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3. Variation in survival in patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation: A multi-institutional analysis of 594 consecutive patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation at 49 hospitals within 21 states

Author

Jacobs, Jeffrey P., Stammers, Alfred H., St. Louis, James D., Tesdahl, Eric A., Hayanga, J. W. Awori, Morris, Rohinton J., Lee, Raymond C., Sestokas, Anthony K., Badhwar, Vinay, and Weinstein, Samuel

Published
2023
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12. Variation in outcomes with extracorporeal membrane oxygenation in the era of coronavirus: A multicenter cohort evaluation.

Author

Stammers, Alfred H, Tesdahl, Eric A, Sestokas, Anthony K, Mongero, Linda B, Patel, Kirti, Barletti, Shannon, Firstenberg, Michael S, St. Louis, James D, Jain, Ankit, Bailey, Caryl, Jacobs, Jeffrey P, and Weinstein, Samuel

Subjects
ADULT respiratory distress syndrome treatment, EVALUATION of medical care, RESEARCH, CAUSES of death, MEDICAL equipment reliability, KRUSKAL-Wallis Test, COVID-19, SCIENTIFIC observation, CRITICALLY ill, EXTRACORPOREAL membrane oxygenation, PATIENTS, RETROSPECTIVE studies, ACQUISITION of data, ANTICOAGULANTS, MEDICAL records, DESCRIPTIVE statistics, CATHETERIZATION, LONGITUDINAL method, ACUTE diseases, LIVER failure, EVALUATION
Abstract

Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients with coronavirus disease 2019 (COVID-19) with acute respiratory distress syndrome unresponsive to other interventions. However, a COVID-19 infection may result in a differential tolerance to both medical treatment and ECMO management. The aim of this study was to compare outcomes (mortality, organ failure, circuit complications) in patients on ECMO with and without COVID-19 infection, either by venovenous (VV) or venoarterial (VA) cannulation. This is a multicenter, retrospective analysis of a national database of patients placed on ECMO between May 2020 and January 2022 within the United States. Nine-hundred thirty patients were classified as either Pulmonary (PULM, n = 206), Cardiac (CARD, n = 279) or COVID-19 (COVID, n = 445). Patients were younger in COVID groups: PULM = 48.4 ± 15.8 years versus COVID = 44.9 ± 12.3 years, p = 0.006, and CARD = 57.9 ± 15.4 versus COVID = 46.5 ± 11.8 years, p < 0.001. Total hours on ECMO were greatest for COVID patients with a median support time two-times higher for VV support (365 [101, 657] hours vs 183 [63, 361], p < 0.001), and three times longer for VA support (212 [99, 566] hours vs 70 [17, 159], p < 0.001). Mortality was highest for COVID patients for both cannulation types (VA-70% vs 51% in CARD, p = 0.041, and VV-59% vs PULM-42%, p < 0.001). For VA supported patients hepatic failure was more often seen with COVID patients, while for VV support renal failure was higher. Circuit complications were more frequent in the COVID group as compared to both CARD and PULM with significantly higher circuit change-outs, circuit thromboses and oxygenator failures. Anticoagulation with direct thrombin inhibitors was used more often in COVID compared to both CARD (31% vs 10%, p = 0.002) and PULM (43% vs 15%, p < 0.001) groups. This multicenter observational study has shown that COVID patients on ECMO had higher support times, greater hospital mortality and higher circuit complications, when compared to patients managed for either cardiac or pulmonary lesions. [ABSTRACT FROM AUTHOR]

Published
2023
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15. Variation in outcomes with extracorporeal membrane oxygenation in the era of coronavirus: A multicenter cohort evaluation

Author

Stammers, Alfred H, primary, Tesdahl, Eric A, additional, Sestokas, Anthony K, additional, Mongero, Linda B, additional, Patel, Kirti, additional, Barletti, Shannon, additional, Firstenberg, Michael S, additional, St. Louis, James D, additional, Jain, Ankit, additional, Bailey, Caryl, additional, Jacobs, Jeffrey P, additional, and Weinstein, Samuel, additional

Published
2022
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16. Multi-institutional Analysis of 505 Patients With Coronavirus Disease-2019 Supported With Extracorporeal Membrane Oxygenation: Predictors of Survival

