This month I was reading a book on the new global enemy – about killer diseases that are migrating and developing around the world and that are resistant to all our standard forms of medicine. I bought this book may be more than 20 years ago, and I remembered I had it somewhere in my bookshelf, and I start reading it this month. Dr. Frank Ryan, a leading authority on disease, has asked experts from around the world to explain where these viruses come from and how they become so lethal. He puts forward a radical new biological theory for the origins and successes of plague viruses.
I read the book in Dutch, but it is also available in English,
Virus X: Understanding the Real Threat of New Pandemic Plagues
In chapter 19, Dr. Ryan explains the Worst Case Scenario;
There is only one way of spreading that would be universally threatening to humanity, and that is the transmission from person to person through the exhaled air.
A pathogen spread that way would have tremendous opportunities. Every adult breathes in about 10,000 liters of air a day, and we can not avoid breathing each other’s exhaled breath. Coughing and sneezing an infected person in a busy room would hand over the microbe to many. It Was very tragic when the bubonic plague turned into a pneumonic epidemic at the time of the Black Death. Today’s viruses that spread through breathing with a high degree of contamination; include rhinoviruses and coronaviruses, which causes the flu. We all know how quickly the influenza virus can spread.
But to threaten our species, or to cause such a catastrophe to ruin human civilization, a virus should combine the infectiousness of influenza with the lethality of HIV-1 or Ebola-Zaire virus.
If HIV-1 had spread through the air around 1980, the worst scenario would have started: the terrifying arrival of a real Virus X, or Virus extinction. (page 256)
(…) All these places are currently being watched by observers who hope to pick up the newest tribes as soon as they emerge. China is not the only place where the virus comes in, and observers are active elsewhere, especially in Italy. ( Page 260, Published in 1997 )
(…) To indicate the task that the medical world would be faced with: a virulent pandemic strain can infect as much as 50% of the world. (page 260)
That is a gigantic task. Meanwhile, one of the most contagious respiratory viruses of all time, the virus is said to be raging in our modern cities, fueled by current air traffic. And while the affluent areas like America, Japan, Australia, and Western Europe might have a chance to win the race, that chance would be much smaller in the poorer countries, where two-thirds of the population is barely protected.
Influenza has had a clear and consistent pattern of recurrent epidemics and pandemics throughout history. Historical evidence shows that the time has come for a new influenza pandemic. (Source: page 260 Frank Ryan first edition 1997)
This book reads like a thriller that predicted everything precisely that was going to happen in the coming days because it is very well scientifically substantiated, and every day more news came what was nearly as equal of the view and vision of this written book.
In the book Virus X, a situation was explained that the doctors knew how to treat lung problems effectively, but their treatment of heart problems was still lacking. They decided to try it with a drastic interventional therapy, ‘extracorporeal membrane oxygenation’ or ECMO. Treatment involved inserting a small tube into a large vein, such as the carotid artery. The venous blood was extracted from the body and supplied with oxygen by mechanical equipment, after which it was returned to a large highway via another tube. In fact, it skips the lungs. ECMO was initially intended for patients with severe breathing problems, but Howard Levy knew that with this therapy, you could also support the heart. (…) In the country as a whole, where patients came to doctors who had much less experience, at least sixty percent of them died. Here in New Mexico, doctors were now so far that the mortality among their patients had decreased from seventy to about thirty-five percent. (Source Page 77 Virus X )
I always had a deep interest in Medical Journals, as a diving instructor and rebreather Trimix diver, sharing skills and keeping up knowledge is the key to survival.
So coming back to YoutTube video of Dr. Cameron Kyle-Sidell, emergency medicine physician in Brooklyn and affiliated to the Maimonides Medical Center in Brooklyn. I thought on this 6th April evening straight back on the book that I have been reading the articles from last month that I was collecting and the problem that this doctor was facing. Because it is a novel virus every day, new information, and new medical knowledge and insight development, so I want to share and send this information to the people who are interested in having a closer look at it, and maybe this can be useful and help people in need.
So, for this reason, I did this open-source research, and post this overview online for a time-saving more in-depth examination.
That is when I thought back reading the book Virus X and the explaining of the extracorporeal membrane oxygenation technique (ECMO). According to these sources, underneath it could be useful as rescue therapy in severely hypoxemic patients who failed conventional strategies.
So I did research and found these recent medical articles with references, from intensive care specialists across the world with experience in SARS, MERS, and COVID-19.
Is ECMO useful with the COVID-19 virus?
