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Venoarterial extracorporeal membrane oxygenation

Jason Q Alexander, Claire Ostertag-Hill, Peter Alden, Jesse Manunga, Jess Titus, Elliot Stephenson, Kasia Hryniewicz-Czeneszew, Timothy Sullivan
No abstract text is available yet for this article.
August 2016: Journal of Vascular Surgery
Umit Kervan, Sinan Sabit Kocabeyoglu, Dogan Emre Sert, Emre Aygün, Kemal Kavasoglu, Mehmet Karahan, Ertekin Utku Unal, Mustafa Pac
OBJECTIVES: The common femoral artery is the standard site for immediate vascular access when initiating adult venoarterial extracorporeal membrane oxygenation. However, this approach is fraught with problems such as femoral artery occlusion, distal limb ischemia, reperfusion injury resulting in compartment syndrome, retroperitoneal hemorrhage, thrombosis, embolization, and most importantly, pulmonary edema. Here, we show our preference of using the subclavian artery with a side graft as a different cannulation technique for outflow of extracorporeal membrane oxygenation, which can avoid complications associated with different access techniques...
October 14, 2016: Experimental and Clinical Transplantation
Maude St-Onge, Kurt Anseeuw, Frank Lee Cantrell, Ian C Gilchrist, Philippe Hantson, Benoit Bailey, Valéry Lavergne, Sophie Gosselin, William Kerns, Martin Laliberté, Eric J Lavonas, David N Juurlink, John Muscedere, Chen-Chang Yang, Tasnim Sinuff, Michael Rieder, Bruno Mégarbane
OBJECTIVE: To provide a management approach for adults with calcium channel blocker poisoning. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: Following the Appraisal of Guidelines for Research & Evaluation II instrument, initial voting statements were constructed based on summaries outlining the evidence, risks, and benefits. DATA SYNTHESIS: We recommend 1) for asymptomatic patients, observation and consideration of decontamination following a potentially toxic calcium channel blocker ingestion (1D); 2) as first-line therapies (prioritized based on desired effect), IV calcium (1D), high-dose insulin therapy (1D-2D), and norepinephrine and/or epinephrine (1D)...
October 3, 2016: Critical Care Medicine
Myung Jin Choi, Sang Ook Ha, Hyoung Soo Kim, Sunghoon Park, Sang Jin Han, Sun Hee Lee
BACKGROUND: The use of extracorporeal membrane oxygenation (ECMO) for patients with septic shock is controversial. The outcomes are favorable in children but heterogeneous in adults. The present study aimed to analyze the outcomes of adult patients who underwent ECMO for septic shock, and to determine the factors associated with prognosis. METHODS: We respectively reviewed the medical records of patients who underwent ECMO for septic shock between January 2007 and December 2013...
October 12, 2016: Annals of Thoracic Surgery
Alban-Elouen Baruteau, Thomas Barnetche, Luc Morin, Zakaria Jalal, Nicholas S Boscamp, Emmanuel Le Bret, Jean-Benoit Thambo, Julie A Vincent, Alain Fraisse, Alejandro J Torres
BACKGROUND: Transcatheter techniques are emerging for left atrial (LA) decompression under venoarterial extracorporeal membrane oxygenation (VA-ECMO). We aimed to assess whether balloon atrioseptostomy (BAS) is a safe and efficient strategy. METHODS: All patients who underwent percutaneous static BAS under VA-ECMO at four tertiary institutions were retrospectively reviewed. RESULTS: From 2000 to 2014, BAS was performed in 64 patients (32 adults and 32 children)...
October 14, 2016: European Heart Journal. Acute Cardiovascular Care
Dawid L Staudacher, Wolfgang Gold, Paul M Biever, Christoph Bode, Tobias Wengenmayer
PURPOSE: For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO. MATERIAL AND METHODS: We report data of a single center registry of all patients after VA-ECMO implantation treated between 2010 and 2015. RESULTS: A total of 195 patients were included in this registry with a medium age of 58...
September 27, 2016: Journal of Critical Care
Aristine Cheng, Hsin-Yun Sun, Mao-Song Tsai, Wen-Je Ko, Pi-Ru Tsai, Fu-Chang Hu, Yee-Chun Chen, Shan-Chwen Chang
BACKGROUND: To identify novel factors associated with the survival of septic adults receiving extracorporeal membrane oxygenation (ECMO) to improve patient selection and outcomes. METHODS: Cases were identified from our ECMO registry from 2001 to 2011 if they were ≥16 years and received ECMO for life-threatening sepsis. RESULTS: A total of 151 adults with a median (25th-75th percentile) age of 51 (37-63) years were analyzed. Pneumonia (50%), myocarditis (20%), and primary bloodstream infections (15%) were the main types of infection, caused by predominantly nonfermentative Gram-negative bacteria (NFGNB) (26%), Enterobacteriaceae (24%), and Gram-positive cocci (21%)...