Author

Hall, Celeste A., primary, Jacobs, Jeffrey P., additional, Stammers, Alfred H., additional, St. Louis, James D., additional, Hayanga, J.W. Awori, additional, Firstenberg, Michael S., additional, Mongero, Linda B., additional, Tesdahl, Eric A., additional, Rajagopal, Keshava, additional, Cheema, Faisal H., additional, Patel, Kirti, additional, Coley, Tom, additional, Sestokas, Anthony K., additional, Slepian, Marvin J., additional, and Badhwar, Vinay, additional

Published
2022
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18. Variation in survival in patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation: A multi-institutional analysis of 594 consecutive patients with Coronavirus Disease 2019 supported with extracorporeal membrane oxygenation at 49 hospitals within 21 states

Author

Jacobs, Jeffrey P., primary, Stammers, Alfred H., additional, St. Louis, James D., additional, Tesdahl, Eric A., additional, Hayanga, J. W. Awori, additional, Morris, Rohinton J., additional, Lee, Raymond C., additional, Sestokas, Anthony K., additional, Badhwar, Vinay, additional, and Weinstein, Samuel, additional

Published
2022
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19. Multi-institutional Analysis of 200 COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation: Outcomes and Trends

Author

Jacobs, Jeffrey P., primary, Stammers, Alfred H., additional, St Louis, James D., additional, Hayanga, J. W. Awori, additional, Firstenberg, Michael S., additional, Mongero, Linda B., additional, Tesdahl, Eric A., additional, Rajagopal, Keshava, additional, Cheema, Faisal H., additional, Patel, Kirti, additional, Coley, Tom, additional, Sestokas, Anthony K., additional, Slepian, Marvin J., additional, and Badhwar, Vinay, additional

Published
2022
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22. Patient Factors Impacting Baseline Motor Evoked Potentials (MEPs) in Patients Undergoing Cervical Spine Surgery for Myelopathy or Radiculopathy

Author

DiMaria, Stephen, primary, Wilent, W. Bryan, additional, Nicholson, Kristen J., additional, Tesdahl, Eric A., additional, Valiuskyte, Kornelija, additional, Mao, Jennifer, additional, Seger, Philip, additional, Singh, Akash, additional, Sestokas, Anthony K., additional, and Vaccaro, Alex R., additional

Published
2022
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23. Multi-institutional Analysis of 200 COVID-19 Patients treated with ECMO:Outcomes and Trends

Author

Jacobs, Jeffrey P., Stammers, Alfred H., St. Louis, James D., Hayanga, J.W. Awori, Firstenberg, Michael S., Mongero, Linda B., Tesdahl, Eric A., Rajagopal, Keshava, Cheema, Faisal H., Patel, Kirti, Coley, Tom, Sestokas, Anthony K., Slepian, Marvin J., and Badhwar, Vinay

Subjects
Time Factors, Critical Illness, Immunization, Passive, COVID-19, acute respiratory distress syndrome, Middle Aged, Pulmonary failure, Coronavirus, surgical procedures, operative, Extracorporeal Membrane Oxygenation, Humans, Original Article, COVID-19 Serotherapy, Retrospective Studies
Abstract

Background The role of ECMO in the management of patients with COVID-19 continues to evolve. The purpose of this manuscript is to review a multi-institutional clinical experience in 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO. Methods This analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 9, 2020. Differences by mortality group were assessed using chi-square tests for categorical variables and Kruskal-Wallis rank sum tests and Welch’s ANOVA for continuous variables. Results Median ECMO time was 15 days (IQR=9-28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with veno-venous ECMO was 87 of 188 patients (46.3%), while survival with veno-arterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, p

Published
2021

25. P118. Establishing baseline motor and somatosensory evoked potentials (MEPs and SSEPs) prior to cervical spine surgery: Association with diagnosis, demographics, comorbidities, and patient-reported measures

Author

DiMaria, Stephen, primary, Nicholson, Kristen, additional, Mao, Jennifer, additional, Vaccaro, Alexander R., additional, Wilent, Bryan, additional, Valiuskyte, Kornelija, additional, Tesdahl, Eric A., additional, and Sestokas, Anthony K., additional

