Browsing by Author "Wohlauer, Max"

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    Managing Central Venous Access during a Healthcare Crisis
    (Elsevier, 2020-07-15) Chun, Tristen T.; Judelson, Dejah R.; Rigberg, David; Lawrence, Peter F.; Cuff, Robert; Shalhub, Sherene; Wohlauer, Max; Abularrage, Christopher J.; Anastasios, Papapetrou; Arya, Shipra; Aulivola, Bernadette; Baldwin, Melissa; Baril, Donald; Bechara, Carlos F.; Beckerman, William E.; Behrendt, Christian-Alexander; Benedetto, Filippo; Bennett, Lisa F.; Charlton-Ouw, Kristofer M.; Chawla, Amit; Chia, Matthew C.; Cho, Sungsin; Choong, Andrew M.T.L.; Chou, Elizabeth L.; Christiana, Anastasiadou; Coscas, Raphael; De Caridi, Giovanni; Ellozy, Sharif; Etkin, Yana; Faries, Peter; Fung, Adrian T.; Gonzalez, Andrew; Griffin, Claire L.; Guidry, London; Gunawansa, Nalaka; Gwertzman, Gary; Han, Daniel K.; Hicks, Caitlin W.; Hinojosa, Carlos A.; Hsiang, York; Ilonzo, Nicole; Jayakumar, Lalithapriya; Joh, Jin Hyun; Johnson, Adam P.; Kabbani, Loay S.; Keller, Melissa R.; Khashram, Manar; Koleilat, Issam; Krueger, Bernard; Kumar, Akshay; Lee, Cheong Jun; Lee, Alice; Levy, Mark M.; Lewis, C. Taylor; Lind, Benjamin; Lopez-Pena, Gabriel; Mohebali, Jahan; Molnar, Robert G.; Morrissey, Nicholas J.; Motaganahalli, Raghu L.; Mouawad, Nicolas J.; Newton, Daniel H.; Ng, Jun Jie; O’Banion, Leigh Ann; Phair, John; Rancic, Zoran; Rao, Ajit; Ray, Hunter M.; Rivera, Aksim G.; Rodriguez, Limael; Sales, Clifford M.; Salzman, Garrett; Sarfati, Mark; Savlania, Ajay; Schanzer, Andres; Sharafuddin, Mel J.; Sheahan, Malachi; Siada, Sammy; Siracuse, Jeffrey J.; Smith, Brigitte K.; Smith, Matthew; Soh, Ina; Sorber, Rebecca; Sundaram, Varuna; Sundick, Scott; Tomita, Tadaki M.; Trinidad, Bradley; Tsai, Shirling; Vouyouka, Ageliki G.; Westin, Gregory G.; Williams, Michael S.; Wren, Sherry M.; Yang, Jane K.; Yi, Jeniann; Zhou, Wei; Zia, Saqib; Woo, Karen; Surgery, School of Medicine
    Introduction During the COVID-19 pandemic, central venous access line teams were implemented at many hospitals throughout the world to provide access for critically ill patients. The objective of this study was to describe the structure, practice patterns and outcomes of these vascular access teams during the COVID-19 pandemic. Methods We conducted a cross sectional, self-reported study of central venous access line teams in hospitals afflicted with the COVID-19 pandemic. In order to participate in the study, hospitals were required to meet one of the following criteria: a) development of a formal plan for a central venous access line team during the pandemic, b) implementation of a central venous access line team during the pandemic, c) placement of central venous access by a designated practice group during the pandemic as part of routine clinical practice, or d) management of an iatrogenic complication related to central venous access in a patient with COVID-19. Results Participants from 60 hospitals in 13 countries contributed data to the study. Central venous line teams were most commonly composed of vascular surgery and general surgery attending physicians and trainees. Twenty sites had 2,657 lines placed by their central venous access line team or designated practice group. During that time, there were 11 (0.4%) iatrogenic complications associated with central venous access procedures performed by the line team or group at those 20 sites. Triple lumen catheters, Cordis® catheters and non-tunneled hemodialysis catheters were the most common types of central venous lines placed by the teams. Eight (14%) sites reported experience placing central venous lines in prone, ventilated patients with COVID-19. A dedicated line cart was used by 35 (59%) of hospitals. Less than 50% (24, 41%) of the participating sites reported managing thrombosed central lines in COVID-patients. Twenty-three of the sites managed 48 iatrogenic complications in patients with COVID-19 (including complications caused by providers outside of the line team or designated practice group). Conclusions Implementation of a dedicated central venous access line team during a pandemic or other healthcare crisis is a way by which physicians trained in central venous access can contribute their expertise to a stressed healthcare system. A line team composed of physicians with vascular skill sets provides relief to resource-constrained ICU, ward, and emergency medicine teams with a low rate of iatrogenic complications relative to historical reports. We recommend that a plan for central venous access line team implementation be in place for future healthcare crises.
