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ECMO AND Stroke

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https://www.readbyqxmd.com/read/30104052/a-computational-framework-for-adjusting-flow-during-peripheral-extracorporeal-membrane-oxygenation-to-reduce-differential-hypoxia
#1
Michael Charles Stevens, Fraser M Callaghan, Paul Forrest, Paul G Bannon, Stuart M Grieve
Peripheral veno-arterial extra corporeal membrane oxygenation (VA-ECMO) is an established technique for short-to-medium support of patients with severe cardiac failure. However, in patients with concomitant respiratory failure, the residual native circulation will provide deoxygenated blood to the upper body, and may cause differential hypoxemia of the heart and brain. In this paper, we present a general computational framework for the identification of differential hypoxemia risk in VA-ECMO patients. A range of different VA-ECMO patient scenarios for a patient-specific geometry and vascular resistance were simulated using transient computational fluid dynamics simulations, representing a clinically relevant range of values of stroke volume and ECMO flow...
July 31, 2018: Journal of Biomechanics
https://www.readbyqxmd.com/read/30042257/-salvage-from-extracorporeal-membrane-oxygenation-due-to-acute-deteriorated-heart-failure-treatment-decision-tree-based-on-the-risk-factors
#2
Tomohiro Mizuno, Tatsuki Fujiwara, Hidehito Kuroki, Kiyotoshi Oishi, Toshihiro Kubo, Keiji Oi, Masafumi Yashima, Seishi Takeshita, Yushi Okumura, Junya Nabeshima, Hirokuni Arai
BACKGROUND: Salvage rates for patients requiring extracorporeal membrane oxygenation (ECMO)due to acute cardiogenic shock remain poor due to difficulties in decision making on optical timing of ECMO removal or conversion to ventricular assist devices( VAD). METHOD: From 2005 to 2018, 37 patients supported with ECMO due to acute circulatory deterioration were referred to our department for implantation of VAD. Their outcomes were analyzed using multi-variate analysis to assess the risk factors of VAD implantation, and we adopted a new decision-tree to improve the outcomes...
July 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29987125/periprocedural-cardiopulmonary-bypass-or-venoarterial-extracorporeal-membrane-oxygenation-during-transcatheter-aortic-valve-replacement-a-systematic-review
#3
REVIEW
Saraschandra Vallabhajosyula, Sri Harsha Patlolla, Harigopal Sandhyavenu, Saarwaani Vallabhajosyula, Gregory W Barsness, Shannon M Dunlay, Kevin L Greason, David R Holmes, Mackram F Eleid
BACKGROUND: There are limited data on the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) or cardiopulmonary bypass (CPB) to provide hemodynamic support periprocedurally during transcatheter aortic valve replacement. This study sought to evaluate patients receiving transcatheter aortic valve replacement with concomitant use of CPB/VA-ECMO. METHODS AND RESULTS: We systematically reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring CPB/VA-ECMO periprocedurally during transcatheter aortic valve replacement...
July 9, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29791822/extracorporeal-membrane-oxygenation-for-severe-acute-respiratory-distress-syndrome
#4
RANDOMIZED CONTROLLED TRIAL
Alain Combes, David Hajage, Gilles Capellier, Alexandre Demoule, Sylvain Lavoué, Christophe Guervilly, Daniel Da Silva, Lara Zafrani, Patrice Tirot, Benoit Veber, Eric Maury, Bruno Levy, Yves Cohen, Christian Richard, Pierre Kalfon, Lila Bouadma, Hossein Mehdaoui, Gaëtan Beduneau, Guillaume Lebreton, Laurent Brochard, Niall D Ferguson, Eddy Fan, Arthur S Slutsky, Daniel Brodie, Alain Mercat
BACKGROUND: The efficacy of venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) remains controversial. METHODS: In an international clinical trial, we randomly assigned patients with very severe ARDS, as indicated by one of three criteria - a ratio of partial pressure of arterial oxygen (Pao2 ) to the fraction of inspired oxygen (Fio2 ) of less than 50 mm Hg for more than 3 hours; a Pao2 :Fio2 of less than 80 mm Hg for more than 6 hours; or an arterial blood pH of less than 7...
