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Extracorporeal life support

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https://www.readbyqxmd.com/read/29144241/shifting-risks-and-conflicting-outcomes-ecmo-for-neonates-with-congenital-diaphragmatic-hernia-in-the-modern-era
#1
Joseph W Turek, Joseph R Nellis, Brenton G Sherwood, Meera Kotagal, Andrew L Mesher, Ravi R Thiagarajan, Sonali S Patel, Jeffrey R Avansino, Peter T Rycus, D Michael McMullan, Thomas V Brogan
OBJECTIVES: To update previously described trends for neonates with congenital diaphragmatic hernia (CDH) receiving ECMO with changes in recommendations for care, and to determine how recent advancements in respiratory care have affected this patient population. STUDY DESIGN: This study is a retrospective review of more than 2500 neonates with CDH who received ECMO listed in the Extracorporeal Life Support Organization (ELSO) registry. Cochran-Armitage and multivariate regression analyses were used to analyze changes in the patient population over time and in mortality-related risk factors...
November 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/29141964/acute-decompensated-pulmonary-hypertension
#2
Laurent Savale, Jason Weatherald, Xavier Jaïs, Constance Vuillard, Athénaïs Boucly, Mitja Jevnikar, David Montani, Olaf Mercier, Gerald Simonneau, Elie Fadel, Olivier Sitbon, Marc Humbert
Acute right heart failure in chronic precapillary pulmonary hypertension is characterised by a rapidly progressive syndrome with systemic congestion resulting from impaired right ventricular filling and/or reduced right ventricular flow output. This clinical picture results from an imbalance between the afterload imposed on the right ventricle and its adaptation capacity. Acute decompensated pulmonary hypertension is associated with a very poor prognosis in the short term. Despite its major impact on survival, its optimal management remains very challenging for specialised centres, without specific recommendations...
December 31, 2017: European Respiratory Review: An Official Journal of the European Respiratory Society
https://www.readbyqxmd.com/read/29141641/gender-and-age-disparity-in-the-initiation-of-life-supporting-treatments-a-population-based-cohort-study
#3
Peng-Sheng Ting, Likwang Chen, Wei-Chih Yang, Tien-Shang Huang, Chau-Chung Wu, Yen-Yuan Chen
BACKGROUND: The relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: (1) to examine the relationship between age and the extracorporeal membrane oxygenation use; (2) to examine the relationship between age and the extracorporeal membrane oxygenation use; and (3) to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal membrane oxygenation...
November 15, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/29132595/remote-ecls-implantation-and-transport-for-retrieval-of-cardiogenic-shock-patients
#4
Sabina P W Guenther, Stefan Buchholz, Frank Born, Stefan Brunner, René Schramm, Dominik J Hoechter, Vera von Dossow, Maximilian Pichlmaier, Christian Hagl, Nawid Khaladj
OBJECTIVE: Extracorporeal life support (ECLS) emerges as a salvage option in therapy refractory cardiogenic shock but is limited to highly specialized tertiary care centers. Critically ill patients are often too unstable for conventional transport. Mobile ECLS programs for remote implantation and subsequent air or ground-based transport for patient retrieval could solve this dilemma and make full-spectrum advanced cardiac care available to patients in remote hospitals in whom shock otherwise might be fatal...
November 2017: Air Medical Journal
https://www.readbyqxmd.com/read/29130616/emergency-extracorporeal-membrane-oxygenation-in-transcatheter-aortic-valve-implantation-a-two-center-experience-of-incidence-outcome-and-temporal-trends-from-2010-to-2015
#5
Teresa Trenkwalder, Costanza Pellegrini, Andreas Holzamer, Alois Philipp, Tobias Rheude, Jonathan Michel, Wibke Reinhard, Michael Joner, Albert M Kasel, Adnan Kastrati, Heribert Schunkert, Dierk Endemann, Kurt Debl, N Patrick Mayr, Michael Hilker, Christian Hengstenberg, Oliver Husser
BACKGROUND: Although the incidence of periprocedural complications has decreased in transcatheter aortic valve implantation (TAVI), life-threatening complications occur and emergency veno-arterial extracorporeal membrane oxygenation (vaECMO) can provide immediate circulatory stabilization. We report our two-center experience of vaECMO during life-threatening complications in TAVI. METHODS: From January 2010 to December 2015, 1,810 consecutive patients underwent TAVI at two centers...
