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Ecmo cardiac arrest

Jaideep Das Gupta, Ramses Saavedra, Sundeep Guliani, John Marinaro, Muhammad Ali Rana
Massive pulmonary embolism (PE) is an embolus sufficiently obstructing pulmonary blood flow to cause right ventricular (RV) failure and hemodynamic instability. We have utilized veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for early and aggressive intervention for massive PE patients. We present a case of a 61-year-old female placed on VA-ECMO for a massive PE while presenting in cardiac arrest and receiving mechanical cardiopulmonary resuscitation (CPR) via the LUCAS 2.0 device (Physio-Control Inc...
October 2018: Journal of Surgical Case Reports
Matthew K Bacon, Seth B Gray, Steven M Schwartz, David S Cooper
Extracorporeal membrane oxygenation (ECMO) is a support modality used within the pediatric cardiac ICU population as a bridge to recovery or decision in the setting of acute myocardial decompensation, support for combined cardiopulmonary failure or in the setting of refractory cardiopulmonary arrest. Patients with univentricular physiology are at particular risk for decompensation requiring ECMO support. This review will focus upon current evidence and techniques for ECMO support of single ventricle patients who have undergone a stage II bidirectional Glenn procedure or the stage III Fontan procedure...
2018: Frontiers in Pediatrics
Tobechi E Okoronkwo, XueWei Zhang, Jessica Dworet, Matthew Wecksell
A 73-year-old male with history of hyperlipidemia and osteoarthritis was transferred from an outside hospital after a fall from a ladder at home. He sustained a severe right sided acetabular fracture involving the femoral head, requiring operative repair. Preoperative evaluation was unremarkable except for oxygen saturation < 95 %. After induction of anesthesia and surgical positioning, the patient went into cardiac arrest. After intraoperative cardiopulmonary resuscitation (CPR) and placement on extracorporeal membrane oxygenation (ECMO), the patient stabilized...
2018: Case Reports in Anesthesiology
Prashant Rao, Zain Khalpey, Richard Smith, Daniel Burkhoff, Robb D Kociol
Venoarterial extracorporeal membrane oxygenation (VA-ECMO)-also referred to as extracorporeal life support-is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange. The initiation of VA-ECMO has emerged as a salvage intervention in patients with cardiogenic shock, even cardiac arrest refractory to standard therapies. Analogous to veno-venous ECMO for acute respiratory failure, VA-ECMO provides circulatory support and allows time for other treatments to promote recovery or may be a bridge to a more durable mechanical solution in the setting of acute or acute on chronic cardiopulmonary failure...
September 2018: Circulation. Heart Failure
Punkaj Gupta, Jeffrey M Gossett, Danny Kofos, Mallikarjuna Rettiganti
PURPOSE: To create a real-time prediction tool to predict probability of ECMO deployment in children with cardiac or pulmonary failure. MATERIALS AND METHODS: Patients ≤18 years old admitted to an ICU that participated in the Virtual Pediatric Systems database (2009-2015) were included. Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with ECMO use. RESULTS: A total of 538,202 ICU patients from 140 ICUs qualified for inclusion...
October 12, 2018: Journal of Critical Care
Roberto Roncon-Albuquerque, Sérgio Gaião, Paulo Figueiredo, Nuno Príncipe, Carla Basílio, Paulo Mergulhão, Sofia Silva, Teresa Honrado, Francisco Cruz, Manuel Pestana, Gerardo Oliveira, Luis Meira, Ana França, João Paulo Almeida-Sousa, Fernando Araújo, José-Artur Paiva
AIM: To assess the feasibility of an integrated program of extracorporeal cardiopulmonary resuscitation (ECPR) and uncontrolled donation after circulatory determination of death (uDCDD) in refractory cardiac arrest (rCA). METHODS: Single center, prospective, observational study of selected patients with in-hospital (IHCA) and out-of-hospital (OHCA) rCA occurring in an urban area of ∼1.5 million inhabitants, between October-2016 and May-2018. 65 year old or younger patients without significant bleeding or comorbidities with witnessed nonasystolic cardiac arrests were triaged to ECPR if they had a reversible cause and high quality CPR lasting < 60 min...
October 13, 2018: Resuscitation
A Reshad Garan, Waqas A Malick, Marlena Habal, Veli K Topkara, Justin Fried, Amirali Masoumi, Aws K Hasan, Dimitri Karmpaliotis, Ajay Kirtane, Melana Yuzefpolskaya, Maryjane Farr, Yoshifumi Naka, Dan Burkhoff, Paolo C Colombo, Paul Kurlansky, Hiroo Takayama, Koji Takeda
Chronic systolic heart failure (HF) with acute decompensation can result in cardiogenic shock (CS) requiring short-term mechanical circulatory support. We sought to identify predictors of survival for acute decompensated HF (ADHF) patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients >18 years old treated at our institution with VA-ECMO from 2009 to 2018 for ADHF with CS were studied. Demographic, hemodynamic, and echocardiographic data were collected. The primary outcome was survival to discharge...