August 30, 2016: Journal of Thoracic and Cardiovascular Surgery
Shinya Unai, My-Le Nguyen, Daizo Tanaka, Nataliya Gorbachuk, Gregary D Marhefka, Hitoshi Hirose, Nicholas C Cavarocchi
BACKGROUND: Spontaneous echo contrast (SEC) is known to be a predisposition to thromboembolism and cerebrovascular accident. The aim of this study was to investigate the risk factors and the consequences of SEC in patients who were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) because of cardiogenic shock. METHODS: Between January 2011 and December 2014, 98 patients underwent the insertion of VA-ECMO because of cardiogenic shock in our institution...
September 28, 2016: Annals of Thoracic Surgery
Marc Pineton de Chambrun, Nicolas Bréchot, Guillaume Lebreton, Matthieu Schmidt, Guillaume Hekimian, Pierre Demondion, Jean-Louis Trouillet, Pascal Leprince, Jean Chastre, Alain Combes, Charles-Edouard Luyt
PURPOSE: To describe the characteristics, outcomes, and risk factors associated with poor outcome of venoarterial extracorporeal membrane oxygenation (VA-ECMO)-treated patients with refractory shock post-cardiac arrest. METHODS: We retrospectively analyzed data collected prospectively (March 2007-January 2015) in a 26-bed tertiary hospital intensive care unit. All patients implanted with VA-ECMO for refractory cardiogenic shock after successful resuscitation from cardiac arrest were included...
September 28, 2016: Intensive Care Medicine
Taylor S Howard, Brian T Kalish, Daniel Wigmore, Meena Nathan, Thomas J Kulik, Aditya K Kaza, Kathryn Williams, Ravi R Thiagarajan
OBJECTIVES: There is a paucity of data regarding the impact of extracorporeal membrane oxygenation support, adequacy of surgical repair, and timing of intervention for residual structural lesions in neonates cannulated to extracorporeal membrane oxygenation after cardiac surgery. Our goal was to determine how these factors were associated with survival. DESIGN: Retrospective study. SETTING: Cardiovascular ICU. SUBJECTS: Neonates (≤ 28 d old) with congenital heart disease cannulated to extracorporeal membrane oxygenation after cardiac surgery during 2006-2013...
September 19, 2016: Pediatric Critical Care Medicine
Juan G Ripoll, Robert A Ratzlaff, David M Menke, Maria C Olave, Joseph J Maleszewski, José L Díaz-Gómez
Giant cell myocarditis (GCM) is a rare and commonly fatal form of fulminant myocarditis. During the acute phase, while immunosuppressive therapy is initiated, venoarterial extracorporeal membrane oxygenation (VA-ECMO) support is commonly used as a bridge to heart transplantation or recovery. Until recently, conventional transesophageal echocardiography and transthoracic echocardiography were the tools available for hemodynamic assessment of patients on this form of mechanical circulatory support. Nevertheless, both techniques have their limitations...
2016: Case Reports in Critical Care
Elmir Omerovic
Takotsubo syndrome (TS) is characterized by severe reversible left ventricular (LV) wall motion abnormality in the absence of explanatory coronary lesion. Despite an increasing number of patients diagnosed with TS worldwide, there are no randomized clinical trials. In mild cases, no treatment or a short course of limited anticoagulation therapy may be sufficient. Positive inotropic and vasodilating agents should be avoided. In severe cases with refractory cardiogenic shock, early treatment with mechanical support using venoarterial extracorporeal membrane oxygenation or a LV assist device should be considered...
October 2016: Heart Failure Clinics
Christopher Lotz, Norbert Roewer, Ralf M Muellenbach
Circulatory support represents an integral part within the treatment of the critically ill patient. Sophisticated pharmacologic regimens help to maintain systemic perfusion pressure by increasing vascular tone as well as mediating positive inotropic effects. Besides the administration of catecholamines and phosphodiesterase-III-inhibitors, in particular the administration of levosimendan represents a promising alternative during low-cardiac-output. Nevertheless, sufficient evidence demonstrating a survival benefit for any pharmacologic regimen is nonexistent...