November 11, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29128016/extracorporeal-life-support-in-lung-transplantation
#6
REVIEW
Darryl Abrams, Daniel Brodie, Selim M Arcasoy
Extracorporeal life support in lung transplantation has been associated with poor posttransplant outcomes. However, recent advances have resulted in more favorable posttransplant outcomes. The increased use of this technology must be weighed against the risks inherent in its use, especially when complications arising in extracorporeal membrane oxygenation (ECMO)-dependent patients result in loss of transplant candidacy, leaving them with no viable alternative for long-term support. Existing and emerging data support the judicious use of this technology in carefully selected patients at high-volume transplant and ECMO centers that prioritize minimization of sedation, avoidance of endotracheal intubation, and early mobilization...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29125053/twenty-minutes-of-normothermic-cardiac-arrest-in-a-pig-model-the-role-of-short-term-hypothermia-for-neurological-outcome
#7
Katharina Foerster, Christoph Benk, Friedhelm Beyersdorf, Heidi Cristina Schmitz, Karin Wittmann, Itumeleng Taunyane, Claudia Heilmann, Georg Trummer
INTRODUCTION: Cardiopulmonary resuscitation restores circulation, but with inconsistent blood-flow and pressures. Our recent approach using an extracorporeal life support system, named "controlled integrated resuscitation device" (CIRD), may lead to improved survival and neurological recovery after cardiac arrest (CA). The basic idea is to provide a reperfusion tailored to the individual patient by control of the conditions of reperfusion and the composition of the reperfusate. Hypothermia is one aspect of this concept...
November 1, 2017: Perfusion
https://www.readbyqxmd.com/read/29124458/pitfalls-of-cannulation-for-extracorporeal-life-support-review-of-the-literature-and-illustrative-case-presentation
#8
REVIEW
Martin Geyer, Bernhard Gohrbandt, Ingo Sagoschen, Thomas Hartmann, Felix Post, Christian-Friedrich Vahl, Thomas Münzel
Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) are an increasingly established advanced therapy for emerging severe lung and/or cardiocirculatory dysfunction or failure. Several reports have provided evidence for a potential benefit in prognosis by ECLS in cases of cardiogenic shock including cardiopulmonary resuscitation. Routine use in specialized centers reduces the incidence of negative side effects (e.g., vascular/ischemic, embolic, hemorrhagic, hemolytic and, furthermore, septic)...
November 9, 2017: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
https://www.readbyqxmd.com/read/29124028/inter-facility-transport-on-extracorporeal-life-support-clinical-outcomes-and-comparative-analysis-with-in-house-patients
#9
Tae Hee Hong, Heemoon Lee, Jae Jun Jung, Yang Hyun Cho, Kiick Sung, Ji-Hyuk Yang, Young-Tak Lee, Su Hyun Cho
Background: Extracorporeal life support (ECLS) is widely used in refractory heart or lung failure, and the demand for inter-facility transportation on ECLS is expanding. However, little is known about post-transportation outcomes, the clinical safety of such transportation, or the characteristics of the transported patients. Methods: This was a retrospective review of a 3-year, single-institution experience with inter-facility ECLS transport, as well as a comparative analysis of clinical outcomes with those of in-house patients...
October 2017: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29120882/donation-after-circulatory-death-and-its-expansion-in-spain
#10
Eduardo Miñambres, Juan J Rubio, Elisabeth Coll, Beatriz Domínguez-Gil
PURPOSE OF REVIEW: Donation after circulatory death (DCD) is still performed in a limited number of countries. This article summarizes the development of DCD in Spain and presents recent Spanish contributions to gain knowledge on the potential benefits and the practical use of normothermic regional perfusion (nRP). RECENT FINDINGS: DCD now contributes to 24% of deceased donors in Spain. The development of DCD has been based on an assessment of practices in the treatment of cardiac arrest and end-of-life care to accommodate the option of DCD; the creation of an adequate regulatory framework; and institutional support, professional training and public education...