October 9, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Luke Masha, Shareez Peerbhai, David Boone, Fisayomi Shobayo, Aman Ghotra, Bindu Akkanti, Yelin Zhao, Igor Banjac, Igor D Gregoric, Biswajit Kar
Abnormalities in markers of liver injury after venoarterial extracorporeal membrane oxygenation (VA-ECMO) initiation are of unclear distribution and clinical significance. This study included all consecutive adult patients from a single institution who underwent VA-ECMO cannulation between May 2012 and September 2016 and had liver function panels drawn during their admission (n = 223). Data points include: age, sex, body mass index, diagnosis, duration of ECMO cannulation, duration of hospitalization, pre-ECMO cardiac arrest, central nervous system (CNS) injury, the presence of chronic kidney disease or acute renal failure, renal replacement therapy utilization, lactate levels, duration of pre-ECMO intubation, admission and peak bilirubin/aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/alkaline phosphatase (ALP) levels, and time to peak bilirubin/AST/ALT/ALP in relation to cannulation...
October 9, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Jared Netley, James Roy, Joseph Greenlee, Shaun Hart, Michael Todt, Bryan Statz
Anticoagulation with unfractionated heparin during extracorporeal membrane oxygenation (ECMO) is common, but alternative agents are being evaluated for safety and efficacy. The objective of this analysis was to assess if a comprehensive bivalirudin dosing and monitoring protocol effectively guides dose adjustments and monitoring of bivalirudin in patients during ECMO. Our analysis included 11 patients who received bivalirudin during ECMO therapy and had dosing managed using our hospital derived protocol. Patients treated over a 1-year period were included in this retrospective analysis...
September 2018: Journal of Extra-corporeal Technology
Yun Luo, Caroline Fritz, Nefissa Hammache, Daniel Grandmougin, Antoine Kimmoun, Sophie Orlowski, N'Guyen Tran, Eliane Albuisson, Bruno Levy
OBJECTIVE: This study was designed to assess the effect of two veno-arterial ExtraCorporeal Membrane Oxygenation (ECMO) blood-flow strategies in an experimental model of Extracorporeal Cardio-Pulmonary Resuscitation (ECPR) on macrocirculatory, metabolic and microcirculatory parameters in the first six hours of ECMO initiation. METHODS: Cardiac arrest was induced in 18 pigs by surgical ligature of the left descending coronary artery followed by a low-flow time of 40 min using internal cardiac massage...
September 20, 2018: Resuscitation
A Claire Watkins, Nathan L Maassel, Mehrdad Ghoreishi, Murtaza Y Dawood, Si M Pham, Zachary N Kon, Bradley S Taylor, Bartley P Griffith, James S Gammie
BACKGROUND: Cardiac surgery for structural heart disease has poor outcomes in the presence of cardiogenic shock or advanced heart failure. We applied venoarterial extracorporeal membrane oxygenation (ECMO) to restore end-organ function and resuscitate patients before high-risk cardiac operation. METHODS: Twelve patients with cardiogenic shock and end-organ failure were evaluated for cardiac surgery. The average Society of Thoracic Surgeons (STS) mortality risk was 24% (±13)...
September 17, 2018: Annals of Thoracic Surgery
Yoshiaki Iwashita, Takuya Hiramoto, Kei Suzuki, Ryotaro Hashizume, Kazuo Maruyama, Hiroshi Imai
RATIONALE: Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but lethal complication of carcinoma, defined as non-occlusive pulmonary tumor embolism complicated by fibrocellular intimal proliferation of the small pulmonary arteries, with eventual occlusion of the pulmonary arteries. Hemodynamic deterioration caused by this condition leads to high mortality. PATIENT CONCERNS: A 46-year-old woman who had undergone radiation therapy for anaplastic oligoastrocytoma and who was taking temozolomide presented with cough and palpitations...
September 2018: Medicine (Baltimore)
M Puślecki, M Ligowski, S Stefaniak, M Dąbrowski, M Zieliński, A Pawlak, T Kłosiewicz, M Sip, M Karczewski, T Małkiewicz, Ł Gąsiorowski, W Telec, M Ładzińska, K Baumgart, P Ładziński, B Perek, M Misterski, W Mrówczyński, P Sobczyński, I Kiel-Puślecka, P Buczkowski, M Kiel, M Czekajlo, M Jemielity
The "ECMO for Greater Poland" program takes full advantage of the extracorporeal membrane oxygenation (ECMO) perfusion therapy opportunities to promote the health of the 3.5 million inhabitants in the region. The main implementation areas are treatment of patients with hypothermia; severe reversible respiratory failure (RRF); critical states resulting in heart failure, that is, cardiac arrest, cardiogenic shock, or acute intoxication; and promotion of the donor after circulatory death (DCD) strategy in selected organ donor cases, after unsuccessful life-saving treatment, to achieve organ recovery...