May 24, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29762229/what-is-the-optimal-blood-pressure-on-veno-arterial-extracorporeal-membrane-oxygenation-impact-of-mean-arterial-pressure-on-survival
#5
Daizo Tanaka, Shogo Shimada, Megan Mullin, Kristin Kreitler, Nicholas Cavarocchi, Hitoshi Hirose
Blood pressure management is crucial for patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO). Lower pressure can lead to end-organ malperfusion, whereas higher pressure may compete with ECMO flow and cardiac output. The impact of mean arterial pressure (MAP) on outcomes of patients on VA ECMO was evaluated. Patients who were supported on VA ECMO from September 2010 to March 2016 were retrospectively analyzed for average MAP throughout their course on ECMO, excluding the first and last day...
May 11, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29560599/cerebral-near-infrared-spectroscopy-in-adult-patients-undergoing-veno-arterial-extracorporeal-membrane-oxygenation
#6
Selene Pozzebon, Aaron Blandino Ortiz, Federico Franchi, Stefano Cristallini, Mirko Belliato, Olivier Lheureux, Alexandre Brasseur, Jean-Louis Vincent, Sabino Scolletta, Jacques Creteur, Fabio Silvio Taccone
BACKGROUND: Acute cerebral complications (ACC) of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are associated with poor long-term neurologic outcome. We described the role of rSO2 monitoring in detecting ACC and desaturations and their relationship with poor outcome when employing VA-ECMO. METHODS: Retrospective analysis of patients monitored by cerebral frontal near-infrared spectroscopy (NIRS) (CAS Medical Systems Inc., Branford, CT, USA) during VA-ECMO (November 2008-December 2015)...
August 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29489461/simultaneous-venoarterial-extracorporeal-membrane-oxygenation-and-percutaneous-left-ventricular-decompression-therapy-with-impella-is-associated-with-improved-outcomes-in-refractory-cardiogenic-shock
#7
Sandeep M Patel, Jerry Lipinski, Sadeer G Al-Kindi, Toral Patel, Petar Saric, Jun Li, Fahd Nadeem, Thomas Ladas, Amer Alaiti, Ann Phillips, Benjamin Medalion, Salil Deo, Yakov Elgudin, Marco A Costa, Mohammed Najeeb Osman, Guilherme F Attizzani, Guilherme H Oliveira, Basar Sareyyupoglu, Hiram G Bezerra
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used for refractory cardiogenic shock; however, it is associated with increased left ventricular afterload. Outcomes associated with the combination of a percutaneous left ventricular assist device (Impella) and VA-ECMO remains largely unknown. We retrospectively reviewed patients treated for refractory cardiogenic shock with VA-ECMO (2014-2016). The primary outcome was all-cause mortality within 30 days of VA-ECMO implantation. Secondary outcomes included duration of support, stroke, major bleeding, hemolysis, inotropic score, and cardiac recovery...
February 27, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29365092/the-influence-of-advanced-age-on-venous-arterial-extracorporeal-membrane-oxygenation-outcomes
#8
Michael Salna, Koji Takeda, Paul Kurlansky, Hirohisa Ikegami, Liqiong Fan, Jiho Han, Samantha Stein, Veli Topkara, Melana Yuzefpolskaya, Paolo C Colombo, Dimitrios Karmpaliotis, Yoshifumi Naka, Ajay J Kirtane, Arthur R Garan, Hiroo Takayama
OBJECTIVES: Ethical and health care economic concerns surround the use of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in elderly patients. Patients requiring VA-ECMO are often in critical condition and the decision to cannulate is time-sensitive. We investigated the relationship between age and VA-ECMO outcomes to better inform this decision. METHODS: This is a retrospective study of 355 patients placed on VA-ECMO between March 2007 and August 2016 at our institution...
June 1, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29284886/monitored-anesthesia-care-for-the-acute-ischemic-stroke-patient-with-end-stage-pulmonary-disease
#9
Kevin C Lee, Brian C Lee, Steven E Miller
The majority of patients who suffer acute ischemic stroke (AIS) from large vessel occlusion are at a significant risk for disability or death. Because patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO) are therapeutically anticoagulated, intravenous recombinant tissue plasminogen activator is contraindicated. For AIS management, these patients must undergo emergent intra-arterial therapy. Presented is a patient on VA ECMO who subsequently suffered a large vessel embolic stroke requiring emergent surgical intervention...
