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To assess the outcomes and risk factors for adult patients with acute fulminant myocarditis (AFM) supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) in China mainland. Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Data from adult patients who were diagnosed with AFM and needed VA ECMO in the database were retrospectively analyzed. The primary outcome was 90-day mortality after ECMO initiation in patients with AFM supported with VA ECMO. Cox proportional hazard regression model was used to examine the risk factors associated with 90-day mortality. Among 221 patients enrolled and followed up to 90 days, 186 (84.2%) patients weaned from ECMO and 159 (71.9%) patients survived and discharged home. The median age was 38 years (IQR 29–49) and males (n = 115) represented 52.0% of the total accounted patients. The median ECMO duration was 134 h (IQR 96–177 h). The main adverse event during ECMO course was bleeding (16.3%), followed by infection (15.4%). In the multivariate Cox model analysis, cardiac arrest prior to ECMO initiation (adjusted HR 2.529; 95%CI: 1.341–4.767, p = 0.004), lower pH value (adjusted HR 0.016; 95%CI: 0.010–0.059, p < 0.001) and higher lactate concentration at 24 h after ECMO initiation (adjusted HR 1.146; 95%CI: 1.075–1.221, p < 0.001) were associated with 90-day mortality. 71.9% patients with AFM (clinical diagnosed) supported with VA ECMO survived. Cardiac arrest prior to ECMO, lower pH and higher lactate concentration at 24 h after ECMO initiation were correlated with 90-day mortality of AFM patients supported with VA ECMO. • >70% of adult patients with acute fulminant myocarditis supported with VA ECMO survived in China mainland. • The median ECMO duration was 134 h. • Cardiac arrest prior to ECMO, pH and lactate after ECMO were independent risk factors correlated with 90-day mortality. [ABSTRACT FROM AUTHOR]

An ongoing outbreak of a novel coronavirus disease (coronavirus disease 2019, COVID-19) has become a global threat. While clinical reports from China to date demonstrate that the majority of cases remain relatively mild and recover with supportive care, it is also crucial to be well prepared for severe cases warranting intensive care. Initiating appropriate infection control measures may not always be achievable in primary care or in acute-care settings. A 45-year-old man was admitted to the intensive care unit due to severe pneumonia, later confirmed as COVID-19. His initial evaluation in the resuscitation room and treatments in the intensive care unit was performed under droplet and contact precaution with additional airborne protection using the N95 respirator mask. He was successfully treated in the intensive care unit with mechanical ventilation and extracorporeal membrane oxygenation for respiratory support; and antiretroviral treatment with lopinavir/ritonavir. His total intensive care unit stay was 15 days and was discharged on hospital day 24. Strict infection control precautions are not always an easy task, especially under urgent care in an intensive care unit. However, severe cases of COVID-19 pneumonia, or another novel infectious disease, could present at any moment and would be a continuing challenge to pursue appropriate measures. We need to be well prepared to secure healthcare workers from exposure to infectious diseases and nosocomial spread, as well as to provide necessary intensive care. [ABSTRACT FROM AUTHOR]

• ECMO has been used as a rescue therapy for severe respiratory failure and ARDS for years and ECMO should also be considered as a rescue therapy for COVID-19 with refractory hypoxemia despite lung-protective ventilation according to WHO. • Although the clinical trials of ECMO for COVID-19 are lacking, its use in COVID-19 might also offer promise based on the previous experience. • In the current situation of pandemic outbreak, many issues of ECMO use deserve our attention. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged since December 2019 in Wuhan city, and has quickly spread throughout China and other countries. To date, no specific treatment has been proven to be effective for SARS-CoV-2 infection. According to World Health Organization (WHO), management of coronavirus disease 19 (COVID-19) has mainly focused on infection prevention, case detection and monitoring, and supportive care. Given to the previous experience, extracorporeal membrane oxygenation (ECMO) has been proven to be an effective therapy in the treatment of respiratory failure or acute respiratory distress syndrome (ARDS). On the basis of similar principle, ECMO may be also an effective therapy in the treatment of severe COVID-19. In this study, we described and discussed the clinical outcomes of ECMO for ARDS patients, ECMO use for severe COVID-19 in China, the indications of ECMO use, and some important issues associated with ECMO. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Lung transplantation (LT) remains the only available option for patients with end-stage lung disease. Until recently, 244 lung transplantations have been performed at approximate 20 institutes in China. The aim of this article was to present the initial experience of LT at a single center in China. Methods: We performed a retrospective review of the database from The Chinese Organ Transplantation Network between January 1978 and December 2010 with detailed records available at our center. Results: We performed 100 of 244 lung transplantions at the Wuxi Center, The remaining procedures were performed at other institutes. The overall survival rates for these patients at 1, 2, 3, and 5 years were 73.3%, 61.6%, 53.5%, and 40.7%, respectively. The indications for lung transplantation included idiopathic pulmonary fibrosis (n = 47), chronic obstructive pulmonary disease (n = 33), silicosis (n = 5), bronchiectasis (n = 5), and Eisenmenger''s syndrome (n = 4). The procedure types consisted of single-lung transplantations (s; n = 72), and bilateral lung transplantations (s; n = 28). Cardiopulmonary bypass was required in 5 patients, whereas 56 required arteriovenous extracorporeal membrane oxygenation, including extended use in 3 before and 10 after LT. The main morbidities and complications after LT were sepsis (n = 11), primary graft dysfunction (PGD, n = 10), anastomotic stenosis (n = 10), acute rejection episodes (n = 25), and bronchiolitis obliterans syndrome (n = 15). In-hospital mortality was 18%, including sepsis (n = 10), PGD (n = 6), acute rejection episode (n = 1) and pulmonary infarction (n = 1). The mean survival time was 3.4 years. Conclusions: In China, lung transplantation may offer a viable therapy for patients with various end-stage pulmonary conditions. The initiation of LT should focus on improving the survival rate by increased clinical practice. [Copyright &y& Elsevier]