September 2018: Transplantation Proceedings
Andrew L Dailey-Schwartz, Hanna J Tadros, Mahshid Sababi Azamian, Seema R Lalani, Shaine A Morris, Hugh D Allen, Jeffrey J Kim, Andrew P Landstrom
OBJECTIVE: To determine the prevalence, spectrum, and prognostic significance of copy number variants of undetermined significance (cnVUS) seen on chromosomal microarray (CMA) in neonates with hypoplastic left heart syndrome (HLHS). STUDY DESIGN: Neonates with HLHS who presented to Texas Children's Hospital between June 2008 and December 2016 were identified. CMA results were abstracted and compared against copy number variations (CNVs) in ostensibly healthy individuals gathered from the literature...
November 2018: Journal of Pediatrics
Jason A Bartos, Kathleen Carlson, Claire Carlson, Ganesh Raveendran, Ranjit John, Tom P Aufderheide, Demetris Yannopoulos
BACKGROUND: Resuscitation of refractory out-of-hospital ventricular fibrillation/ventricular tachycardia (VF/VT) cardiac arrest using extracorporeal membrane oxygenation (ECMO) establishes a complex patient population. We aimed to describe the critical care strategies and outcomes in this population. METHODS: Between December 1, 2015 and January 1, 2018, 100 consecutive adult patients with refractory VF/VT out-of-hospital cardiac arrest and ongoing CPR were transported to the cardiac catheterization laboratory...
November 2018: Resuscitation
Bishoy Zakhary, Vinodh B Nanjayya, Jayne Sheldrake, Kathleen Collins, Joshua F Ihle, Vincent Pellegrino
OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a promising adjunct to cardiopulmonary resuscitation (CPR) in refractory cardiac arrest (CA). Factors associated with outcome are incompletely characterised. The aim of our study was to identify pre-ECMO factors associated with in-hospital mortality after extracorporeal CPR (ECPR). DESIGN: Retrospective analysis of a prospective cohort of patients. SETTING: Academic quaternary referral hospital...
September 2018: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Mathew Jose Chakaramakkil, Cumaraswamy Sivathasan
PURPOSE OF REVIEW: This review aims to discuss the role of ECMO in the treatment of cardiogenic shock in heart failure. RECENT FINDINGS: Trials done previously have shown that IABP does not improve survival in cardiogenic shock compared to medical treatment, and that neither Impella 2.5 nor TandemHeart improves survival compared to IABP. The "IMPRESS in severe shock" trial compared Impella CP with IABP and found no difference in survival. A meta-analysis of cohort studies comparing ECMO with IABP showed 33% improved 30-day survival with ECMO (risk difference 33%; 95% CI 14-52%; p = 0...
August 16, 2018: Current Cardiology Reports
Alexander Robinson, Aniket S Rali, Zubair Shah, Travis Abicht, Eric Hockstad, Andrew Sauer
National trends suggest that less than one in four patients experiencing in-hospital cardiac arrest (IHCA) in the United States survive to discharge. This is especially relevant as the rates of IHCA are expected to rise in the years to come. Only a modest upward trend in survival to discharge among patients with IHCA over the past decade warrants evaluation of novel ideas to improve outcomes postcardiopulmonary resuscitation. One such idea is that the use of veno-arterial-extracorporeal membrane oxygenation (VA-ECMO) to augment standard advanced cardiac life support algorithm in patients with an identifiable and reversible cause of cardiac arrest would improve survival to discharge...
July 2018: Indian Journal of Critical Care Medicine
Atsushi Sugiura, Ryuzo Abe, Takashi Nakayama, Noriyuki Hattori, Yoshihide Fujimoto, Toshiharu Himi, Koichi Sano, Shigeto Oda, Yoshio Kobayashi
AIM: While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been utilized to resuscitate and stabilize haemodynamics in patients of acute myocardial infarction (AMI) complicated by cardiac arrest (CA), it is essential to predict the possibility of weaning from ECMO to determine further strategies, including use of ventricular assist device. We aimed to determine predictors of successful weaning from VA-ECMO in the early phase of ECMO treatment. METHODS: We identified consecutive patients of AMI complicated by CA treated with VA-ECMO and percutaneous coronary intervention (PCI)...
August 3, 2018: Shock
Xiao-Li Yuan, Chun-Sheng Li, Yun Zhang, Ji-Yang Ling, Qiang Zhang, Yong Liang, Bo Liu, Lian-Xing Zhao
Background: Acute kidney injury (AKI) frequently occurs in cardiopulmonary resuscitation patients. Studies comparing the effects of extracorporeal membrane oxygenation (ECMO) with conventional cardiopulmonary resuscitation (CCPR) on AKI were rare. This study aimed to compare the effects of ECMO with those of CCPR on survival rate and AKI and explore the underlying mechanisms in a swine model of cardiac arrest (CA). Methods: Sixteen male pigs were treated with ventricular fibrillation to establish CA model and then underwent CCPR (CCPR group, n = 8) or ECMO during cardiopulmonary resuscitation (ECPR group, n = 8)...
August 5, 2018: Chinese Medical Journal
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