Experience in getting COVID pts off vent

[deleted547339]

So Epo is cheaper then?
Please elaborate about being "super aggressive" with proning. On what vent settings, for how long/per day? If they don't show benefit do you keep trying? I do it when they require high vent settings not on moderate to low, although I see other teams doing it.

We follow the proseva study inclusion to a t. If you have a P:F <150 on 60% and 10, we flip you immediately. Usually within an hour or two of those criteria, they’re flipped. 16 hours, supine then check abg at 4-6 hours and reprone if <150. Some folks are even proning PFs slightly higher if you’re in epo.

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[Radetzky]

If only I could tolerate the cold and gloom I would be there in a heart beat!! More power to you. For some reason I am thinking Canada.

Nope. In the South Pacific. Quite warm here actually.

 

[chocomorsel]

Nope. In the South Pacific. Quite warm here actually.

Oh Gosh. Even better!!

 

[chessknt]

Interesting to see people limping by on bipap. I have not seen a single patient actually get better once Bipap dependent without getting a tube first. Longest I saw was 6d on bipap before he needed a tube, others usually will decompensate after day 2 or 3. How many days on bipap in a row is everyone doing? Like are you dealing with pressure ulcers on the face because it has been so long but somehow people are still going? Or is it 2-3 days stuck on bipap then they can get back to HFNC? Are you tolerating low sats while HFNC to allow eating?

Im like TNR above--tried long bouts of bipap in march/april and was very unimpressed. Now once they fail HFNC and need bipap for anything other than sleeping it's time for a tube. I also badger patients and nurses in to proning for 16+ hours per day and those that actually manage this always seem to do better.

 

[chocomorsel]

Interesting to see people limping by on bipap. I have not seen a single patient actually get better once Bipap dependent without getting a tube first. Longest I saw was 6d on bipap before he needed a tube, others usually will decompensate after day 2 or 3. How many days on bipap in a row is everyone doing? Like are you dealing with pressure ulcers on the face because it has been so long but somehow people are still going? Or is it 2-3 days stuck on bipap then they can get back to HFNC? Are you tolerating low sats while HFNC to allow eating?

Im like TNR above--tried long bouts of bipap in march/april and was very unimpressed. Now once they fail HFNC and need bipap for anything other than sleeping it's time for a tube. I also badger patients and nurses in to proning for 16+ hours per day and those that actually manage this always seem to do better.

Yes. Tolerate low sats to eat. Tolerate low sats in general. Alternate between HFNC and BiPap. Requires a bit of handholding with the RNs. Encourage proning and side sleeping in a very blunt discussion about death. Night NP is worse (more blunt and brutal) than me on this, but it works. If they deteriorate then they buy the tube. If status quo I keep going. I am willing to go the entire week I am there and longer if I were there. I would prefer to put everyone on daily lasix, but like I said nurses are scared to let them drink so I spot diurese many. The ones on HFNC daily or BID Lasix.
I usually come back from week off and they are intubated.
How low of sats are you guys tolerating?

 

[Tipsy McStagger]

We'll put people on BiPAP but often times they start taking >1L breaths. I can't justify leaving someone on BiPAP who is taking volumes >8cc/kg when I can intubate them and control it - regardless of how comfortable they look. We're also very aggressive about proning. Roughly 65% of our intubated patients survive. Though who knows what the fallout will be from survival.

 

[chocomorsel]

We'll put people on BiPAP but often times they start taking >1L breaths. I can't justify leaving someone on BiPAP who is taking volumes >8cc/kg when I can intubate them and control it - regardless of how comfortable they look. We're also very aggressive about proning. Roughly 65% of our intubated patients survive. Though who knows what the fallout will be from survival.

Great stats. Mine are still like >75% death.

Question, if they are taking such giant breaths, why can’t you decrease their pressure support so they don’t take such giant volumes? That’s a way to control it without intubating.

And those are spontaneous breaths. Although assisted with pressure support they aren’t as detrimental to the lungs as purely positive pressure breaths because they are initiated by negative pressure.

I don’t understand.

 

[CCM-MD]

Large spontaneous breaths and large set tidal volumes on invasive mechanical ventilation are physiologically different. Also, if one intubates less sick patients, one is going to end up with more extubations.

On another note: all of our Optiflows are in use. Hospital is almost out of Levophed and propofol. ICU patients are overflowing into the ED, PACU, cath lab. It’s a total disaster. Today was one of the busiest days of my life.