November 7, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29117038/development-and-validation-of-extracorporeal-membrane-oxygenation-mortality-risk-models-for-congenital-diaphragmatic-hernia
#11
Yigit S Guner, Danh V Nguyen, Lishi Zhang, Yanjun Chen, Matthew T Harting, Peter Rycus, Ryan Barbaro, Matteo Di Nardo, Thomas V Brogan, John P Cleary, Peter T Yu
The purpose of our study was to develop and validate extracorporeal membrane oxygenation (ECMO)-specific mortality risk models for congenital diaphragmatic hernia (CDH). We utilized the data from the Extracorporeal Life Support Organization Registry (2000-2015). Prediction models were developed using multivariable logistic regression. We identified 4,374 neonates with CDH with an overall mortality of 52%. Predictive discrimination (C statistic) for pre-ECMO mortality model was C = 0.65 (95% confidence interval, 0...
November 7, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29112104/cardiogenic-shock-due-to-end-stage-heart-failure-and-acute-myocardial-infarction-characteristics-and-outcome-of-temporary-mechanical-circulatory-support
#12
Hoong Sern Lim, Neil Howell
BACKGROUND: Mechanical circulatory support (MCS) is increasingly used in cardiogenic shock, but outcomes may differ between patients with acute myocardial infarction (AMI) or end-stage heart failure (ESHF). This study aimed to describe the characteristics of patients with cardiogenic shock due to AMI and ESHF. METHODS: Single centre study of consecutive patients with cardiogenic shock due to AMI (n = 26) and ESHF (n = 42) who underwent MCS (extracorporeal life support, Impella or temporary ventricular assist devices)...
November 3, 2017: Shock
https://www.readbyqxmd.com/read/29112078/survival-outcomes-following-the-use-of-extracorporeal-membrane-oxygenation-as-a-rescue-technology-in-critically-ill-patients-results-from-pennsylvania-2007-2015
#13
Marco D Huesch, Andrew Foy, Christoph Brehm
OBJECTIVE: To examine real-world outcomes of survival, length of stay, and discharge destination, among all adult extracorporeal membrane oxygenation admissions in one state over nearly a decade. DESIGN: Retrospective analysis of administrative discharge data. SETTING: State-wide administrative discharge data from Pennsylvania between 2007 and 2015. PATIENTS: All 2,948 consecutive patients billed under a Diagnosis-Related Grouper 3 grouper and in whom a procedural code for extracorporeal membrane oxygenation was present, admitted between the beginning of 2007 and the end of 2015 to hospitals regulated by the state of Pennsylvania...
November 3, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29106605/surgical-treatment-of-a-pericardio-oesophageal-fistula-using-a-right-lower-lobe-pulmonary-tissue-patch
#14
Geraud Galvaing, Nicolas D'Ostrevy, Olivier Rouquette, Kasra Azarnoush
A 58-year-old man presented with fever and chest pain 11 days after atrial fibrillation catheter ablation. The diagnosis of pericardio-oesophageal fistula was made. Aggressive surgical management was decided. The patient was managed using extracorporeal life support, aortic valve replacement and a pulmonary patch, as well as an oesophageal stent. The patient was discharged from hospital approximately 2 months later. The use of a pulmonary patch is a rare but a highly effective technique that can be used in this indication...
July 4, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29105485/thrombotic-thrombocytopenic-purpura-presenting-as-a-severe-peripartum-cardiogenic-shock-role-of-myocardial-biopsy-and-assist-device-for-diagnosis-and-resuscitation
#15
Sébastien Champion, Dominique Belcour, Bernard Alex Gaüzère
We describe the case of a peripartum thrombotic thrombocytopenic purpura with fulminant cardiogenic shock treated with extracorporeal life support. Thrombotic thrombocytopenic purpura should be considered in the case of thrombotic microangiopathy with several or severe organ involvement and needs emergent treatment with plasmapheresis (with or without rituximab). In the case of cardiac involvement, aggressive treatment should be considered given the high mortality and the potential complete recovery.