Abstract: Background: Severe community-acquired pneumonia (CAP) due to human adenoviruses (HAdVs) in immunocompetent adults has raised concerns. Objective: To describe the clinical, laboratorial, and radiological characteristics of adenovirus pneumonia and detect the type and diversity of human adenoviruses that caused acute respiratory distress syndrome (ARDS) in Beijing. Study design: An etiological study of adult community-acquired pneumonia was carried out prospectively at Beijing Chao-Yang Hospital. A total of 18 cases with laboratory-confirmed adenovirus infections in 487 cases with CAP were observed clinically. The viral type and phylogenetic analysis were tested by polymerase chain reaction (PCR). Results: Patients with adenovirus pneumonia typically reported flu-like symptoms. Some of them developed shortness of breath or severe dyspnea on 6 days after disease onset. The patients with ARDS usually present dyspnea, higher level of serum muscle enzymes and bilateral, mutilobal consolidation and patchy/ground-glass opacities. HAdVs type was detected in 17 samples and all of them belonged to species B (HAdV-11, 7, 3 and 14). Among them, HAdV-11 was most frequently (10/17), followed by HAdV-7 (5/17). Phylogenetic analysis of the partial penton nucleotide confirmed a close relationship with stains circulating in the Beijing region. Conclusions: Our identification of severe respiratory illness due to adenovirus, especially type 11 may highlight the need for rapid diagnosis and improved surveillance, which may assist with targeted development of antiviral agents or type-specific vaccines. [Copyright &y& Elsevier]

• The longest VA-ECMO support days in China history • Maximize humanistic care • Awake VA-ECMO, eCASH model and music therapy to prevent delirium • Good organ function maintenance [ABSTRACT FROM AUTHOR]

• Most of the patients with COVID-19 who need to be admitted to hospital are older. • Older patients with COVID-19 had much more co-morbidity, complications and mortality. • Age, SOFA score, APACHEⅡ score, platelet count＜125 × 109/L, d-dimer, creatinine＞133 μmol/L, interleukin-6, and lung consolidation on admission were independent risk factors for severe cases among older patients with COVID-19. • More attention should be paid to older patients with COVID-19. Much of the previous research on COVID-19 was based on all population. But substantial numbers of severe episodes occur in older patients. There is a lack of data about COVID-19 in older adults. The aims of this study were to analyze the clinical characteristics of older adult patients with COVID-19. Retrospective study of older patients hospitalized with COVID-19 from February 1 st to March 31 st, 2020 was conducted in the Sino-French New City Branch of Tongjing Hospital in Wuhan, China. According to the degree of severity of COVID-19 during hospitalization, 312 older patients were divided into non-severe and severe cases. the mean age of the patients was 69.2 ± 7.3 years, and 47.4 % of patients had exposure history. 77.2 % of patients had a co-morbidity, with hypertension being the most common (57.1 %), followed by diabetes (38.8 %) and cardiovascular disease (29.8 %). Multivariable regression showed increasing odds of severe COVID-19 associated with age(OR 1.59, 95 %CI 1.13−2.08), SOFA score(OR 5.89, 95 %CI 3.48−7.96), APACHEⅡ score(OR 3.13, 95 %CI 1.85−5.62), platelet count＜125 × 109/L(OR 2.36, 95 %CI 1.03−4.14), d -dimer (OR 4.37, 95 %CI 2.58−7.16), creatinine＞133 μmol/L(OR 1.85, 95 %CI 1.12−3.04), interleukin-6(OR 4.32, 95 %CI 2.07−7.13), and lung consolidation(OR 1.94, 95 %CI 1.45−4.27) on admission. The most common complication was acute respiratory distress syndrome (35.6 %), followed by acute cardiac injury (33.0 %) and coagulation disorders (30.8 %). 91.7 % of patients were prescribed antiviral therapy, followed by immune globulin (52.9 %) and systemic glucocorticoids (43.6 %). 21.8 % of patients received invasive ventilation, 1.92 % for extracorporeal membrane oxygenation. The overall mortality was 6.73 %, and mortality of severe patients was 17.1 %, which was higher than non-severe patients (0.962 %). Older patients with COVID-19 had much more co-morbidity, complications and mortality. More attention should be paid to older patients with COVID-19. [ABSTRACT FROM AUTHOR]