What is ECMO? : Source Wikipedia, that is where I started the research from;
Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is an extracorporeal technique of providing prolonged cardiac and respiratory support to persons whose heart and lungs are unable to provide an adequate amount of gas exchange or perfusion to sustain life. The technology for ECMO is mostly derived from cardiopulmonary bypass, which provides shorter-term support with arrested native circulation.
ECMO works by removing blood from the person’s body and artificially removing the carbon dioxide and oxygenating red blood cells. Generally, it is used either post-cardiopulmonary bypass or in late-stage treatment of a person with a profound heart and/or lung failure. However, it is now seeing use as a treatment for cardiac arrest in specific centers, allowing treatment of the underlying cause of arrest while circulation and oxygenation are supported.
ECMO used in COVID-19 patients ( Source: Wikipedia )
Beginning in early February 2020, doctors in China have increasingly been using ECMO as adjunct support for patients presenting with acute viral pneumonia associated with SARS-CoV-2 infection (COVID-19); when, even after ventilation, the blood oxygenation levels remain too low to sustain the patient.
“30 to 39 pct of severe COVID-19 patients discharged from Wuhan hospitals: official – Xinhua | English.news.cn”. www.xinhuanet.com. Retrieved February 16, 2020.
30 to 39 pct of severe COVID-19 patients discharged from Wuhan hospitals: official
Source: Xinhua| 2020-02-15 11:07:29|Editor: Huaxia
WUHAN, February 15 (Xinhua) — Up to 30 to 39 percent of patients infected with the novel coronavirus (COVID-19) has been discharged from two of Wuhan’s hospitals that take in severe patients, including the Jinyintan Hospital, the National Health Commission (NHC) said Saturday.
For severe and critically ill patients, antivirus treatment, together with treatment combining traditional Chinese and Western medicine and supportive therapies, such as the use of a ventilator, blood plasma from recovered patients and extracorporeal membrane oxygenation (ECMO), have shown an effect, Jiao Yahui, an official with the NHC, said at a press conference in Wuhan, epicenter of the outbreak.
“Recently, we have been urging doctors to use ECMO at an early stage to help restore patients’ blood oxygen saturation and reduce fatalities,” Jiao said.
The initial reports indicate that it is assisting in restoring patients’ blood oxygen saturation and reducing fatalities among the approximately 3% of severe cases where it has been utilized.
CDC (February 11, 2020). “2019 Novel Coronavirus (2019-nCoV)”. Centers for Disease Control and Prevention. Retrieved February 16, 2020.
Source: The WHO
The World Health Organization and the Surviving Sepsis Campaign have both released comprehensive guidelines for the inpatient and ICU management of patients with COVID-19, including those who are critically ill. For more information visit: Interim Guidance on Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected (WHO)
The following recommendations pertain to adult and pediatric patients with ARDS that fail lung-protective ventilation strategy.
In settings with access to expertise in extracorporeal membrane oxygenation (ECMO), consider referral of patients with refractory hypoxemia despite lung-protective ventilation.
Remarks for adult and children: An RCT of ECMO for adult patients with ARDS was stopped early and found no statistically significant difference in the primary outcome of 60-day mortality between ECMO and standard medical management (including prone positioning and neuromuscular blockade) (47).
47. Combes A, Hajage D, Capellier G, Demoule A, Lavoue S, Guervilly C et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378(21):1965-75. Epub 2018/05/24. doi: 10.1056/NEJMoa1800385. PubMed PMID: 29791822.
However, ECMO was associated with a reduced risk of the composite outcome of mortality and crossover to ECMO (47), and a post hoc Bayesian analysis of this RCT showed that ECMO is very likely to reduce mortality across a range of prior assumptions (48).
48. Goligher EC, Tomlinson G, Hajage D, Wijeysundera DN, Fan E, Juni P, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc Bayesian analysis of a randomized clinical trial. JAMA. 2018;320(21):2251-9. Epub 2018/10/23. doi: 10.1001/jama.2018.14276. PubMed PMID: 30347031.
In patients with MERS-CoV infection, ECMO vs. conventional treatment was associated with reduced mortality in a cohort study (49).
49. Alshahrani MS, Sindi A, Alshamsi F, Al-Omari A, El Tahan M, Alahmadi B et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018;8(1):3. Epub 2018/01/14. doi: 10.1186/s13613-017-0350-x. PubMed PMID: 29330690; PMCID: PMC5768582.
ECMO should only be offered in expert centers with a sufficient case volume to maintain expertise, and that can apply the IPC measures required for adult and pediatric
COVID-19 patients (50, 51).
Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus
Source: Annals of intensive care
The Middle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as rescue therapy in severely hypoxemic patients who failed conventional strategies.
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