Published
2021
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27. Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time

Author

Jacobs, Jeffrey p., primary, Stammers, Alfred H., additional, Louis, James St., additional, Hayanga, J.W. Awori, additional, Firstenberg, Michael S., additional, Mongero, Linda B., additional, Tesdahl, Eric A., additional, Rajagopal, Keshava, additional, Cheema, Faisal H., additional, Patel, Kirti, additional, Esseghir, Feriel, additional, Coley, Tom, additional, Sestokas, Anthony K., additional, Slepian, Marvin J., additional, and Badhwar, Vinay, additional

Published
2021
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32. Intraoperative vascular complications during 2278 cerebral endovascular procedures with multimodality IONM: relationship between signal change, complication, intervention and postoperative outcome

Author

Wilent, W Bryan, primary, Belyakina, Olga, additional, Korsgaard, Eric, additional, Tjoumakaris, Stavropoula I, additional, Gooch, M Reid, additional, Jabbour, Pascal, additional, Rosenwasser, Robert, additional, English, Joey D, additional, Kim, Warren, additional, Tesdahl, Eric, additional, Cohen, Jeffrey, additional, and Sestokas, Anthony K, additional

Published
2020
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37. Intraoperative vascular complications during 2278 cerebral endovascular procedures with multimodality IONM: relationship between signal change, complication, intervention and postoperative outcome.

Author

Wilent, W. Bryan, Belyakina, Olga, Korsgaard, Eric, Tjoumakaris, Stavropoula I., Gooch, M. Reid, Jabbour, Pascal, Rosenwasser, Robert, English, Joey D., Kim, Warren, Tesdahl, Eric, Cohen, Jeffrey, and Sestokas, Anthony K.

Subjects
BRAIN surgery, CONFIDENCE intervals, ELECTROENCEPHALOGRAPHY, SURGICAL complications, SOMATOSENSORY evoked potentials, RETROSPECTIVE studies, TREATMENT effectiveness, DESCRIPTIVE statistics, CASE studies, ENDOVASCULAR surgery, INTRAOPERATIVE monitoring, DATA analysis software, ODDS ratio
Abstract

Background Intraoperative neuromonitoring (IONM) is often used during cerebral endovascular procedures. Objective To investigate the relationship between intraoperative vascular complications and IONM signal changes, and the impact of interventions on signal resolution and postoperative outcomes. Methods A series of 2278 cerebral endovascular procedures conducted under general anesthesia and using electroencephalography and somatosensory evoked potential monitoring were retrospectively reviewed. A subset of 763 procedures also included motor evoked potentials (MEPs). IONM alerts were categorized as either a partial attenuation or complete loss of signal. Vascular complications were subcategorized as due to rupture, emboli, instrumentation, or vasospasm. Odds ratios (ORs) for new postoperative motor deficits were calculated and diagnostic accuracy was measured using sensitivity, specificity, and likelihood ratios. Results The overall incidence of new postoperative motor deficit was 1.2%; 20.4% in cases with an IONM alert and 0.09% in cases without an alert. Relative to procedures with no alerts, odds of a new deficit increased if there was partial signal attenuation (OR=210.9, 95% CI 44.3 to 1003.5, p<0.0001) and increased further with complete loss of signal (OR=1437.3, 95% CI 297.3 to 6948.2, p<0.0001). Relative to procedures with unresolved alerts, odds of a new deficit decreased if the alert was fully resolved (OR=0.039, 95% CI 0.005 to 0.306, p<0.002). Procedures using MEPs had slightly higher sensitivity (92.3% vs 85.7%) but slightly lower specificity (96.7% vs 98.2%). Conclusions An IONM alert associated with an arterial complication is associated with a dramatic increase in odds of a new postoperative deficit; however, if there is resolution of the alert prior to closure, odds of a new deficit decrease significantly. [ABSTRACT FROM AUTHOR]

Published
2021
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38. Intraoperative neurophysiology in tethered cord surgery: Techniques and results