 

[deleted547339]

Large spontaneous breaths and large set tidal volumes on invasive mechanical ventilation are physiologically different. Also, if one intubates less sick patients, one is going to end up with more extubations.

On another note: all of our Optiflows are in use. Hospital is almost out of Levophed and propofol. ICU patients are overflowing into the ED, PACU, cath lab. It’s a total disaster. Today was one of the busiest days of my life.

Phenobarb ftw

 

[chocomorsel]

Holy F. Never used it except in status w neurology on board.

Gotta look up dosages.

 

[chocomorsel]

Large spontaneous breaths and large set tidal volumes on invasive mechanical ventilation are physiologically different. Also, if one intubates less sick patients, one is going to end up with more extubations.

On another note: all of our Optiflows are in use. Hospital is almost out of Levophed and propofol. ICU patients are overflowing into the ED, PACU, cath lab. It’s a total disaster. Today was one of the busiest days of my life.

Now I feel better after reading your line about less sick intubations.
Thank you.

 

[Radetzky]

And those are spontaneous breaths. Although assisted with pressure support they aren’t as detrimental to the lungs as purely positive pressure breaths because they are initiated by negative pressure.

I don’t understand.

You don’t believe in P-SILI?

 

[jdh71]

Well now you are teaching me something new as well. I know we have iNO. Gonna ask the RTs to see if they can hook it up with HFNC/Bipap for the non intubated ones who aren't progressing well. Don't think they can use it with most of the Bipap machines though because we are always swapping them out when someone needs iNO for the larger vents. I don't know if they have Epo but will ask. I hear iNO is ridiculously expensive.
Always learning something new.

If you can neb the flolan through the vent you can also through the NIPPV. I know our problem with flolan is getting enough supply.

I think our experience is sounding very familiar to yours. Seen plenty make it out of the ICU even after week even two of 100% on the CPAP but I’ve not seen a single extubation on an older male patient in a long long time.

 

[jdh71]

You don’t believe in P-SILI?

Not in the way it’s brutally used and assumed with NIPPV.

There is literally a huge (millions of patients) cohort in the US spending 6-8 hours every night on NIPPV and no one is regulating their volumes and there isn’t some rash of ARDS, millions of them, from sleep apnea treatment.

Now I know we assume normal enough lungs in these patients. But my point it’s NOT simply just volume and something with positive pressure. In ARDS the studies were looking for a safe spot during mechanical ventilation. And they found a signal. We simply can’t be so quick to translate that signal into something significant outside of the confines of the science that gave us the signal. The trans pulmonary pressures (the actual bad actor in VILI where we use volume as a crude mark for safe/not safe) for any given volume in a patient who is initiating breaths is going to be much lower due to the negative intrathoracic pressure needed to initiate the breath in the first place. A liter might be a big breath but 1) you can turn down the IPAP so it’s smaller and 2) anyone taking a LITER breath has fine enough compliance and likely low risk trans pulmonary pressures. Hell. BIPAP is often so totally and completely unnecessary in these patients who ventilate fine unless the lungs have been completely roasted.

 

[turkeyjerky]

My experience in using NIV for these patients is pretty minimal, as in the ED they're either so sick that they need to be tubed up front or they do pretty well for awhile on HFNC, most commonly the latter. But I would think CPAP is the way to go over BiPAP, no?

 

[jdh71]

My experience in using NIV for these patients is pretty minimal, as in the ED they're either so sick that they need to be tubed up front or they do pretty well for awhile on HFNC, most commonly the latter. But I would think CPAP is the way to go over BiPAP, no?

My experience is these folks generally do not need the IPAP. They ventilate fine. They need help with their mean airway pressures.

 

[Tipsy McStagger]

Interesting, I'll think on it.

So a thought experiment then. Lets say I have an intubated patient on pressure control, they are triggering the inspiration but I have cleverly set the cycle exactly when their spontaneous cycle would be. So they're on the vent, getting pressure control, patient triggering and the cycle is the same time as when they would naturally cycle - I just happen to set it perfectly. This is, as far as I can see, exactly the same as spontaneous NIV (assuming BiPAP if inspiratory/PEEP pressures are set). So a patient in this configuration could take tidal volumes well over 1 L and not have any issues with VILI - given that the physiology is now the same as BiPAP, one is just delivered through an ETT ?

Yet I suspect any one of us seeing a patient on the vent, even in these settings taking huge tidal volumes would do something about it. Or am I overlooking something? Which I might be.

