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https://www.readbyqxmd.com/read/29033360/veno-arterial-ecmo-in-the-intensive-care-unit-from-technical-aspects-to-clinical-practice
#1
REVIEW
Arthur Le Gall, Arnaud Follin, Bernard Cholley, Jean Mantz, Nadia Aissaoui, Romain Pirracchio
The use of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) as a salvage therapy in cardiogenic shock is becoming of current practice. While VA-ECMO is potentially a life-saving technique, results are sometimes mitigated, emphasising the need for selecting the right indication in the right patient. This relies upon a clear definition of the individual therapeutic project, including the potential for recovery as well as the possible complications associated with VA-ECMO. To maximise the benefits of VA-ECMO, the basics of extracorporeal circulation should be perfectly understood since VA-ECMO can sometimes be detrimental...
October 12, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29033043/in%C3%A2-vivo-lung-perfusion-rehabilitates-sepsis-induced-lung-injury
#2
J Hunter Mehaffey, Eric J Charles, Sarah Schubert, Morgan Salmon, Ashish K Sharma, Dustin Money, Mark H Stoler, Victor E Laubach, Curtis G Tribble, Mark E Roeser, Irving L Kron
BACKGROUND: Sepsis is the leading cause of lung injury in adults and can lead to acute respiratory distress syndrome (ARDS). Using a novel technique of isolated in vivo lung perfusion (IVLP), we hypothesized that normothermic IVLP will improve oxygenation and compliance in a porcine model of sepsis-induced lung injury. METHODS: Mature adult swine (n = 8) were administered lipopolysaccharide (LPS; 50 μg/kg over 2 hours) via the external jugular vein, followed by sternotomy and central extracorporeal membrane oxygenation (ECMO) cannulation (right atrium to ascending aorta)...
September 14, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29033041/short-term-venoarterial-extracorporeal-membrane-oxygenation-for-massive-endobronchial-hemorrhage-after-pulmonary-endarterectomy
#3
Stefan Guth, Christoph B Wiedenroth, Marc Wollenschläger, Manuel Jonas Richter, Hossein A Ghofrani, Matthias Arlt, Eckhard Mayer
OBJECTIVES: Pulmonary endarterectomy (PEA) is the only curative treatment option for patients with chronic thromboembolic pulmonary hypertension. Massive endobronchial bleeding that precludes weaning from cardiopulmonary bypass is an often-fatal complication of PEA. The aim of this study was to determine whether short-term extracorporeal membrane oxygenation (ECMO) is a safe and feasible procedure in patients with severe endobronchial bleeding. METHODS: From January 2014 to December 2016, 396 patients (mean age 60 ± 18 years, 54...
September 20, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29027193/single-center-experience-with-intraoperative-extracorporeal-membrane-oxygenation-use-in-lung-transplantation
#4
Tugba Cosgun, Sandra Tomaszek, Isabelle Opitz, Markus Wilhelm, Macé M Schuurmans, Walter Weder, Ilhan Inci
BACKGROUND: Studies have shown that survival after lung transplantation is impaired if extracorporeal membrane oxygenation (ECMO) support is implemented. We investigated the outcome and potential independent risk factors on survival in recipients undergoing lung transplantation with intraoperative ECMO support. MATERIALS AND METHODS: Medical records of recipients were retrospectively evaluated (January 2000-December 2014). Retransplantation and bridge to transplantation on ECMO were excluded...
October 9, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/29019017/leptospirosis-associated-catastrophic-respiratory-failure-supported-by-extracorporeal-membrane-oxygenation
#5
Tamara Cantwell, Andrés Ferre, Nicolette Van Sint Jan, Rodrigo Blamey, Jorge Dreyse, Cristian Baeza, Rodrigo Diaz, Tomás Regueira
A previously healthy, 39-year-old obese farmer, arrived hypotensive and tachycardic, with fever, myalgia, headache, abdominal pain, diarrhea, and progressive dyspnea. Ten days before symptoms onset, he was in direct contact with mice and working in a contaminated drain. Patient laboratory showed acute kidney injury and thrombocytopenia. Chest X-ray exhibited bilateral diffuse interstitial infiltrates. First-line empirical antibiotics were started and influenza discarded. Patient evolved with severe respiratory failure, associated with hemoptysis, and rapidly severe hemodynamic compromise...
