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By Anil Gopinath Pulmonary Critical Care. Medical Director, Adult ECMO. Interests - Cardiopulmonary physiology, Muscle physiology, Mechanical ventilation, ECMO
Katharine L Hamlington, Bradford J Smith, Gilman B Allen, Jason H T Bates
Managing patients with acute respiratory distress syndrome (ARDS) requires mechanical ventilation that balances the competing goals of sustaining life while avoiding ventilator-induced lung injury (VILI). In particular, it is reasonable to suppose that for any given ARDS patient, there must exist an optimum pair of values for tidal volume (VT) and positive end-expiratory pressure (PEEP) that together minimize the risk for VILI. To find these optimum values, and thus develop a personalized approach to mechanical ventilation in ARDS, we need to be able to predict how injurious a given ventilation regimen will be in any given patient so that the minimally injurious regimen for that patient can be determined...
July 1, 2016: Journal of Applied Physiology
Richard Cheng, Rory Hachamovitch, Raj Makkar, Danny Ramzy, Jaime D Moriguchi, Francisco A Arabia, Fardad Esmailian, Babak Azarbal
OBJECTIVE: Intraaortic balloon pumps (IABPs) are frequently used as an adjunctive device to extracorporeal membrane oxygenation (ECMO) and are routinely placed at the initiation of ECMO at many institutions. Evidence for the additive benefit of IABP therapy is limited and conflicting in part due to small sample sizes. In the absence of large randomized trials, a meta-analysis would best elucidate potential benefit. METHODS: A systematic PubMed/Medline search was performed...
October 2015: Journal of Invasive Cardiology
Nicolas J Prat, Andrew D Meyer, Thomas Langer, Robbie K Montgomery, Bijaya K Parida, Andriy I Batchinsky, Andrew P Cap
BACKGROUND: Over 32% of burned battlefield causalities develop trauma-induced hypoxic respiratory failure, also known as acute respiratory distress syndrome (ARDS). Recently, 9 out of 10 US combat soldiers' survived life-threatening trauma-induced ARDS supported with extracorporeal membrane oxygenation (ECMO), a portable form of cardiopulmonary bypass. Unfortunately, the size, incidence of coagulation complications, and the need for systematic anticoagulation for traditional ECMO devices have prevented widespread use of this lifesaving technology...
December 2015: Shock
Marcelo B P Amato, Maureen O Meade, Arthur S Slutsky, Laurent Brochard, Eduardo L V Costa, David A Schoenfeld, Thomas E Stewart, Matthias Briel, Daniel Talmor, Alain Mercat, Jean-Christophe M Richard, Carlos R R Carvalho, Roy G Brower
BACKGROUND: Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (VT), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (CRS) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size), we hypothesized that driving pressure (ΔP=VT/CRS), in which VT is intrinsically normalized to functional lung size (instead of predicted lung size in healthy persons), would be an index more strongly associated with survival than VT or PEEP in patients who are not actively breathing...
February 19, 2015: New England Journal of Medicine
Mubashar H Khan, Brian J Corbett, Steven M Hollenberg
Cardiogenic shock complicates about 5% to 8% of all admissions for acute myocardial infarction, and despite advancement in treatment over the past 50 years, mortality remains unacceptably high. Management with vasoactive agents after revascularization can have its limitations and thus mechanical circulatory support is often initiated. Intra-aortic balloon pumps (IABPs) are the devices most commonly used worldwide. IABPs appeared to improve mortality when used along with fibrinolytic therapy but may not when used along with percutaneous coronary interventions...
2014: F1000Prime Reports
Katia Donadello, Jason A Roberts, Stefano Cristallini, Marjorie Beumier, Kiran Shekar, Frédérique Jacobs, Asmae Belhaj, Jean-Louis Vincent, Daniel de Backer, Fabio Silvio Taccone
INTRODUCTION: The aim of this study was to describe the population pharmacokinetics of vancomycin in critically ill patients treated with and without extracorporeal membrane oxygenation (ECMO). METHODS: We retrospectively reviewed data from critically ill patients treated with ECMO and matched controls who received a continuous infusion of vancomycin (35 mg/kg loading dose over 4 hours followed by a daily infusion adapted to creatinine clearance, CrCl)). The pharmacokinetics of vancomycin were described using non-linear mixed effects modeling...