 

[Radetzky]

I think we probably have to differentiate between BiPap and CPAP here. I don’t think there’s any difference between the same trans pulmonary pressure and volume in terms of lung injury between invasive ventilation and BiPap (ie your scenario).

However I find it hard to imagine that someone taking litre TVs on, for example, 8 of CPAP is doing anymore injury than the person on high flow getting maybe 2-3 of PEEP from the high flow. The appropriate comparison would be someone intubated and breathing litre tidal volumes just on PEEP. Would you act to decrease the TV? No, you’d probably just extubate.

I believe most of the NIV studies showing harm of NIPPV were done with BiPap.

 

[chocomorsel]

You don’t believe in P-SILI?

Almost forgot to answer this. I have seen one case of Pulmonary edema caused by negative pressure in my 7 years of practice and I take care of lots of strapping young men in the OR.
So yeah, sure it does exist.
But I don’t think it’s that prevalent at all. I have not bought into all its hype.
Research changes all the time. What’s en vogue today may change next year.

 

[chocomorsel]

Interesting, I'll think on it.

So a thought experiment then. Lets say I have an intubated patient on pressure control, they are triggering the inspiration but I have cleverly set the cycle exactly when their spontaneous cycle would be. So they're on the vent, getting pressure control, patient triggering and the cycle is the same time as when they would naturally cycle - I just happen to set it perfectly. This is, as far as I can see, exactly the same as spontaneous NIV (assuming BiPAP if inspiratory/PEEP pressures are set). So a patient in this configuration could take tidal volumes well over 1 L and not have any issues with VILI - given that the physiology is now the same as BiPAP, one is just delivered through an ETT ?

Yet I suspect any one of us seeing a patient on the vent, even in these settings taking huge tidal volumes would do something about it. Or am I overlooking something? Which I might be.

Yes. I would decrease my Inspiratory pressure.
Or just put them on straight CPAP.

 

[chessknt]

Interesting, I'll think on it.

So a thought experiment then. Lets say I have an intubated patient on pressure control, they are triggering the inspiration but I have cleverly set the cycle exactly when their spontaneous cycle would be. So they're on the vent, getting pressure control, patient triggering and the cycle is the same time as when they would naturally cycle - I just happen to set it perfectly. This is, as far as I can see, exactly the same as spontaneous NIV (assuming BiPAP if inspiratory/PEEP pressures are set). So a patient in this configuration could take tidal volumes well over 1 L and not have any issues with VILI - given that the physiology is now the same as BiPAP, one is just delivered through an ETT ?

Yet I suspect any one of us seeing a patient on the vent, even in these settings taking huge tidal volumes would do something about it. Or am I overlooking something? Which I might be.

I have been tolerating larger TVs in some patients if their driving pressures are good (eg <12) in a pressure control mode keeping Pinsp well less than 30 and if the usual sedation (eg prop/fent) was ineffective at controlling their inspiratory efforts because I felt that the heavy sedation/paralytics would be of greater harm. I just can't buy that someone on the vent with a driving pressure of 8 pulling 600 cc volumes is being harmed more than me paralyzing him to keep his numbers right.

 

[Siggy]

I have been tolerating larger TVs in some patients if their driving pressures are good (eg <12) in a pressure control mode keeping Pinsp well less than 30 and if the usual sedation (eg prop/fent) was ineffective at controlling their inspiratory efforts because I felt that the heavy sedation/paralytics would be of greater harm. I just can't buy that someone on the vent with a driving pressure of 8 pulling 600 cc volumes is being harmed more than me paralyzing him to keep his numbers right.

This is the same reason why I'm not convinced that most SARS-CoV-2 patients are actually in ARDS. Sure, they meet criteria, but most don't have the expected loss of compliance. Is there a benefit to ARDSNet protocol if Pplat and DP are good at 7-8 mL/kg ideal body weight?

 

[grt398]

What's the oldest patient anyone has successfully extubated? Anyone successful in extubating any pts 80+ yrs old? Or even 70+ yrs old? It's obviously anecdotal but I'm really wondering why we even offer the vent option when mortality rate I'm seeing is 100% in that group.

 

[CCM-MD]

What's the oldest patient anyone has successfully extubated? Anyone successful in extubating any pts 80+ yrs old? Or even 70+ yrs old? It's obviously anecdotal but I'm really wondering why we even offer the vent option when mortality rate I'm seeing is 100% in that group.

We had some early on. I remember having people survive that I did not expect. But recently... None. I don’t know if the virus has changed or what the deal is.

