Id |
Subject |
Object |
Predicate |
Lexical cue |
T53 |
0-21 |
Sentence |
denotes |
MATERIALS AND METHODS |
T54 |
22-89 |
Sentence |
denotes |
The data were collected from 16 March 2020 to 8 May 2020 (54 days). |
T55 |
90-165 |
Sentence |
denotes |
Until 25 March, we received referrals by telephone on a standard pro forma. |
T56 |
166-314 |
Sentence |
denotes |
Thereafter, we used a dedicated electronic referral portal to cope with the increased demand—referapatient® (Bloomsbury Health Limited, London, UK). |
T57 |
315-417 |
Sentence |
denotes |
The electronic-based referral system was user-friendly, secure and improved efficacy in communication. |
T58 |
418-479 |
Sentence |
denotes |
It did not require additional training or hardware resources. |
T59 |
480-559 |
Sentence |
denotes |
A team of 3 experienced intensive care consultants reviewed the ECMO referrals. |
T60 |
560-732 |
Sentence |
denotes |
They provided direct advice and activated the retrieval team when necessary following multidisciplinary discussions with 2 other senior intensivists working alternate days. |
T61 |
733-886 |
Sentence |
denotes |
Before considering ECMO support, as a prerequisite, referring units were advised to place the patient in a prone position to improve the ventilation [9]. |
T62 |
887-1034 |
Sentence |
denotes |
There was no specific time frame for patient to stay proned before considering for ECMO, decision was based on clinical progression of the patient. |
T63 |
1035-1211 |
Sentence |
denotes |
To ascertain the candidacy of the patient for ECMO, the retrieval team initially assessed the patient in the ICU, and reviewed the chest radiographs and results of blood tests. |
T64 |
1212-1342 |
Sentence |
denotes |
We obtained verbal consent for ECMO from the patient’s next of kin over the telephone explaining the risks and potential benefits. |
T65 |
1343-1482 |
Sentence |
denotes |
When the decision is made to proceed with ECMO, our preference is that cannulation be performed in the referring hospital’s operating room. |
T66 |
1483-1719 |
Sentence |
denotes |
We require a dedicated anaesthetist, theatre practitioner and a radiographer with an image intensifier from the referring team to insert a new central venous line on the left side of the neck and facilitate ECMO insertion, respectively. |
T67 |
1720-1809 |
Sentence |
denotes |
A World Health Organization surgical safety checklist was completed prior to cannulation. |
T68 |
1810-2013 |
Sentence |
denotes |
We observed the recommendations from the Extracorporeal Life Support Organization (that veno-venous ECMO (VV-ECMO) be initiated by staff personal protective equipment with full contact precautions) [10]. |
T69 |
2014-2136 |
Sentence |
denotes |
Before the patient arrived in the operating room, the ECMO retrieval team had scrubbed and donned the appropriate apparel. |
T70 |
2137-2244 |
Sentence |
denotes |
The equipment was ready so the team could proceed immediately (Fig. 1) in case the patient became unstable. |
T71 |
2245-2359 |
Sentence |
denotes |
Changing the patient from the prone to the supine position for cannulation was performed onto the operating table. |
T72 |
2360-2712 |
Sentence |
denotes |
Under aseptic conditions, the femoral vessel was punctured percutaneously under directed ultrasound guidance and the old central line in the neck was rewired for insertion of the return cannula into the internal jugular vein (our preference is to insert return cannulas on the right side of the neck because of the straighter path to the right atrium). |
T73 |
2713-2907 |
Sentence |
denotes |
Once the positions of both guide wires were confirmed with the image intensifier, systemic heparin was administered, initially 2500 IU and another 2500 IU if required based on body surface area. |
T74 |
2908-2965 |
Sentence |
denotes |
We followed our institutional anticoagulation guidelines. |
T75 |
2966-3167 |
Sentence |
denotes |
A higher than usual degree of anticoagulation may be indicated, and a case-by-case assessment of bleeding versus thrombotic risks is recommended pending further evidence in patients with COVID-19 [10]. |
T76 |
3168-3259 |
Sentence |
denotes |
The puncture site was then dilated sequentially to the appropriate diameter of the cannula. |
T77 |
3260-3737 |
Sentence |
denotes |
For drainage, we used the femoral venous Maquet (BIOLINE coating) HLS cannula® (Getinge AB, Gothenburg, Sweden), type PVL-2555 with an outer diameter of 7.6–8.3 mm (23–25 Fr) and a maximum insertion length of 380–550 mm; it connects to standard 9.5 mm (3/8 inch) diameter tubing.The return internal jugular venous cannula used is the Maquet (BIOLINE coating) HLS arterial cannula® type PAS-1915 with an outer diameter of 6.3 mm (19 Fr) and a maximum insertion length of 150 mm. |
T78 |
3738-3843 |
Sentence |
denotes |
It has 2 side holes with a perforation length of 10 mm and connects to standard 9.5 mm (3/8 inch) tubing. |
T79 |
3844-3974 |
Sentence |
denotes |
The cannulae were fixed securely in position with 3 sutures and Hollister® dressings (Hollister Limited, Winnersh, Wokingham, UK). |
T80 |
3975-4266 |
Sentence |
denotes |
We used Thoratec Levitronix® (Levitronix GmbH, Zurich, Switzerland) consoles and ranges of oxygenators depending on availability (Paragon® Chalice Medical Limited, Worksop, Nottinghamshire, UK; Eurosets® Eurosets S.R.L, Medolla, Italy and Medos hilite®, Inspiration Healthcare, Crawley, UK). |
T81 |
4267-4276 |
Sentence |
denotes |
Figure 1: |
T82 |
4278-4337 |
Sentence |
denotes |
Extracorporeal membrane oxygenator insertion trolley setup. |
T83 |
4338-4525 |
Sentence |
denotes |
All patients were transferred by a dedicated ECMO ambulance service (Amvale Medical Transport Limited, Scunthorpe, UK) [11]; 2 vehicles were used for transfer to ensure social distancing. |
T84 |
4526-4584 |
Sentence |
denotes |
A standardized ECMO report was recorded for every patient. |
T85 |
4585-4681 |
Sentence |
denotes |
Management of ECMO in patients with COVID-19 was similar to that in standard patients with ECMO. |