2014: Critical Care: the Official Journal of the Critical Care Forum
Darryl Abrams, Matthew Bacchetta, Daniel Brodie
Recirculation, a phenomenon in which reinfused oxygenated blood is withdrawn by the drainage cannula without passing through the systemic circulation, decreases the efficiency with which venovenous extracorporeal membrane oxygenation (ECMO) provides oxygenation. The precise amount of recirculation may be difficult to quantify. However, interventions should be attempted to reduce recirculation when oxygen delivery is suboptimal and recirculation is suspected. Several techniques, including the use of dual-lumen cannulae, have been successful in minimizing recirculation in venovenous ECMO...
March 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Arek J Wiktor, Jonathan W Haft, Robert H Bartlett, Pauline K Park, Krishnan Raghavendran, Lena M Napolitano
The usual duration of extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome is 7-10 days. Prolonged duration ECMO (defined as greater than 14 days) is increasingly being documented with native lung recovery or as a bridge to lung transplantation. We report a case of prolonged duration ECMO (6,364 hours, 265 days) requiring no complete circuit exchange. As critical care improves, prolonged ECMO will continue to pose unique technological and ethical challenges that test our expectations of this treatment modality...
March 2015: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Taek Kyu Park, Jeong Hoon Yang, Kyeongman Jeon, Seung-Hyuk Choi, Jin-Ho Choi, Hyeon-Cheol Gwon, Chi Ryang Chung, Chi Min Park, Yang Hyun Cho, Kiick Sung, Gee Young Suh
OBJECTIVES: The role of extracorporeal membrane oxygenation (ECMO) remains controversial in adult patients with refractory septic shock. We sought to describe the clinical outcomes of adult patients supported by ECMO during septic shock refractory to conventional treatment. METHODS: We analysed consecutive adult patients with refractory septic shock, assisted by an ECMO system between January 2005 and December 2013 in a single-centre registry. The primary outcome was survival to hospital discharge...
February 2015: European Journal of Cardio-thoracic Surgery
A Lucchini, C De Felippis, S Elli, R Gariboldi, S Vimercati, P Tundo, H Bondi, M C Costa
INTRODUCTION: Transport of patients undergoing extracorporeal membrane oxygenation is currently available in 5 referral centers in our country. METHODS: Retrospective case series of patients managed by our mobile extracorporeal membrane oxygenation team and transferred to San Gerardo University Hospital from December 2004 to December 2012. RESULTS: 42 patients were transported. The mean age was 42.11 (standard deviation ±18.11) years, with a range between 2 years and 70...
2014: Heart, Lung and Vessels
Enrique Diaz-Guzman, Joseph B Zwischenberger, Victor J Thannickal, Charles W Hoopes
No abstract text is available yet for this article.
December 1, 2014: American Journal of Respiratory and Critical Care Medicine
Kollengode Ramanathan, Matthew E Cove, Michael G Caleb, Kristine L K Teoh, Graeme Maclaren
No abstract text is available yet for this article.
February 2015: Journal of Cardiothoracic and Vascular Anesthesia
Robert J Steffen, Shiva Sale, Balaram Anandamurthy, Vincent B Cruz, Patrick M Grady, Edward G Soltesz, Nader Moazami
Patients on peripheral extracorporeal membrane oxygenation (ECMO) are at risk for lower extremity ischemia. Effective monitoring is needed to identify complications quickly and allow timely correction. Near-infrared spectroscopy has been used extensively in cerebral monitoring during cardiac surgery. We present its use in monitoring lower extremity perfusion in patients on ECMO. Five patients on ECMO had near-infrared spectroscopy monitors placed on the calf of both lower extremities. Continuous real-time tissue oxygen saturation data (stO2) was displayed and recorded...