 

[chocomorsel]

This is the same reason why I'm not convinced that most SARS-CoV-2 patients are actually in ARDS. Sure, they meet criteria, but most don't have the expected loss of compliance. Is there a benefit to ARDSNet protocol if Pplat and DP are good at 7-8 mL/kg ideal body weight?

Not been my experience. Very few have compliant lungs. I am usually having to deal with high plateau pressures on many of them in order to keep them oxygenated. Very few complaints ones.

 

[chocomorsel]

What's the oldest patient anyone has successfully extubated? Anyone successful in extubating any pts 80+ yrs old? Or even 70+ yrs old? It's obviously anecdotal but I'm really wondering why we even offer the vent option when mortality rate I'm seeing is 100% in that group.

Not 80. But I have a 73 year old who was Covid + and more of a bacterial PNA component that is on trach collars. His CXR never looked Covid like though.

The other one is a bit of a struggle as he’s got stage four rectal CA. He teeters on the edge of trach and not for the past week.

Most of my patients once intubated just die.

 

[chessknt]

What's the oldest patient anyone has successfully extubated? Anyone successful in extubating any pts 80+ yrs old? Or even 70+ yrs old? It's obviously anecdotal but I'm really wondering why we even offer the vent option when mortality rate I'm seeing is 100% in that group.

I have had a handful in the 75+ club (oldest 78). Most of them are trashed tachypneic even on support delirious out of their minds, too weak to lift their arms off the bed. Another #goodoutcome.

Had a 42 year old die last week . Had been on vent for a month, driving pressures in the 40s, kidneys compensated for PCO2 of 115 even with a MV of 6, off sedation unresponsive (probably from PCO2), had been on 100% FIO2 for weeks. Dies in less than a minute on pressure support. Only risk factor BMI 40ish. He was the youngest one I lost so far.

 

[WheezyBaby]

I have had a handful in the 75+ club (oldest 78). Most of them are trashed tachypneic even on support delirious out of their minds, too weak to lift their arms off the bed. Another #goodoutcome.

Had a 42 year old die last week . Had been on vent for a month, driving pressures in the 40s, kidneys compensated for PCO2 of 115 even with a MV of 6, off sedation unresponsive (probably from PCO2), had been on 100% FIO2 for weeks. Dies in less than a minute on pressure support. Only risk factor BMI 40ish. He was the youngest one I lost so far.

Sucks ecmo decline?

 

[chessknt]

Sucks ecmo decline?

Yea no ECMO locally and by the time it was brought up he was too far along. Should have been done much earlier probably but I wasnt involved until later and didnt know the full context of why it wasnt pursued initially.

Also it is very hard to get an ECMO transfer for COVID these days to an outside facility. I know when I had in-house ECMO at the start of the pandemic it was entertained but now we are basically being told no on everyone for COVID so I think a lot of my partners have stopped asking.

 

[chocomorsel]

I have had a handful in the 75+ club (oldest 78). Most of them are trashed tachypneic even on support delirious out of their minds, too weak to lift their arms off the bed. Another #goodoutcome.

Had a 42 year old die last week . Had been on vent for a month, driving pressures in the 40s, kidneys compensated for PCO2 of 115 even with a MV of 6, off sedation unresponsive (probably from PCO2), had been on 100% FIO2 for weeks. Dies in less than a minute on pressure support. Only risk factor BMI 40ish. He was the youngest one I lost so far.

Where you trying to extubate him? Why trial him on pressure support?

 

[chessknt]

Where you trying to extubate him? Why trial him on pressure support?

After the switch to comfort care we go to pressure support and leave them intubated so i usually have them do tube comp with 0 ps so it's basically a ghetto version of cpap

 

[Nephro critical care]

Yea no ECMO locally and by the time it was brought up he was too far along. Should have been done much earlier probably but I wasnt involved until later and didnt know the full context of why it wasnt pursued initially.

Also it is very hard to get an ECMO transfer for COVID these days to an outside facility. I know when I had in-house ECMO at the start of the pandemic it was entertained but now we are basically being told no on everyone for COVID so I think a lot of my partners have stopped asking.

No thoughts for bilateral lung transplant ? We had a couple age 40 to 50 who have been on MV for a couple of weeks and now pCO2 are in the 100s. I asked about ECMO and they said if they were accepted for lung transplants they would consider. Neither are candidates at present as only one facility in our Midwest region does lung transplants for COVID.

 

[chessknt]

No thoughts for bilateral lung transplant ? We had a couple age 40 to 50 who have been on MV for a couple of weeks and now pCO2 are in the 100s. I asked about ECMO and they said if they were accepted for lung transplants they would consider. Neither are candidates at present as only one facility in our Midwest region does lung transplants for COVID.

