Ayush Goel

Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-support system that provides cardiopulmonary support. With recent advances, the duration of ECMO has increased but data on the outcomes of prolonged V-V ECMO are limited and inconsistent.Materials and methods: It is a retrospective observational study done at a tertiary care center in Kolkata to study the outcome of patients receiving prolonged V-V ECMO defined as >14 days.Observation: A total of 22 patients received prolonged ECMO support. Fifteen patients (68.2%) had severe coronavirus disease-2019 (COVID-19). The mean duration of invasive mechanical ventilation (IMV) before ECMO was 5 days. Baseline PaO2/FiO(2) (p/f) ratio was 82 and Murray score was 3.5. The mean duration of ECMO support was 27.18 days (SD: 11.59). Five patients (22.7%) had minor bleeding and one patient had oxygenator failure. Survival at hospital discharge was seven patients (31.8%).Conclusion: Duration of ECMO support alone should not represent a basis for decision making to decide futility or continuation of ECMO support. Prolonged ECMO in acute respiratory distress syndrome (ARDS) has minor complications and can lead to recovery in almost one-third of the patients.

COVID‐19 causes morbid pathological changes in different organs including lungs, kidneys, liver, and so on, especially in those who succumb. Though clinical outcomes in those with comorbidities are known to be different from those without—not much is known about the differences at the histopathological level. To compare the morbid histopathological changes in COVID‐19 patients between those who were immunocompromised (Gr 1), had a malignancy (Gr 2), or had cardiometabolic conditions (hypertension, diabetes, or coronary artery disease) (Gr 3), postmortem tissue sampling (minimally invasive tissue sampling [MITS]) was done from the lungs, kidney, heart, and liver using a biopsy gun within 2 hours of death. Routine (hematoxylin and eosin) and special staining (acid fast bacilli, silver methanamine, periodic acid schiff) was done besides immunohistochemistry. A total of 100 patients underwent MITS and data of 92 patients were included (immunocompromised: 27, malignancy: 18, cardiometabolic conditions: 71). In lung histopathology, capillary congestion was more in those with malignancy, while others like diffuse alveolar damage, microthrombi, pneumocyte hyperplasia, and so on, were equally distributed. In liver histopathology, architectural distortion was significantly different in immunocompromised; while steatosis, portal inflammation, Kupffer cell hypertrophy, and confluent necrosis were equally distributed. There was a trend towards higher acute tubular injury in those with cardiometabolic conditions as compared to the other groups. No significant histopathological difference in the heart was discerned. Certain histopathological features were markedly different in different groups (Gr 1, 2, and 3) of COVID‐19 patients with fatal outcomes.

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