COVID-19:  FDA Issues Emergency Use Authorization for Hemolung RAS
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COVID-19 Literature Summary

The following citations represent current scientific and clinical management reports for COVID-19

Coronavirus epidemic: preparing for extracorporeal organ support in intensive care. Ronco, et al. Lancet Respir Med. (2020) https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30060-6/fulltext

  • This Lancet Respiratory Medicine Spotlight piece provides a brief overview of the potential use of extracorporeal organ support therapies during COVID-19. The authors cover the possible roles of ECMO, ECCO2R, CRRT as well as blood purification techniques. The authors suggest the lower complexity of ECCO2R may allow it to be performed in more ICUs than ECMO, while also correctly indicating that ECCO2R is not ECMO.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Lai, et al. Int J Antimicrob Agents. (2020) https://www.sciencedirect.com/science/article/pii/S0924857920300674

  • Lai, et al provide an overview of COVID-19 from the epidemiology of the virus, to the clinical manifestations and outcomes of COVID-19 positive patients. Detailed clinical characteristics of from 278 COVID-19 patients, taken from 3 publications, in Wuhan, China are provided. The cited authors report ARDS occurred in 12 – 27% of admitted patients.

Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. Arentz, et al. JAMA (2020) https://jamanetwork.com/journals/jama/fullarticle/2763485

  • Arentz, et al. provide the first published description of critically ill COVID-19 patients in the US (n=21, Kirkland, WA). Mechanical ventilation was required in 71% of the patients, all of which developed ARDS. High-flow O2 or noninvasive positive pressure ventilation was used to support 5 patients. Mild ARDS occurred in 2 patients, moderate ARDS in 6 patients and severe ARDS was reported in 12 patients.

 Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. Richardson, et al. JAMA. (2020)

  • Richardson, et al. report the characteristics and early outcomes of 5700 COVID-19 positive patients admitted to hospitals in New York State. Mechanical ventilation was required in 320 patients. Mortality of mechanically ventilated patients was 88.1%.

Ventilatory Ratio in Hypercapnic Mechanically Ventilated Patients with COVID-19 Associated ARDS.  Liu, et al. AJRCCM. (2020) https://www.atsjournals.org/doi/pdf/10.1164/rccm.202002-0373LE

  • Liu, et al. report a small case series (n=8) evaluating ventilatory ratio in COVID-19 related ARDS patients. Patients ventilated with low tidal volumes commonly had hypercapnia and an increased ventilatory ratio. The authors show in their case series an intermediate tidal volume can significantly decreased PaCO2 and ventilatory ratio.

COVID-19 pneumonia: different respiratory treatment for different phenotypes?. Gattinoni, et al. Intensive Care Med. (2020) https://link.springer.com/article/10.1007/s00134-020-06033-2

  • In this editorial Gattinoni, et al. put forth the idea that COVID-19 pneumonia presents as two phenotypes. The authors suggest the phenotype should dictate ventilation strategies.

ICU and Ventilator mortality among critically ill adults with COVID-19. Auld, et al. Pre-print. (2020)

  • This pre-print article provides the results of 217 COVID-19 patients admitted to Emory Healthcare ICUs. In the United States. The authors report lower ICU and ventilator mortality rates than earlier reports from China, the US and the UK. Possible reasons for this include additional time to prepare, all critically ill COVID-19 patients were able to be treated in pre-existing ICUs and internal guidelines emphasizing early intubation and LPV strategies.

Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID-19. Joly, et al. Intensive Care Med. (2020) http://link.springer.com/article/10.1007/s00134-020-06088-1

  • Joly, et al provide an overview of the hemostasis disorders which have been observed in critically ill COVID-19. The authors suggest COVID-19 hemostatic disorders may be due to hypoxia and the inflammatory response.

High risk of thrombosis in patients with severe SARS-CoV-2 infections: a multicenter prospective cohort study. Helms, et al. Intensive Care Med. (2020) https://link.springer.com/article/10.1007%2Fs00134-020-06062-x

  • Helms, et al. evaluate the thrombotic risk of 150 COVID-19 ARDS patients. Of these 150 patients, 64 clinically relevant thrombotic complications occurred despite anticoagulation. The authors additionally matched 77 of these COVID-19 ARDS patients with historical, non-COVID-19 ARDS controls. The results showed significantly more pulmonary embolisms and significantly more renal replacement therapy filters were used per day in COVID-19 patients.

Additional COVID-19 Resources:

JAMA: https://jamanetwork.com/collections/46099/coronavirus-covid19

The Lancet: https://www.thelancet.com/coronavirus

ESICM: https://www.esicm.org/resources/coronavirus-public-health-emergency/

Critical Care Reviews: https://www.criticalcarereviews.com/index.php/covid-19

ATS Journals: https://www.atsjournals.org/page/ajrccm/collections/COVID-19

ELSO: ECMO in COVID-19: https://www.elso.org/COVID19.aspx