October 2017: Anesthesia, Essays and Researches
https://www.readbyqxmd.com/read/29222320/anticoagulation-with-vads-and-ecmo-walking-the-tightrope
#10
REVIEW
Leslie Raffini
The evolution of devices for mechanical circulatory support (MCS), including ventricular assist devices (VADs) for patients with heart failure and extracorporeal membrane oxygenation (ECMO) for patients with acute cardiac or respiratory failure, has improved survival for subsets of critically ill children and adults. The devices are intricate and complex, allowing blood to bypass the heart or lungs (or both). As blood flows through these artificial devices, normal hemostasis is disrupted, coagulation is promoted, and in the absence of anticoagulation, a thrombus may form in the device, resulting in device failure or embolic stroke...
December 8, 2017: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/29084038/brain-magnetic-resonance-imaging-findings-in-pediatric-patients-post-extracorporeal-membrane-oxygenation
#11
Venessa L Pinto, Sumit Pruthi, Ashly C Westrick, Chevis N Shannon, Brian C Bridges, Truc M Le
Neurologic complications can occur with extracorporeal membrane oxygenation (ECMO) due to several factors. Prior studies identified neonates as having unique risk factors and neuroimaging findings post ECMO. The aim of this study is to describe brain magnetic resonance imaging findings of pediatric patients treated with ECMO. We conducted a retrospective study of nonneonatal pediatric patients who underwent a comprehensive brain magnetic resonance imaging after ECMO between January 2000 and July 2015. We identified 47 pediatric patients in the study cohort with a median age of 8 months (interquartile range 3-170 months) and a median ECMO run duration of 7...
November 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29076945/the-starling-relationship-and-veno-arterial-ecmo-ventricular-distension-explained
#12
Marc L Dickstein
The use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) to support patients with acute heart failure has been associated with ventricular distension and pulmonary edema, the mechanism of which is not fully understood. This study examined the impact of VA ECMO on left ventricular (LV) Starling curves to elaborate a framework for anticipating and treating LV distension. A previously developed and validated model of the cardiovascular system was used to generate pressure-volume (PV) loops and Starling curves while holding mean arterial pressure (mABP) constant at a range of values either by adjusting systemic resistance or by adding VA ECMO support...
July 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29045747/extracorporeal-membrane-oxygenation-support-for-right-ventricular-failure-after-left-ventricular-assist-device-implantation
#13
Julia Riebandt, Thomas Haberl, Dominik Wiedemann, R Moayedifar, Thomas Schloeglhofer, Stéphane Mahr, Kamen Dimitrov, Philipp Angleitner, Guenther Laufer, Daniel Zimpfer
OBJECTIVES: Right ventricular (RV) failure complicating left ventricular assist device implantation is associated with increased mortality. Despite a lack of supporting evidence, venoarterial extracorporeal membrane oxygenation (ECMO) support is increasingly being used as an alternative to traditional temporary RV support. We report our institutional experience with ECMO-facilitated RV support after left ventricular assist device implantation. METHODS: We retrospectively reviewed the concept of temporary ECMO support for perioperative RV failure in 32 consecutive left ventricular assist device (mean age 52 ± 14 years; male 84...
March 1, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28887931/extracorporeal-membrane-oxygenation-management-techniques-to-liberate-from-extracorporeal-membrane-oxygenation-and-manage-post-intensive-care-unit-issues
#14
REVIEW
Joseph B Zwischenberger, Harrison T Pitcher
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique when patients require pulmonary and/or cardiac support for days to weeks for recovery, bridge to decision, or transplantation. Due to complications associated with ECMO, it is best to stay on ECMO as little time as necessary. Foremost is weaning from ECMO, but the post-ECMO period recapitulates the entire field of critical care. Identified issues include (1) potential for systemic inflammatory response syndrome post-decannulation; (2) post-ECMO complications, such as deep vein thrombosis, wounds, renal failure, and stroke; (3) delirium; (4) posttraumatic stress disorder; (5) rehabilitation; and (6) end of life...
October 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28863024/neurologic-injury-with-severe-adult-respiratory-distress-syndrome-in-patients-undergoing-extracorporeal-membrane-oxygenation-a-single-center-retrospective-analysis
#15
REVIEW
Stephanie Klinzing, Urs Wenger, Federica Stretti, Peter Steiger, Elisabeth J Rushing, Urs Schwarz, Marco Maggiorini
This retrospective single-center study investigated the incidence of neurologic injury as determined by autopsy or cerebral imaging in 74 patients undergoing extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome. Seventy-three percent of patients were treated with venovenous and 27% with venoarterial ECMO. ECMO-associated intracerebral hemorrhage was diagnosed in 10.8% of patients. There were no cases of ischemic stroke. Clinical characteristics did not differ between patients with and without neurologic injury...