November 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29084200/-real-life-report-on-the-management-of-chronic-gvhd-in-the-gruppo-italiano-trapianto-midollo-osseo-gitmo
#16
L Giaccone, G Mancini, N Mordini, G Gargiulo, V De Cecco, S Angelini, M Arpinati, D Baronciani, V Bozzoli, S Bramanti, E Calore, I M Cavattoni, M Cimminiello, A A Colombo, L Facchini, S Falcioni, M Faraci, R Fedele, S Guidi, A P Iori, S Marotta, M C Micò, G Milone, F Onida, D Pastore, F Patriarca, M Pini, R Raimondi, A Rovelli, S Santarone, A Severino, C Skert, M T L Stanghellini, C Tecchio, E Vassallo, M Chiarucci, B Bruno, F Bonifazi, A Olivieri
Several guidelines have been published about management of chronic GvHD (cGvHD), but the clinical practice still remains demanding. The Gruppo Italiano Trapianto di Midollo Osseo (GITMO) has planned a prospective observational study on cGvHD, supported by a dedicated software, including the updated recommendations. In view of this study, two surveys have been conducted, focusing the management of cGvHD and ancillary therapy in cGvHD, to address the current 'real life' situation. The two surveys were sent to all 57 GITMO centers, performing allografting in Italy; the response rate was 57% and 66% of the interviewed centers, respectively...
October 30, 2017: Bone Marrow Transplantation
https://www.readbyqxmd.com/read/29084039/esperanza-the-first-neonatal-ecmo-patient
#17
Robert H Bartlett
The first successful neonatal extracorporeal membrane oxygenation case (1975) is important in the development of extracorporeal life support, but the case report was never published. This is the report of that case with commentary on the evolution of extracorporeal membrane oxygenation since 1975.
November 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29084037/extracorporeal-cardiopulmonary-resuscitation-among-patients-with-structurally-normal-hearts
#18
Stephanie J Conrad, Brian C Bridges, Yuvraj Kalra, John B Pietsch, Andrew H Smith
Extracorporeal cardiopulmonary resuscitation (eCPR) has been well described as a rescue therapy in refractory cardiac arrest among patients with congenital heart disease. The purpose of this retrospective analysis of data from the Extracorporeal Life Support Organization was to evaluate outcomes of eCPR in patients with structurally normal hearts and to identify risk factors that may contribute to mortality. During the study period, 1,431 patients met inclusion criteria. Median age was 16 years. Overall survival to hospital discharge was 32%...
November 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29079045/three-dimensional-echocardiography-derived-right-ventricular-ejection-fraction-correlates-with-success-of-decannulation-and-prognosis-in-patients-stabilized-by-venoarterial-extracorporeal-life-support
#19
Kuan-Chih Huang, Lian-Yu Lin, Yih-Sharng Chen, Chien-Heng Lai, Juey-Jen Hwang, Lung-Chun Lin
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been proved to effectively rescue patients from refractory cardiogenic shock. The role of the right ventricle in VA-ECMO has been emphasized, but quantitative right ventricular (RV) analysis in this population has been lacking. Three-dimensional echocardiography (3DE) is currently suggested for RV volumetric analysis. The aims of this study were to assess 3DE-derived RV ejection fraction (RVEF) in patients with refractory cardiogenic shock stabilized by VA-ECMO and to explore the association between 3DE-derived RVEF and weaning success as well as the prognosis after the first intent of decannulation...
October 24, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/29076453/-in-hospital-cardiac-arrest-in-a-69-year-old-woman-treated-with-extracorporeal-cardiopulmonary-resuscitation
#20
Ali Akkawi, Joachim Hoffmann Petersen, Lars Riber
A 69-year-old woman was admitted to the emergency unit due to respiratory distress. Initially the blood pressure was normal. However, it decreased concomitant with low saturation (70%), and it was decided to intubate her due to hypoxia. During intubation, she developed in-hospital cardiac arrest with pulseless electric activity as initial rhythm. Cardio pulmonary resuscitation was initiated, but sufficient spontaneous circulation was not obtained. We successfully initiated extracorporeal life support, and the patient survived with a good outcome...
October 23, 2017: Ugeskrift for Laeger
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