November 2014: Annals of Thoracic Surgery
Li-Chung Chiu, Feng-Chun Tsai, Han-Chung Hu, Chih-Hao Chang, Chen-Yiu Hung, Chung-Shu Lee, Shih-Hong Li, Shih-Wei Lin, Li-Fu Li, Chung-Chi Huang, Ning-Hung Chen, Cheng-Ta Yang, Yung-Chang Chen, Kuo-Chin Kao
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) can be used as a salvage therapy, but the effectiveness is controversial. The aim of this study was to investigate the predictors of mortality and the influence of organ dysfunction scores in severe acute respiratory distress syndrome (ARDS) patients treated with ECMO. METHODS: The records of adult severe ARDS patients receiving ECMO support from May 2006 to December 2011 at Chang Gung Memorial Hospital were retrospectively analyzed...
January 2015: Annals of Thoracic Surgery
Christian A Bermudez, Akira Shiose, Stephen A Esper, Norihisa Shigemura, Jonathan D'Cunha, Jay K Bhama, Thomas J Richards, Peter Arlia, Maria M Crespo, Joseph M Pilewski
BACKGROUND: The intraoperative use of cardiopulmonary bypass (CPB) in lung transplantation has been associated with increased rates of pulmonary dysfunction and bleeding complications. More recently, extracorporeal membrane oxygenation (ECMO) has emerged as a valid alternative method of support and has been our preferred method of support since March 2012. We compared early and midterm outcomes of these 2 support methods. METHODS: Between July 2007 and April 2013, 271 consecutive patients underwent lung transplant using CPB (n = 222) or ECMO (n = 49)...
December 2014: Annals of Thoracic Surgery
Sung Bum Park, Jeong Hoon Yang, Taek Kyu Park, Yang Hyun Cho, Kiick Sung, Chi Ryang Chung, Chi Min Park, Kyeongman Jeon, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Gee Young Suh
BACKGROUND: Limited data are available on a risk model for survival to discharge after extracorporeal membrane oxygenation (ECMO)-assisted cardiopulmonary resuscitation (ECPR). We aimed to develop a risk prediction model for survival to discharge in cardiac arrest patients who undergo ECMO. METHODS: Between January 2004 and December 2012, 505 patients supported by ECMO were enrolled in a retrospective, observational registry. Among those, we studied 152 adult patients with in-hospital cardiac arrest...
December 20, 2014: International Journal of Cardiology
Bruno Levy, Fabio S Taccone, Fabio Guarracino
No abstract text is available yet for this article.
March 2015: Intensive Care Medicine
Mauer Biscotti, Jonathan Yang, Joshua Sonett, Matthew Bacchetta
OBJECTIVE: This study compared differences in patient outcomes and operative parameters for extracorporeal membrane oxygenation (ECMO) versus cardiopulmonary bypass (CPB) in patients undergoing lung transplants. METHODS: Between January 1, 2008, and July 13, 2013, 316 patients underwent lung transplants at our institution, 102 requiring intraoperative mechanical cardiopulmonary support (CPB, n=55; ECMO, n=47). We evaluated survival, blood product transfusions, bleeding complications, graft dysfunction, and rejection...
November 2014: Journal of Thoracic and Cardiovascular Surgery
Matthias Lubnow, Alois Philipp, Maik Foltan, Tone Bull Enger, Dirk Lunz, Thomas Bein, Assad Haneya, Christof Schmid, Günter Riegger, Thomas Müller, Karla Lehle
OBJECTIVES: Technical complications are a known hazard in veno-venous extracorporeal membrane oxygenation (vvECMO). Identifying these complications and predictive factors indicating a developing system-exchange was the goal of the study. METHODS: Retrospective study on prospectively collected data of technical complications including 265 adult patients (Regensburg ECMO Registry, 2009-2013) with acute respiratory failure treated with vvECMO. Alterations in blood flow resistance, gas transfer capability, hemolysis, coagulation and hemostasis parameters were evaluated in conjunction with a system-exchange in all patients with at least one exchange (n = 83)...
2014: PloS One
David C Chu, Abdel Ghanie Abu-Samra, Grayson L Baird, Cynthia Devers, Joseph Sweeney, Mitchell M Levy, Christopher S Muratore, Corey E Ventetuolo
No abstract text is available yet for this article.
February 2015: Intensive Care Medicine
2014-12-17 12:13:33
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