October 10, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/29017847/the-biomarkers-neuron-specific-enolase-and-s100b-measured-the-day-following-admission-for-severe-accidental-hypothermia-have-high-predictive-values-for-poor-outcome
#6
Sebastian Wiberg, Jesper Kjaergaard, Benedict Kjærgaard, Bjarne Møller, Bo Nørnberg, Anne Marie Sørensen, Christian Hassager, Michael Wanscher
AIM: The aim of the present study was to assess the ability of the biomarkers neuron-specific enolase (NSE) and S100 calcium-binding protein b (S100b) to predict mortality and poor neurologic outcome after 30days in patients admitted with severe accidental hypothermia. METHODS: Consecutive patients with severe accidental hypothermia, defined as a core temperature <32°C, were included. Patients were treated with active rewarming and/or extracorporeal life support (ECLS) using extra corporeal circulation (ECC) and/or extra corporeal membrane oxygenation (ECMO)...
October 7, 2017: Resuscitation
https://www.readbyqxmd.com/read/29017659/-massive-pulmonary-embolism-similar-to-acute-myocardial-infarction-rescued-by-ecmo-a-case-report
#7
Wenqing Gao, Tong Li, Xiaomin Hu, Dawei Duan, Peng Wu, Yue Zhao, Meng Ning
Acute myocardial infarction (AMI) and acute massive pulmonary embolism can be characterized by no pulse electrical activity. Patients of cardiac arrest (CA) with no pulse electrical activity have a high mortality rate before the cause was corrected. Extracorporeal membrane oxygenation (ECMO), as a kind of artificial heart-lung support organ, provides treatment for CA patients. A case of massive pulmonary embolism similar to AMI was treated in the Third Central Hospital of Tianjin, who received interventional thrombolysis assisted by ECMO...
October 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28985704/extracorporeal-membrane-oxygenation-for-kawasaki-disease-two-case-reports-and-the-extracorporeal-life-support-organization-experience-1999-2015
#8
Derek Best, Johnny Millar, Igor Kornilov, Yury Sinelnikov, Roberto Chiletti, Peter Rycus, Warwick Butt
Kawasaki disease is usually a limited illness of early childhood. However, life-threatening cardiac manifestations can occur, either at acute presentation or as a consequence of coronary arterial involvement. We report the successful use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiac support in two children with Kawasaki disease: one with acute Kawasaki disease shock syndrome, the other with complications of coronary arteritis and subsequent surgery. We also reviewed the reported experience in the ELSO database and available literature...
October 2017: Perfusion
https://www.readbyqxmd.com/read/28985703/escalation-of-extracorporeal-life-support-as-a-bridge-to-lung-transplantation-in-end-stage-lung-disease
#9
Prashant N Mohite, Alexander Rosenberg, Clara Hernández Caballero, Simona Soresi, Javid Fatullayev, Anna Reed, Aron-Frederik Popov, Anton Sabashnikov, André R Simon
Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplant (LTx) is not uncommon, but it is not commonplace yet. We present a case of a 45-year-old man with cystic fibrosis with recent deterioration in lung function who was initially supported with veno-venous (VV) ECMO. However, he subsequently required conversion to veno-veno-arterial (VVA) ECMO. After 21 days of support, he underwent double lung transplantation, with an uneventful postoperative course. This case shows that, in patients with end-stage respiratory failure awaiting lung transplantation, extracorporeal life support may require escalation to improve gas exchange and address circulatory requirements...
October 2017: Perfusion
https://www.readbyqxmd.com/read/28980031/-use-of-near-infrared-spectroscopy-for-control-of-limb-perfusion-during-venoarterial-ecmo-treatment-application-and-limitations
#10
T Werner, D Lunz, A Philipp, B Flörchinger, B M Graf, Y A Zausig
Patients undergoing peripheral venoarterial extracorporeal membrane oxygenation have a high risk of lower limb ischemia. In general, regular controls are carried out based on clinical and laboratory parameters in order to quickly detect and treat complications. These controls are challenging due to states of shock, nonpulsatile flow and vasopressor therapy. As additional monitoring the use of near-infrared spectroscopy (NIRS) is described in the literature as being very successful in detecting ischemia. The present article describes the use and possible limitations of NIRS for the diagnostics of peripheral ischemia...