September 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Jeremy R DeGrado, Benjamin Hohlfelder, Brianne M Ritchie, Kevin E Anger, David P Reardon, Gerald L Weinhouse
PURPOSE: The objective of this study was to evaluate the use of sedative, analgesic, and neuromuscular blocking agents (NMBAs) in patients undergoing extracorporeal membrane oxygenation (ECMO) support. MATERIALS AND METHODS: This was a 2-year, prospective, observational study of adult intensive care unit patients on ECMO support for more than 48hours. RESULTS: We analyzed 32 patients, including 15 receiving VA (venoarterial) ECMO and 17 VV (venovenous) ECMO...
August 10, 2016: Journal of Critical Care
Cornelis Johannes van Zwet, Andreas Rist, Achim Haeussler, Kirk Graves, Andreas Zollinger, Stephan Blumenthal
We describe the first case of a pregnant woman presenting with an acute inverted takotsubo-like cardiomyopathy caused by a postpartum diagnosed hemorrhagic pheochromocytoma, successfully treated with percutaneous venoarterial extracorporeal membrane oxygenation (va-ECMO). During admission, an emergency cesarean delivery had to be performed. The fetus needed resuscitation for 5 minutes. The mother was successfully resuscitated and treated with percutaneous va-ECMO for 7 days. Despite advances in diagnostic techniques during the past decade, in many cases, pheochromocytoma in pregnancy is still missed...
September 7, 2016: A & A Case Reports
Ugur Gocen, Atakan Atalay, Orhan Kemal Salih
Congenital left ventricular diverticulum is a rare cardiac anomaly. During the newborn period, symptomatic patients are diagnosed with heart failure findings. We present a 23-day-old male newborn with congenital left ventricular diverticulum diagnosed during fetal echocardiographic examination. After the birth, the patient had heart failure symptoms and his echocardiographic examination showed low cardiac ejection fraction. Diverticulum was operated with endoventricular circular patch plasty (DOR) technique, and after, cardiopulmonary bypass venoarterial extracorporeal membrane oxygenation (ECMO) support was performed because of low cardiac output syndrome...
2016: Heart Surgery Forum
Jeffrey B Riley, Gregory J Schears, Gregory A Nuttall, William C Oliver, Mark H Ereth, Joseph A Dearani
Excessive bleeding and allogeneic transfusion during adult post-cardiotomy venoarterial extracorporeal membrane oxygenation (ECMO) are potentially harmful and expensive. Balancing the inhibition of clotting and distinguishing surgical from non-surgical bleeding in post-operative period is difficult. The sensitivity of coagulation tests including Thromboelastography(®) (TEG) to predict chest tube drainage in the early hours of ECMO was examined with the use of receiver-operating characteristics (ROC). The results are useful to incorporate in clinical evidence-based algorithms to guide management decisions...
June 2016: Journal of Extra-corporeal Technology
Hannelisa Callisen, Ayan Sen, Louis Lanza, Bhavesh Patel, Efrain Cubillo, Lori Gushue, Stacy Libricz, Jama Jahanyar, J Christopher Farmer, Robert Scott
No abstract text is available yet for this article.
May 7, 2016: Journal of Cardiothoracic and Vascular Anesthesia
Tapan Kavi, Megan Esch, Brenda Rinsky, Axel Rosengart, Shouri Lahiri, Patrick D Lyden
BACKGROUND: Transcranial Doppler (TCD) has significant implications for neurovascular assessment in patients being treated with venoarterial-extracorporeal membrane oxygenation (VA-ECMO). However, there have been no studies demonstrating the changes in pulsatility indices (PIs) seen in these patients. Nonpulsatile waveforms are seen during on-pump coronary artery bypass graft, but low or low-normal PIs have never been reported. It is important to be aware of these changes, as they can be misinterpreted as cerebral vasodilation, vasoconstriction, increased intracranial pressures (ICPs), or cerebral circulatory arrest...
August 26, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
J-K Baek, J S Lee, T H Kim, Y H Kim, D J Han, S K Hong
BACKGROUND: Kidney transplant (KT) recipients are vulnerable to infections because of their immunosuppressive treatments, and they occasionally exhibit serious acute cardiopulmonary dysfunction. The purpose of this study was to report the clinical outcomes of using extracorporeal membrane oxygenation (ECMO) in KT recipients and to identify risk factors for ECMO weaning failure. METHODS: We retrospectively reviewed the electronic medical records of KT patients who experienced severe cardiopulmonary dysfunction refractory to conventional therapy and received ECMO at the Asan Medical Center Surgical Intensive Care Unit between December 2010 and December 2014...
July 2016: Transplantation Proceedings
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