He wouldn't have been a candidate due to his debilitated state (no mental status, not an ecmo candidate) I am guessing but either way sometimes death is better than a lung transplant

 

[deleted547339]

What's the oldest patient anyone has successfully extubated? Anyone successful in extubating any pts 80+ yrs old? Or even 70+ yrs old? It's obviously anecdotal but I'm really wondering why we even offer the vent option when mortality rate I'm seeing is 100% in that group.

Over 80.

 

[deleted547339]

This is the same reason why I'm not convinced that most SARS-CoV-2 patients are actually in ARDS. Sure, they meet criteria, but most don't have the expected loss of compliance. Is there a benefit to ARDSNet protocol if Pplat and DP are good at 7-8 mL/kg ideal body weight?

Yes.

 

[grt398]

So here's a paper with some outcome data for mortality in ventilated patients:

Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure

Purpose The outcomes of patients requiring invasive mechanical ventilation for COVID-19 remain poorly defined. We sought to determine clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation in an appropriately resourced US health care system...

journals.plos.org

Very small numbers (164 pts total) so usual caveats associated with that, but at least they break it down by age group. Their results were 84% mortality for pts >70 yrs old.

 

[chessknt]

Yes.

The real question is: is that benefit lost if it requires paralysis and heavy sedation to achieve?

 

[deleted547339]

The real question is: is that benefit lost if it requires paralysis and heavy sedation to achieve?

also (probably) yes

 

[chessknt]

also (probably) yes

I guess I just personally haven't been able to see a benefit in leaving people paralyzed for over a week in order to maintain low tidal volumes when instead using pressure control allows me to reduce sedation and actually get neuro exams out of them while maintaining plateau pressures under 30. I've definitely inherited folks who've been paralyzed for a long time and they are so profoundly debilitated they usually can't even move their heads I just can't imagine that that doesn't have some long-term impact on their outcome.

 

[CCM-MD]

I’m not a fan of prolonged paralysis, but I’m also not a fan of pressure control. Middle of the night compliance changes leading to hypoventilation due to poor monitoring is something I have personally witnessed.

 

[CCM-MD]

So here's a paper with some outcome data for mortality in ventilated patients:

Outcomes of mechanically ventilated patients with COVID-19 associated respiratory failure

Purpose The outcomes of patients requiring invasive mechanical ventilation for COVID-19 remain poorly defined. We sought to determine clinical characteristics and outcomes of patients with COVID-19 managed with invasive mechanical ventilation in an appropriately resourced US health care system...

journals.plos.org

Very small numbers (164 pts total) so usual caveats associated with that, but at least they break it down by age group. Their results were 84% mortality for pts >70 yrs old.

84% mortality seems spot on. Had a couple extubated this week but overall outcomes are super ****ty.

 

[Radetzky]

Interesting to compare practices in different parts of the world. Where I live, it would be a rare case indeed that someone over the age of 75 would be offered ventilation for a CAP, well before COVID was a thing.

 

[deleted547339]

Interesting to compare practices in different parts of the world. Where I live, it would be a rare case indeed that someone over the age of 75 would be offered ventilation for a CAP, well before COVID was a thing.

You hiring? lol.

I literally had a service with >10 people 72 and older on the vent.

 

[chocomorsel]

We don’t care if his chances are 0.001 percent. Do everything to keep them alive. Once they are gone they are gone and you will never see them again.

This from a retired RN who used to work in the postsurgical CT floor. My dad. SMH. After telling him that this family wanted “everything” done on their dad because he was previously a healthy 70 year old. After the family accused us on doing “whatever we want with their families because they have Covid.” Since we don’t call and update them daily.
Then why the hell am I on the phone w you telling you what’s happening? Now he gonna be on IHD and already on iNO.

This job is thankless and a waste of resources and time sometimes.

 

[chessknt]

We don’t care if his chances are 0.001 percent. Do everything to keep them alive. Once they are gone they are gone and you will never see them again.

This from a retired RN who used to work in the postsurgical CT floor. My dad. SMH. After telling him that this family wanted “everything” done on their dad because he was previously a healthy 70 year old. After the family accused us on doing “whatever we want with their families because they have Covid.” Since we don’t call and update them daily.
Then why the hell am I on the phone w you telling you what’s happening? Now he gonna be on IHD and already on iNO.

This job is thankless and a waste of resources and time sometimes.