October 4, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28979045/left-ventricular-unloading-during-peripheral-extracorporeal-membrane-oxygenator-support-a-bridge-to-life-in-profound-cardiogenic-shock
#11
Paolo Centofanti, Matteo Attisani, Michele La Torre, Davide Ricci, Massimo Boffini, Andrea Baronetto, Erika Simonato, Alberto Clerici, Mauro Rinaldi
A limit of peripheral veno-arterial Extracorporeal Membrane Oxigenator (VA-ECMO) is the inadequate unloading of the left ventricle. The increase of end-diastolic pressure reduces the possibility of a recovery and may cause severe pulmonary edema. In this study, we evaluate our results after implantation of VA-ECMO and Transapical Left Ventricular Vent (TLVV) as a bridge to recovery, heart transplantation or long-term left ventricular assit devices (LVAD). From 2011 to 2014, 24 consecutive patients with profound cardiogenic shock were supported by peripheral VA-ECMO as bridge to decision...
September 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28979038/antifungal-extraction-by-the-extracorporeal-membrane-oxygenation-circuit
#12
Kevin M Watt, Michael Cohen-Wolkowiez, Duane C Williams, Desiree K Bonadonna, Ira M Cheifetz, Dhiren Thakker, Daniel K Benjamin, Kim L R Brouwer
Invasive candidiasis is common and often fatal in patients supported with extracorporeal membrane oxygenation (ECMO), and treatment relies on optimal antifungal dosing. The ECMO circuit can extract drug and decrease drug exposure, placing the patient at risk of therapeutic failure. This ex vivo study determined the extraction of antifungal drugs by the ECMO circuit. Fluconazole and micafungin were studied separately in three closed-loop circuit configurations to isolate the impact of the oxygenator, hemofilter, and tubing on circuit extraction...
September 2017: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/28974647/a-quality-improvement-project-to-improve-evidence-based-inhaled-nitric-oxide-use
#13
Colleen A Hughes Driscoll, Natalie L Davis, Megan Miles, Dina El-Metwally
BACKGROUND: Inhaled nitric oxide (INO) reduces extracorporeal membrane oxygenation (ECMO) use in term and near-term neonates with persistent pulmonary hypertension of the newborn; however, its overutilization is increasing. We hypothesized that implementing a shared baseline protocol would safely improve evidence-based INO use in a Level IV neonatal ICU. METHODS: Through several plan-do-study-act cycles, a shared baseline protocol for initiation and weaning of INO was developed and implemented starting in August 2014...
October 3, 2017: Respiratory Care
https://www.readbyqxmd.com/read/28970652/the-need-for-extracorporeal-membrane-oxygenation-in-adults-undergoing-congenital-heart-surgery-impact-and-trends-of-utilization
#14
Salvatore Aiello, Rohit S Loomba, Connor Kriz, Matthew Buelow, Saurabh Aggarwal, Rohit R Arora
INTRODUCTION: Adults with congenital heart disease (ACHD) represent a population with unique health-care needs. Many patients require cardiac surgery, with some requiring postoperative extracorporeal membrane oxygenation (ECMO). This study aimed to identify the risk factors for the need of postoperative ECMO and characterize the impact of ECMO on admission characteristics. METHODS: Data from the 2005-2012 iterations of the Nationwide Inpatient Sample were used. ACHD admissions over 18 years with a documented cardiac surgery were included...
September 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28970319/extracorporeal-membrane-oxygenation-for-neonatal-collapse-caused-by-enterovirus-myocarditis
#15
Gerard Cortina, Derek Best, Markus Deisenberg, Roberto Chiletti, Warwick Butt
OBJECTIVE: To describe the effect of extracorporeal membrane oxygenation (ECMO) on survival and cardiac outcome of neonates with myocardial failure secondary to severe enterovirus (EV) myocarditis. DESIGN: Retrospective case series. SETTING: A 15-bed cardiac paediatric intensive care unit (ICU). PATIENTS: We describe the clinical presentations, cardiac findings, ECMO characteristics and outcome of seven neonates with severe EV myocarditis...
