Respiratory Care Currents

 Published: October 20, 2021

By: Debbie Bunch

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ECMO Survival Numbers Drop

ECMO has been a last ditch life-saver for many patients with COVID-19, but new research from international investigators, including those from the University of Michigan and Columbia University, suggests the effectiveness of the treatment has declined over time.

In a study conducted among three groups of patients — those treated before May 1, 2020, those treated in hospitals that were early to adopt ECMO for COVID-19 after May 1, and those treated with ECMO in other hospitals from May 1 through the end of 2020 — they found that the survival rate dropped from about 60% to a little under 50%. Overall, 4,800 patients over age 16 from 41 countries were included in the study.

An analysis of the results showed that patients treated later in the pandemic were staying on ECMO longer (an average of 20 days vs. 14 days), and they were more likely to have been treated with medications such as remdesivir and dexamethasone. They more often had received noninvasive ventilation prior to being intubated as well.

Given limited resources during the pandemic, the authors believe ECMO centers should carefully consider the risk factors and personal characteristics that could impact a patient’s chance of survival on ECMO. The study was publish by The Lancet.

Air Pollutant Mixtures Linked to Poor Asthma Outcomes

A novel machine learning algorithm allowed researchers from the Icahn School of Medicine at Mount Sinai to uncover certain mixtures of air pollutants linked to poor asthma outcomes later in childhood.

The investigators started by mapping emissions estimates for 125 known pollutants to the residential areas and birth years of 151 children with asthma who were taking part in Mount Sinai’s Airway in Asthma study. After identifying 18 individual chemicals associated with outcomes such as needing a daily controller inhaler, or visiting the emergency room or hospital for asthma, they found 20 different pollutant mixtures that were also associated with these outcomes. Several of them had not previously been linked to long-term asthma risk.

“Our results show how breathing individual and combinations of pollutants may lead to poor asthma outcomes,” said senior study author Supinda Bunyavanich, MD, MPH, MPhil. “We hope that having a more comprehensive, holistic view of air pollution may one day be able to reduce the chances that children will be burdened by asthma.”

The study was published by the Journal of Clinical Investigation.

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Vaccine Effectiveness in Health Care Workers

Respiratory therapists and other health care workers were among the first to receive the COVID-19 vaccines when they became available at the end of 2020. Have those vaccines kept them safe from the virus?

According to a study published in The New England Journal of Medicine, the answer is yes. Investigators involved in the Preventing Emerging Infections through Vaccine Effectiveness Testing trial surveyed nearly 5,000 health care workers from 33 U.S. academic medical centers, including 1,482 who had tested positive for COVID-19 and displayed symptoms and 3,449 who had COVID-19-like symptoms but had tested negative.

Results showed —

  • Health care personnel who received a two-dose regimen of the Pfizer-BioNTech vaccine had an 89% lower risk for symptomatic illness than those who were unvaccinated; the risk was reduced by 96% for those who received the two-dose regimen of the Moderna vaccine.
  • A two-dose regimen of either of the mRNA vaccines reduced the risk of illness by 95% among Blacks and African Americans, 89% among Hispanics, 89% among Asian or Pacific Islanders, and 94% among American Indians and Alaskan Natives, compared to unvaccinated people.
  • Of all those who received a single dose of either mRNA vaccine, the risk of illness was reduced by 86% among Blacks and African Americans, 82% among Hispanics, 80% among Asian or Pacific Islanders, and 76% among American Indians and Alaskan Natives compared to unvaccinated people.
  • For people who were obese or overweight, a two-dose regimen reduced the risk of illness by 91%; among the same group, partial vaccination reduced the risk by 76%.
  • For those with hypertension, a two-dose regimen of either mRNA vaccine reduced the risk of illness by 92%; partial vaccination reduced the risk by 83%.
  • For people with asthma, a two-dose regimen of either mRNA vaccine reduced the risk of illness by 91%; partial vaccination reduced the risk by 78%.
  • For immunocompromised people, the risk of illness was reduced by 39% whether they received a single dose or two doses of either mRNA vaccine.
  • Among the 62 people in the study who were pregnant at the time they were surveyed, vaccination was 77% effective in preventing symptomatic COVID-19 illness in those who had received at least one dose of one of the mRNA vaccines.

The study was conducted between December 2020 and May 2021.

What’s Really in E-Cigarettes?

E-cigarette makers are not disclosing everything that goes into their products, report researchers from Johns Hopkins. When they applied an advanced fingerprinting technique that’s often used to identify chemicals in food and wastewater to tobacco flavored e-cigarette aerosols made by Mi-Salt, Vuse, Juul, and Blu, they found thousands of unknown chemicals and substances not listed on the labels.

Six were deemed potentially harmful, including three never found in tobacco flavored e-cigarettes before, including caffeine. Previously caffeine had only been seen in caffeine-oriented flavors like coffee and chocolate.

“Existing research that compared e-cigarettes with normal cigarettes found that cigarette contaminants are much lower in e-cigarettes. The problem is that e-cigarette aerosols contain other completely uncharacterized chemicals that might have health risks that we don’t yet know about,” said senior author Carsten Prasse. “More and more young people are using these e-cigarettes and they need to know what they’re being exposed to.”

In addition to all the chemicals and other substances they identified in their investigation, the researchers also found evidence of hydrocarbon-like compounds typically associated with combustion, even though combustion is not supposed to be occurring during vaping.

The study appeared in Chemical Research in Toxicology.

Saliva Test Might Guide Treatment in Kids with COVID-19

A simple saliva test might be able to determine which children with COVID-19 will develop a severe case. U.S. researchers who presented the results of a preliminary analysis of saliva samples taken from 150 children found that levels of two cytokines were higher in those who went on to have a severe case than in those who did not develop a severe infection.

Dozens of microRNA levels were altered as well, with most of them found to be significantly lower in the children with severe infections.

“Since pediatric COVID-19 infections are rising across the country, there is an urgent need to understand which children are at risk for severe infection,” said Dr. Steven Hicks, pediatrician at Penn State Health Children’s Hospital and coauthor of the study. “This noninvasive and painless method for determining COVID-19 severity could have the potential to help clinicians begin timely and appropriate treatment, which may improve patient outcomes.”

The researchers plan to continue the study, with the goal of obtaining saliva samples from 400 children ages 18 and younger who seek emergency care at two Pennsylvania hospitals.

The preliminary results were shared during a presentation at the American Academy of Pediatrics National Conference and Exhibition on Oct. 8.

Email newsroom@aarc.org with questions or comments, we’d love to hear from you.

Debbie Bunch

Debbie Bunch is an AARC contributor who writes feature articles, news stories, and other content for Newsroom, the AARC website, and associated emailed newsletters. In her spare time, she enjoys reading, traveling, photography, and spending time with her children and grandchildren. Connect with Debbie by email or on AARConnect or LinkedIn.

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