ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Cardiopulmonary bypass without the use of donor blood components in heart surgery in an 8-kg infant: case report

The issue of rejecting donor blood components intraoperatively in children with congenital heart defects is widely discussed in the world literature. This is primarily due to the presence of a low volume of circulating blood, which leads to excessive hemodilution during artificial circulation. The purpose of this report is to demonstrate the safety and effectiveness of conducting operations associated with congenital heart defects without the use of transfusion of donor blood components. A case of surgical treatment of the interatrial septum defect in an 11-month (8 kg) infant with the use of cardiopulmonary bypass and a set of measures enabling to abandon transfusion media is presented. Retrograde filling of the oxygenator and maximum minimization of the extracorporeal circuit were used to reduce the primary volume. To ensure the required volume of blood in the cardiotomy tank, dosed vacuum was applied. Clinical and laboratory characteristics of the intraoperative and postoperative periods are given, which demonstrate sufficient oxygen supply of the organism, absence of anemia and any organ dysfunctions, as well as a low level of the systemic inflammatory response, once again confirming the immediate advantages of blood-saving technologies. Following the correction of congenital heart disease, the infant was transferred to a specialized surgical department on the second day. The outcome of the clinical case was the infant’s recovery and discharge from the hospital.Received 17 April 2018. Revised 17 June 2018. Accepted 18 June 2018.Informed consent: The informed consent to use the infant’s medical data for scientific purposes was obtained from his legal representative.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.</p

Mitochondrial DNA as a Candidate Marker of Multiple Organ Failure after Cardiac Surgery

Assess the level of mitochondrial DNA depending on the presence of multiple organ failure in patients after heart surgery. The study included 60 patients who underwent surgical treatment of valvular heart disease using cardiopulmonary bypass. Uncomplicated patients were included in the 1st group (n = 30), patients with complications and multiple organ failure (MOF) were included in the 2nd group (n = 30). Serum mtDNA levels were determined by quantitative real-time polymerase chain reaction with fluorescent dyes. Mitochondrial DNA gene expression did not differ between group before surgery. Immediately after the intervention, cytochrome B gene expression was higher in the group with MOF, and it remained high during entire follow-up period. A similar trend was observed in cytochrome oxidase gene expression. Increased NADH levels of gene expressions during the first postoperative day were noted in both groups, the expression showed tendency to increase on the third postoperative day. mtDNA gene expression in the “MOF present” group remained at a higher level compared with the group without complications. A positive correlation was reveled between the severity of MOF according to SOFA score and the level of mtDNA (r = 0.45; p = 0.028) for the end-point “First day”. The ROC analysis showed that mtDNA circulating in plasma (AUC = 0.605) can be a predictor of MOF development. The level of mtDNA significantly increases in case of MOF, irrespective of its cause. (2) The expression of mtDNA genes correlates with the level of MOF severity on the SOFA score