September 29, 2017: Archives of Disease in Childhood. Fetal and Neonatal Edition
https://www.readbyqxmd.com/read/28966321/veno-arterial-extracorporeal-membrane-oxygenation-with-conventional-anticoagulation-can-be-a-best-solution-for-shock-due-to-massive-pe
#16
Yusuke Watanabe, Kenichi Sakakura, Naoyuki Akashi, Mami Ishikawa, Yousuke Taniguchi, Kei Yamamoto, Hiroshi Wada, Hideo Fujita, Shin-Ichi Momomura
While most of pulmonary thromboembolism (PE) cases can be managed by thrombolytic and anticoagulation therapy, massive PE remains a life-threatening disease. Although surgical embolectomy can be a curative therapy for massive PE, peri-operative mortality for hemodynamically collapsed PE is extremely high. We present a case of hemodynamically collapsed massive PE. We avoided either thrombolytic therapy or surgical embolectomy, because the patient had recent cerebral contusion. Therefore, we managed the patient with the combination of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and conventional anticoagulation, which dramatically improved the patient's hemodynamics...
September 30, 2017: International Heart Journal
https://www.readbyqxmd.com/read/28958705/twenty-years-of-lung-transplantation-in-taiwan-effects-of-cumulative-institutional-experience-on-early-outcomes
#17
Shun-Mao Yang, Shu-Chien Huang, Shuenn-Wen Kuo, Pei-Ming Huang, Po-Ni Hsiao, Ke-Cheng Chen, Mong-Wei Lin, Sung-Ching Pan, Jui-Hsiang Lin, Ya-Jung Cheng, Jang-Ming Lee, Hsao-Hsun Hsu
BACKGROUND/PURPOSE: Lung transplantation in Taiwan began in 1991, but the experience was limited and diverse in the early years. We examined the cumulative institutional experience of the largest lung transplant cohort in Taiwan. METHODS: A retrospective review of lung transplantations performed at a single institution from December 1995 through August 2016 was conducted. For comparative purposes, the cohort was divided into halves, with an early group (undergoing lung transplantation in the first decade) vs a late group (undergoing lung transplantation in the second decade)...
September 25, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/28953198/ejection-fraction-may-not-reflect-contractility-example-in-veno-arterial-extracorporeal-membrane-oxygenation-for-heart-failure
#18
Philippe Morimont, Bernard Lambermont, Julien Guiot, Vincent Tchana Sato, Christophe Clotuche, Jonathan Goffoy, Jean-Olivier Defraigne
Precise assessment of left ventricular (LV) contractility during veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is crucial. However, changes in loading conditions may mask changes in LV function when assessed with load-dependent parameters. We compared end-systolic elastance (Ees, mm Hg/ml), the reference load-independent parameter of LV contractility, with LV ejection fraction (LVEF) in two patients. The first patient was a 54-year-old patient supported with femoro-femoral VA-ECMO for a cardiogenic shock...
September 25, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28953197/effect-of-impella-during-veno-arterial-extracorporeal-membrane-oxygenation-on-pulmonary-artery-flow-as-assessed-by-end-tidal-carbon-dioxide
#19
Jacob Eliet, Philippe Gaudard, Norddine Zeroual, Philippe Rouvière, Bernard Albat, Marc Mourad, Pascal H Colson
Peripheral veno-arterial extracorporeal membrane oxygenation (VA ECMO) exposes the patient to a pulmonary blood flow bypass and a left ventricle afterload increase. Impella, a catheter-mounted microaxial rotary pump, has been proposed for left ventricle (LV) unloading in combination with VA ECMO. In order to assess the effect of Impella on pulmonary flow and LV preload, we checked Doppler pulmonary artery velocity-time integral (pVTI) and LV diastolic diameter (LVED) by transesophageal echocardiography and end-tidal carbon dioxide (EtCO2) during a step-by-step increase in Impella flow (Impella ramp test)...
September 25, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/28951661/mechanical-circulatory-support-as-a-bridge-to-lung-transplantation-a-single-canadian-institution-review
#20
Katie Kinaschuk, Sabin J Bozso, Kieran Halloran, Ali Kapasi, Kathy Jackson, Jayan Nagendran
BACKGROUND: Lung transplant (LTx) waitlists continue to grow internationally. Consequently, more patients are progressing to require mechanical circulatory support (MCS) as a bridge to transplantation (BTT). MCS strategies include interventional lung assist (iLA) and venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO). We review our series of patients bridged with MCS while listed for LTx. METHODS: All consecutive patients, listed for LTx requiring MCS as a BTT at the University of Alberta from 2004 to 2015, were included...
2017: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
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