ventilation ranging from 10 to 88\ndays (median 49 days), 4 received ECMO and 1 received ECCO2<\/sub>R. The\nstudy demonstrates that a diagnosis of IPAF should be considered in any\ncritically ill patient with interstitial lung disease of unknown origin. This\ndiagnosis leads to the interventions recommended, helping these patients\nachieve survival rates comparable to ARDS patients with a known clinical\ninsult. <\/p>\n\n\n\n Brazzi L et al<\/em>. Sim Healthcare<\/em>\n2012; 7<\/strong>: 32\u201334.<\/p>\n\n\n\n https:\/\/bit.ly\/3dPeONg<\/a><\/p>\n\n\n\n Simulation-based training shows potential\nfor the identification and treatment of complex clinical problems, enabling\nimmediate feedback, remote collaborations and training in a controlled and safe\nenvironment. During the 2009 H1N1 outbreak, the Italian health authorities\ninstigated a network of ICU centres in preparation for the treatment of the\nsickest H1N1 patients by means of ECMO. Two major urgencies were identified:\nthe absolute imperative of having all necessary equipment needed to support the\nprovision of ECMO, and the importance of comprehensive training for all\nphysicians working within the ICU on the correct use of ECMO. Using simulation\ntechnology, physicians were upskilled and prepared as demonstrated by the\nresultant survival data. This paper clearly shows the benefits of\nsimulation-based training for quickly and comprehensively preparing ICU\npersonnel in the use of ECMO.<\/p>\n\n\n\n For\nprofessional use. <\/strong><\/p>\n\n\n\n Edwards\nLifesciences, the stylized E logo, are trademarks of Edwards Lifesciences\nCorporation or its affiliates. All other trademarks or service marks are the\nproperty of their respective owners.<\/strong><\/p>\n\n\n\n \u00a9\n2020 Edwards Lifesciences Corporation. All rights reserved. <\/strong>PP–EU-0099<\/strong><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":" Introduction During the ongoing COVID-19 pandemic, it 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of coronavirus disease 2019 (COVID-19) with\nmyocardial injury and mortality<\/h3>\n\n\n\n
Association of cardiac injury with mortality in hospitalized\npatients with COVID-19 in Wuhan, China<\/h3>\n\n\n\n
Section 2: Learnings from previous pandemics<\/h2>\n\n\n\n
The 1918 influenza pandemic: Lessons for 2009 and\nthe future<\/h3>\n\n\n\n
<\/p>\n\n\n\nExtracorporeal membrane oxygenation in pandemic\nflu: Insufficient evidence or worth the effort?<\/h3>\n\n\n\n
Section 3: Technical manuscripts on the use of ECCO2<\/sub>R and ECMO<\/h2>\n\n\n\n
Daily use of extracorporeal CO2<\/sub> removal\nin a critical care unit: Indications and results<\/h3>\n\n\n\n
Extracorporeal membrane oxygenation for acute\nrespiratory distress syndrome<\/h3>\n\n\n\n
Feasibility and safety of extracorporeal CO2<\/sub>\nremoval to enhance protective ventilation in acute respiratory distress\nsyndrome: The SUPERNOVA study<\/h3>\n\n\n\n
Extracorporeal membrane oxygenation in acute\nrespiratory distress syndrome due to influenza A (H1N1) pdm09 pneumonia. A\nsingle-center experience during the 2013-2014 season<\/h3>\n\n\n\n
Interstitial pneumonia with autoimmune features: An\nadditional risk factor for ARDS?<\/h3>\n\n\n\n
Simulation-based training\nof extracorporeal membrane oxygenation during H1N1 influenza pandemic: The Italian experience<\/h3>\n\n\n\n