Author

Hoving, Eelco W., Haitsma, Esther, Ophuis, Charlotte M.C.Oude, Journée, Henricus L., Phillips, Leslie A., Burton, Justin M., Evans, Sarah Helen, Hwang, Hyeoncheol, Wang, Kyu Chang, Bang, Moon Suk, Shin, Hyung Ik, Kim, Seung Ki, Phi, Ji Hoon, Lee, Ji Yeoun, Choi, Jinwoo, Cha, Seungwoo, Kim, Keewon, Buxton, Neil, Sala, Francesco, Squintani, Giovanna, Tramontano, Vincenzo, Arcaro, Chiara, Faccioli, Franco, Mazza, Carlo, Jackson, Eric M., Schwartz, Daniel M., Sestokas, Anthony K., Zarnow, Deborah M., Adzick, N. Scott, Johnson, Mark P., Heuer, Gregory G., Sutton, Leslie N., Kothbauer, Karl F., and Novak, Klaus

Subjects
Bulbocavernosus reflex, Fetal surgery, Electromyography, Surgical technique, Dysraphism: spina bifida, Motor-evoked potentials, Spinal dysraphism, Cauda equina, Motor evoked potentials, Spine, Dethetering, Neurophysiological mapping, Craniofacial, Congenital spinal anomalies, Intraoperative neurophysiological monitoring, Surgery for spina bifida, Electric stimulation, Myelomeningocele, Tethered cord syndrome, Infants, Intraoperative monitoring, Intraoperative neuromonitoring, Tethered cord
Abstract

©AANS, 2017. OBJECTIVE The aim of this study was to establish optimal electric stimulation parameters for intraoperatively monitoring the bulbocavernosus reflexes (BCRs) in infants. METHODS The authors retrospectively reviewed the medical records of all infants (age < 24 months) who had undergone an untethering operation for tethered cord syndrome between May 2013 and February 2014 at a single institution and whose baseline BCR had been elicited during surgery. Using different combinati ons of stimulation parameters-number of stimulation pulses: 4 or 8 pulses, interpulse interval: 1, 2, or 5 msec, and polarity of stimulation: biphasic or monophasic-the authors compared the relative mean amplitude of 10 BCR responses (rmaBCRs) to each combination of parameters. RESULTS The rmaBCRs were larger with the 8-pulse stimulations than with the 4-pulse stimulations (p < 0.0001). There was a tendency, though not statistically significant, for larger rmaBCRs to be obtained with the longer interpulse interval in the 8-pulse stimulation (p = 0.1289). The biphasic stimulation produced larger rmaBCRs than the monophasic stimulation (p = 0.0005). CONCLUSIONS Biphasic 8-pulse stimulations with 5-msec or 2-msec intervals yield the largest BCR responses. Considering that an 8-pulse stimulation with 5-msec intervals may overlap the onset of the BCR, a biphasic 8-pulse stimulation with 2-msec intervals is recommended as the optimal stimulation paradigm to monitor intraoperative BCRs in infants.

Published
2017

39. Wednesday, September 26, 2018 9:00 AM – 10:00 AM Best Papers

Author

Wilent, Bryan, primary, Tesdahl, Eric A., additional, Harrop, James S., additional, Welch, William C., additional, Cannestra, Andrew F., additional, Poelstra, Kornelis A., additional, Stivali, Taylor M., additional, Epplin-Zapf, Thomas J., additional, Cohen, Jeffrey, additional, and Sestokas, Anthony K., additional

Published
2018
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45. Efficacy of intraoperative monitoring of transcranial electrical stimulation–induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery

Author

Bhalodia, Vidya M., primary, Schwartz, Daniel M., additional, Sestokas, Anthony K., additional, Bloomgarden, Gary, additional, Arkins, Thomas, additional, Tomak, Patrick, additional, Gorelick, Judith, additional, Wijesekera, Shirvinda, additional, Beiner, John, additional, and Goodrich, Isaac, additional

Published
2013
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49. Transcranial Electric Motor Evoked Potential Monitoring During Spine Surgery

Author

Schwartz, Daniel M., primary, Sestokas, Anthony K., additional, Dormans, John P., additional, Vaccaro, Alexander R., additional, Hilibrand, Alan S., additional, Flynn, John M., additional, Li, P. Mark, additional, Shah, Suken A., additional, Welch, William, additional, Drummond, Denis S., additional, and Albert, Todd J., additional

Published
2011
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