You do realize that you don't have to offer therapies with no benefit (eg iNO, CPR in refractory hypoxic arrest from ARDS).

But yes it is often thankless but is helpful to understand that a lot of it is projection. People are scared and at least where I work they aren't allowed to visit so everything is remote. To me it is just another in the COVID death pile but for the family it is their last chance to do something before their loved one is gone etc. It is hard for me to maintain that mindset when I am accused of giving up on someone who I've spent 3 hours on ****ing around with the vent, lining, ultrasound, reviewing chart etc but I do try.

 

[chocomorsel]

You do realize that you don't have to offer therapies with no benefit (eg iNO, CPR in refractory hypoxic arrest from ARDS).

But yes it is often thankless but is helpful to understand that a lot of it is projection. People are scared and at least where I work they aren't allowed to visit so everything is remote. To me it is just another in the COVID death pile but for the family it is their last chance to do something before their loved one is gone etc. It is hard for me to maintain that mindset when I am accused of giving up on someone who I've spent 3 hours on ****ing around with the vent, lining, ultrasound, reviewing chart etc but I do try.

This is America. People wanna sue for everything. Usually I find the iNO already started by someone else. I offer iNO to the younger/healthier a ones but hell we seem to have an endless supply.
I don’t do crazy codes on these patients because I know they are futile. But gotta do some kinda code.
I am not even bad. I see people literally keeping brain dead patients alive. No joke. Because they need “permission” from the family to disconnect.
What a bunch of BS.

 

[chessknt]

This is America. People wanna sue for everything. Usually I find the iNO already started by someone else. I offer iNO to the younger/healthier a ones but hell we seem to have an endless supply.
I don’t do crazy codes on these patients because I know they are futile. But gotta do some kinda code.
I am not even bad. I see people literally keeping brain dead patients alive. No joke. Because they need “permission” from the family to disconnect.
What a bunch of BS.

Fair enough. I have no concern about a lawsuit over withholding iNO since there is no way it could ever be won. We have stopped offering HD/CRRT to covid patients over 70 in most cases which has also been nice since we had a local mortality rate of 100%

 

[chocomorsel]

Fair enough. I have no concern about a lawsuit over withholding iNO since there is no way it could ever be won. We have stopped offering HD/CRRT to covid patients over 70 in most cases which has also been nice since we had a local mortality rate of 100%

Yeah. Agreed. I am just a traveler and I most often try to go with the culture. I work with mostly Hispanic patients since I live in TX and they “want everything” for their 70-80 year olds and believe in miracles. I have seen a 50s Jamaican dude survive CRRT. That’s it. Just one out of all of them. And only one again 50s survive iNO.

I wish hospitals would just stop offering these treatments honestly. I don’t know how they do in rehab but I hear plenty die there as well.
Wish I practice in a socialist society.

 

[SurfingDoctor]

Alright, so we don't see much COVID ARDS in pediatrics (more the occasional MIS-C), but in our infinite wisdom, we took a 21 year old COVID ARDS on ECMO to offload the adult side and because we take care of young adults and have a pretty high ECMO volume for pediatrics with good familiarity. Anyway, what is everyone else's experience having successful decannulation? This is an n=1 for me in this disease but our adult colleagues quoted some statistic like 40% survival to hospital discharge for COVID ECMO. I thought, no way unless survival to hospital discharge meant survivor to hospice or transfer to another center, but maybe that's accurate? I personally don't think this young man will survive since he's week 2 into his ECMO run and his lungs look like garbage, but what is everyone else's experience with COVID ECMO?

 

[WheezyBaby]

Alright, so we don't see much COVID ARDS in pediatrics (more the occasional MIS-C), but in our infinite wisdom, we took a 21 year old COVID ARDS on ECMO to offload the adult side and because we take care of young adults and have a pretty high ECMO volume for pediatrics with good familiarity. Anyway, what is everyone else's experience having successful decannulation? This is an n=1 for me in this disease but our adult colleagues quoted some statistic like 40% survival to hospital discharge for COVID ECMO. I thought, no way unless survival to hospital discharge meant survivor to hospice or transfer to another center, but maybe that's accurate? I personally don't think this young man will survive since he's week 2 into his ECMO run and his lungs look like garbage, but what is everyone else's experience with COVID ECMO?

No personal experience

DEFINE_ME

Median ecmo duration 14d with iqr 8-23d. Lots of ECF discharges not unexpectedly. Doesn't sound like they're anywhere close to liberating. What about transplant?