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• ECMO for COVID ARDS has rarely been compared to ECMO for a variety of non-COVID ARDS indications. • We report data from a United States quaternary referral center on such a comparison. • Survival and complications were not significantly different between the two categories of ECMO patients. • COVID ECMO patients had longer ICU length of stay and a higher rate of prolonged ECMO. The COVID-19 pandemic has led to a boom in the use of V-V ECMO for ARDS secondary to COVID. Comparisons of outcomes of ECMO for COVID to ECMO for influenza have emerged. Very few comparisons of ECMO for COVID to ECMO for ARDS of all etiologies are available. To compare clinically important outcome measures in recipients of ECMO for COVID to those observed in recipients of ECMO for ARDS of other etiologies. V-V ECMO recipients between March 2020 and March 2022 consisted exclusively of COVID patients and formed the COVID ECMO group. All patients who underwent V-V ECMO for ARDS between January 2014 and March 2020 were eligible for analysis as the non-COVID ECMO comparator group. The primary outcome was survival to hospital discharge. Secondary outcomes included ECMO decannulation, ECMO duration >30 days, and serious complications. Thirty-six patients comprised the COVID ECMO group and were compared to 18 non-COVID ECMO patients. Survival to hospital discharge was not significantly different between the two groups (33% in COVID vs. 50% in non-COVID; p = 0.255) nor was there a significant difference in the rate of non-palliative ECMO decannulation. The proportion of patients connected to ECMO for >30 days was significantly higher in the COVID ECMO group: 69% vs. 17%; p = 0.001. There was no significant difference in serious complications. This study could not identify a statistically significant difference in hospital survival and rate of successful ECMO decannulation between COVID ECMO and non-COVID ECMO patients. Prolonged ECMO may be more common in COVID. Complications were not significantly different. [ABSTRACT FROM AUTHOR]

Summary: Background and study objective: Deep inspiration (DI) protects against methacholine-induced bronchoconstriction in healthy subjects. We hypothesized that this bronchoprotective effect of DI depends upon the inspiratory flow rate. Design: Prospective, controlled study. Setting: Pulmonary function laboratory within a large tertiary medical center. Participants: Ten healthy nonsmokers without asthma or rhinitis. Measurements: First, we performed a methacholine challenge in the absence of DI to determine the concentration sufficient to reduce FEV1 by 20%. On two subsequent days, the challenge was repeated with the addition of either a fast or slow DI immediately before the threshold concentration of methacholine. We calculated the % reduction in FEV1 and FVC from baseline. Results: Mean % reduction in FEV1 and FVC was significantly less with a fast DI than with no DI (20±3% vs. 34±4% for FEV1, p=0.02; 12±3% vs. 23±3% for FVC, p=0.03); slow DIs did not significantly affect the methacholine-induced reduction in lung function. Conclusion: A fast DI is bronchoprotective while a slow DI is not. Elucidating the conditions that maximize or alternatively, eliminate bronchoprotection in healthy subjects may ultimately provide insight into the pathophysiology of asthma. [Copyright &y& Elsevier]

Intrathecal (IT), intraventricular (IVt), and intracisternal administration of nicardipine deliver treatment directly into the central nervous system. This route of drug delivery is being investigated as a potential treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). The authors reviewed the existing literature regarding the direct administration of nicardipine into the intracranial space for the treatment of vasospasm following aSAH. An electronic search of literature published between 1994 and 2018 was performed using PubMed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A variety of combinations of the search terms "intrathecal nicardipine," "intraventricular nicardipine," and "nicardipine prolonged-release" were used. A total of 17 studies were included in this systematic review, 3 of which were studies in animals. The studies consistently demonstrated that IT nicardipine successfully reverses vasospasm, but the effect, as shown in some studies, was limited to the immediate vicinity of drug release. The data regarding long-term clinical outcomes are variable, with some studies demonstrating marked improvement whereas others fail to demonstrate improved outcomes when compared with patients who receive standard of care. Although adverse sequalae were uncommon, IT and IVt administration and therapy were associated with adverse effects including headache, meningitis, and hydrocephalus. Given the findings presented in these studies, IT, IVt, and intracisternal (pellet) nicardipine administration can be useful treatment adjuncts for vasospasm following aSAH, especially in cases refractory to conventional forms of treatment. However, larger, controlled clinical trials are warranted. [ABSTRACT FROM AUTHOR]