A UNIQUE APPROACH TO HYBRID EXTRACORPOREAL MEMBRANE OXYGENATION: A CASE REPORT Rakin Areef MD; Arpita Pawa MD, Ahmed Virani MD, Willis-Knighton Medical Center, Shreveport, LA.
Introduction: Extracorporeal membrane oxygenation (ECMO) is a life support system used in patients with severe cardiac or respiratory failure that is potentially reversible but is resistant to traditional medical management. Two major ECMO circuits are utilized throughout the country, Veno-Arterial (VA) and Veno-Venous (VV). Over the years, the concept of Hybrid ECMO using additional cannulas has come into existence for better hemodynamic support. Case: A 72-year-old male presented as a transfer post percutaneous intervention to the right coronary and left circumflex artery following an ST elevated myocardial infarction after a cardiac arrest. Upon arrival, the patient was in cardiogenic shock and was initiated on mechanical circulatory support using a percutaneous left ventricular assist device. An echocardiogram revealed severe aortic stenosis, severe mitral regurgitation, moderate tricuspid regurgitation and an ejection fraction of 30-35% with moderately depressed right ventricular
function. Given the degree of aortic stenosis, the patient was planned for a Transcatheter Aortic Valve Replacement (TAVR), however, he continued to decline hemodynamically and was not considered stable for the procedure. Given the severity of hemodynamic compromise and complexity of his condition, the patient was initiated on a hybrid ECMO with Veno-Veno-Arterial (VVA) configuration with dual venous drainage from the right atria and the pulmonary artery using a PROTEK cannula with femoral artery return. As hemodynamics improved, the patient was taken for TAVR procedure and transitioned to VV ECMO and finally explanted. Discussion: In conditions where severe hemodynamic compromise is noted, Hybrid ECMO circuits instead of traditional ECMO circuits should be considered to improve patient outcomes. Veno-Veno-Arterial ECMO using Pulmonary artery drainage is rarely mentioned in literature which makes its use unique.
PHARMACY-DRIVEN MRSA NASAL SWABS TO REDUCE VANCOMYCIN USAGE Besim Ademi, MD, Samuel Ficenec, MD, Joy Fesen, MD and Nicholas Tolat, MD; Department of Medicine, Tulane University, New Orleans, LA.
Introduction: Vancomycin is one of the most common antibiotic used in practice. This is problematic given rising resistance and inappropriate usage. De-escalation of antimicrobial therapy is paramount to avoid increased patient risks, costs, and growing resistance. However, de-escalation is a difficult choice for many physicians which may cause prolonged vancomycin therapy. A MRSA nasal swab is a minimally invasive clinical tool which has been helpful to guide therapy in cases of pneumonia. Study: This study implemented a pharmacy- driven MRSA nasal swab order after vancomycin prescription. The pharmacist would then review the result and make a recommendation to the primary team for either continuation or discontinuation of vancomycin. Data was collected retrospectively from all patients admitted to the hospital that received a confirmed dose of vancomycin for 1 month pre-and 2 months post-intervention. 129 and 185 patients respectively were included in the pre- and post-intervention groups. A significantly greater
proportion of patients that were admitted to the hospital during the post-intervention period had a MRSA nasal swab that was collected in comparison to the pre-intervention period (81% vs 67%, p =0.008). In the pre-intervention period, the mean duration of vancomycin therapy was 3.26 ±3.56 days. In comparison, during the post-intervention period the duration of vancomycin was significantly shorter with a median duration of 2.74 ±3.06 days (p =0.024). Discussion: The results of this study show that a pharmacy-driven MRSA nasal swab intervention reduces the total days of vancomycin therapy by about 12 hours. These results are similar to other studies examining MRSA nares interventions which demonstrated a reduction of vancomycin duration of 10 hours. However, our findings are unique, in that this is the first known study to demonstrate a significant reduction in vancomycin use in all infections. These findings are important as the growth of antimicrobial resistance is a major public health concern. The limited number of 15
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