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    Revascularization Outcomes of Acute Limb Ischemia in Patients With COVID-19
    (Elsevier, 2022) Kabeil, Mahmood; Wohlauer, Max; Moore, Ethan; Harroun, Nikolai; Gillette, Riley; Boggs, Shelbi; Motaganahalli, Raghu L.; Judelson, Dejah R.; Sundaram, Varuna; Mouawad, Nicolas J.; Bonaca, Marc P.; Cuff, Robert; Surgery, School of Medicine
    Objective: Acute limb ischemia (ALI) is one of the most catastrophic thrombotic manifestations of COVID-19 resulting in limb loss if not promptly treated. Our goal is to evaluate revascularization outcomes of ALI in patients with COVID-19 who underwent either open or endovascular treatment. Methods: The Vascular Surgery COVID-19 Collaborative started in March 2020 to assess hematological changes of COVID-19. We performed an interim data analysis on 46 patients with COVID-19 associated ALI submitted to the ALI module of the Vascular Surgery COVID-19 Collaborative REDcap database from 10 institutions in the United States. Results: Among the 46 patients included in the analysis, the mean age was 62.2 (standard deviation [SD]: 9.51) years. The majority of patients were male (73.9%). A total of 67.4% were White, 13% were Hispanic, and 4.3% were Black. In total, 93.5% of patients met Rutherford’s criteria of ALI class 2 or 3. On average, patients developed ALI 12.2 (SD: 13.5) days after a positive COVID test. Revascularization was attempted using open thrombectomy in 50.0%, endovascular lysis or thrombectomy in 23.9%, and bypass in 2.2%, and revascularization was not attempted in 23.9% of the patients (Table). Revascularization was successful in 41.3% with symptom resolution and 15.2% with limb salvage but persistent symptoms; 2.2% had minor amputation, 4.3% ultimately had a major amputation, 4.3% required reoperation, and revascularization was unsuccessful in 10.9% of patients. The average length of hospital stay was 13.2 (SD: 13.3) days, the average intensive care unit (ICU) length of stay was 4.66 (SD: 6.85) days, and the average ventilation days was 12.3 (SD: 10.8) days. Overall, in-hospital mortality was 21.7%, 8.7% had major amputation, 8.7% had stroke, 6.5% required major limb intervention, and 2.2% had sepsis. Successful revascularization rate was 62.5% in the 24 patients who underwent open surgery vs 36.4% in the 11 patients who underwent endovascular repair. The average length of stay in the ICU was shorter in the open group (mean = 3.24 days) than in the endovascular group (mean = 8.60 days). Of the 11 patients who had no revascularization attempt, 36.4% died, 18.2% had a major amputation, 9.1% had a pulmonary embolism, and 9.1% had a stroke. Conclusions: COVID-19-associated ALI carries a high mortality. Patients with COVID-19 who develop ALI can be managed successfully with open surgery or endovascular intervention. In our cohort, open revascularization resulted in reduced ICU stay and reduced ventilation days with improved limb salvage than the endovascular group. Further data are needed to develop management algorithms for ALI in patients with COVID-19.