November 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28709666/novel-rotational-speed-modulation-system-used-with-venoarterial-extracorporeal-membrane-oxygenation
#16
Noritsugu Naito, Takashi Nishimura, Kei Iizuka, Yutaka Fujii, Yoshiaki Takewa, Akihide Umeki, Masahiko Ando, Minoru Ono, Eisuke Tatsumi
BACKGROUND: Femoral venoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to maintain blood flow in patients with cardiogenic shock. However, retrograde blood flow increases left ventricular (LV) afterload during femoral VA-ECMO. Additional support by means of an intraaortic balloon pump (IABP) alleviates LV afterload but is associated with significant adverse events. We previously developed a system for rotational speed modulation in synchrony with the native cardiac cycle, for use with implantable continuous-flow LV assist devices...
November 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28643997/brain-monitoring-in-adult-and-pediatric-ecmo-patients-the-importance-of-early-and-late-assessments
#17
Roberto Lorusso, Fabio S Taccone, Mirko Belliato, Thijs Delnoij, Paolo Zanatta, Mirjana Cvetkovic, Mark Davidson, Jan Belohlavek, Nashwa Matta, Carl Davis, Hanneke Ijsselstijn, Thomas Mueller, Ralf Muellenbach, Dirk Donker, Piero David, Matteo Di Nardo, Dirk Vlasselaers, Dinis Dos Reis Miranda, Aparna Hoskote
Monitoring brain integrity and neurocognitive function is a new and important target for the management of a patient treated with extracorporeal membrane oxygenation (ECMO), in particular because of the increasing awareness of cerebral abnormalities that may potentially occur in this setting. Continuous regular monitoring, as well as repeated assessment for cerebral complications has become an essential element of the ECMO patient management. Besides well-known complications, like bleeding, ischemic stroke, seizures, and brain hypoperfusion, other less defined yet relevant injury and clinical manifestations are increasingly reported and impacting on ECMO patient prognosis at short term...
October 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28625752/neurologic-complications-of-extracorporeal-membrane-oxygenation-a-review
#18
REVIEW
Ashleigh Xie, Phillip Lo, Tristan D Yan, Paul Forrest
OBJECTIVE: To review the evidence on neurologic complications in adult extracorporeal membrane oxygenation (ECMO) patients with regard to incidence, pathophysiology, risk factors, diagnosis, monitoring techniques, prevention, and management. DESIGN: Literature review. SETTING: Observational studies and case reports from a variety of institutions. PARTICIPANTS: Adult ECMO patients. INTERVENTIONS: Six electronic databases were searched from their dates of inception to October 2016...
October 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28591467/the-effect-of-impella-cp-on-cardiopulmonary-physiology-during-venoarterial-extracorporeal-membrane-oxygenation-support
#19
Hoong Sern Lim
Left ventricle (LV) distension is a complication of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. The effects of Impella on the pulmonary circulatory physiology were studied in a single-center study of six consecutive patients on VA-ECMO support who had LV unloading with Impella. Right ventricular stroke volume, pulmonary hemodynamics, and partial pressure of end-tidal CO2 (PETCO2 ) were measured on echocardiogram, pulmonary artery catheter, and capnography, respectively. The addition of Impella CP increased total blood flow and reduced pulmonary artery wedge pressure...
December 2017: Artificial Organs
https://www.readbyqxmd.com/read/28553778/pulmonary-hypertension-and-right-heart-failure-due-to-severe-hypernatremic-dehydration
#20
Saurabh Chiwane, Tageldin M Ahmed, Christian P Bauerfeld, Monika Chauhan
INTRODUCTION: Neonates are at risk of developing hypernatremic dehydration and its associated complications, such as stroke, dural sinus thrombosis and renal vein thrombosis. Pulmonary hypertension has not been described as a complication of hypernatremia. CASE REPORT: We report a case of a seven-day-old neonate with severe hypernatremic dehydration who went on to develop pulmonary hypertension and right heart failure needing extracorporeal membrane oxygenation (ECMO)...
July 2017: Perfusion
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