Page 9 - ANZCP Gazette April 2021 TEASER

“IF YOU DO NOT MEASURE IT, YOU CANNOT IMPROVE IT”
J. Suthumporn (Clinical Trainee), J. Pauli (Clinical Trainee), J. McMillan CCP (USA), CCP (AUS)
Perfusion Services, Victoria
Background: Technologies developed to measure blood flow in coronary artery bypass grafts such as the Doppler flowmeter have been around since 1988. Measurements of blood flow intraoperatively permit early detection of technical errors and therefore their correction without subjecting patients to further invasive investigative procedures.
Aim: To retrospectively study the use of transit time flow measurement (TTFM) within one cardiac unit through understanding the technology of the device used and its benefits and limitations.
Methods: A cohort of 151 patients from September 2019 to June 2020 were reviewed which included a total of 399 grafts.
Findings: Measurements showed a mean pulsatility index (PI) of 2.4 ± 1.5, mean graft flow (MGF) of 45 ± 30 ml/min and diastolic filling percentage (DF%) of 66% ± 9%. It was observed that 81% of the collected PI values were below 3, 95% of the acoustic coupling index (ACI) data were above 30% and 94% of DF% were above 50% of all data collected.
Conclusion: TTFM is a promising quality control adjunct to the surgeon’s judgement, with the potential to aid decision making when considering to re-anastomose a graft. Furthermore, its utilization may result in a reduction or avoidance of reinvestigation of coronary artery grafts at the catheterization laboratory.
LESSONS LEARNED USING ECMO TO MANAGE SEVERELY ILL COVID-19 PATIENTS: RESULTS FROM OUR FIRST 210 PATIENTS
Alfred H. Stammers, MSA, PBMS, CCP Emeritus, Jeffrey P. Jacobs, MD, Linda B. Mongero, BS, CCP Emeritus, Eric A. Tesdahl, PhD, Kirti Patel, MPS, MPH, CCP, LP, CPBMT, Michael S Firstenberg, MD FAIM FACC
Background: ECMO has been used as a tool to manage severe respiratory collapse in patients suffering from coronavirus disease (COVID-19). While the role of ECMO in managing adult patients with ARDS is well accepted its utility as a modality for COVID-19 remains to be seen. The goal of this report is to analyze registry data on the use of ECMO across American hospitals.
Methods: Beginning in March 2020, an adjunct database for COVID-19 patients managed on ECMO was created as a supplement to a national registry of medical procedures (SpecialtyCare Operative Procedural rEgistry, SCOPE). Data was obtained from hospitals across America where perfusion and ECMO services were provided. The data metrics included demographic profiles of patients, medication and treatment regimens applied before and while on ECMO, and outcomes of these interventions. Patients were further separated into two groups dependent on survivability.
Results: There were 210 COVID-19 ECMO patients from 29 distinct hospitals from March 17, 2020 to October 20, 2020. The median yearly age of patients was 51.5, 71.4% were male, and 92.9% were placed on veno-venous ECMO. 44.2% of patients
were Latino, 17.1% African American, and 23.3% Caucasian. While 27 patients are still on ECMO, 183 are off support with 94 (51.4%) unable to be weaned or succumbing while hospitalized. Of the 89 survivors 70% have been discharged from the hospital. Median time on ECMO was 12.1 days (IQR=7.3-16.0 days) for survivors and 14.7 days (IQR=7.3-27.7 days) for non-survivors. Survivors were generally younger (47 v. 53 years) more likely to be Caucasian (29.2% v. 17.6%), have lower composite pre-ECMO comorbidity (26.1% v 29.2%) and had higher usage of commercial ECMO systems and lower use of dual lumen cannulae. While the use of adjunctive therapies changed over the seven month period, the use of intravenous steroids, anti-interleukin-6 receptor blockers, convalescent plasma, Remdesivir, hydroxychloroquine, and prostaglandins were similar across groups.
Conclusion: The use of ECMO resulted in approximately a 50% survival rate of select critically ill patients with COVID-19. Substantial variation exists in pharmacotherapeutic management of these challenging patients, but ECMO offers a reasonable rescue strategy.
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