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Chi-Cheng Huang, Jung-Cheng Hsu, Yen-Wen Wu, Shin-Rong Ke, Jih-Hsin Huang, Kuan-Ming Chiu, Pen-Chih Liao
BACKGROUND: The mortality of patients with ST-segment elevation myocardial infarction (STEMI) and refractory cardiogenic shock (RCS) is high. Extracorporeal membrane oxygenation (ECMO) before percutaneous coronary intervention (PCI) has shown some favorable results, but this may delay door-to-balloon (D2B) time. Whether the benefit surpasses the risk of longer D2B time remains controversial. METHODS: From January 2005 to December 2014, there were 46 patients with STEMI RCS who received ECMO and PCI...
July 7, 2018: International Journal of Cardiology
Juwon Kim, Yang Hyun Cho, Kiick Sung, Taek Kyu Park, Ga Yeon Lee, Joo Myung Lee, Young Bin Song, Joo-Yong Hahn, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Jeong Hoon Yang
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is an effective mechanical circulatory support for cardiopulmonary failure. Conventionally, an arterial cannula over 15 Fr is inserted for full circulatory support in peripheral VA ECMO. However, limited data are available regarding the impact of cannula size on clinical and procedural outcomes. Between January 2014 and April 2016, 165 patients underwent peripheral VA ECMO with femoral artery cannulation were enrolled in a single-center registry. We classified patients into two groups according to the arterial cannula's size: "small cannula group" (14-15 Fr, n = 87) and "large cannula group" (16-21 Fr, n = 78)...
July 25, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Matteo Di Nardo, Piero David, Francesca Stoppa, Roberto Lorusso, Massimiliano Raponi, Antonio Amodeo, Corrado Cecchetti, Yigit Guner, Fabio S Taccone
Background: Extracorporeal membrane oxygenation (ECMO) is used to support patients with severe respiratory and/or cardiac failure unresponsive to conventional treatments. Despite being one of the most complex supportive therapy used in intensive care unit, there is a still a lack of training programs dedicated to improve both clinical and nonclinical skills. The aim of the current study was to evaluate if the introduction of an ECMO high-fidelity simulation curriculum among personnel reduces the times to manage bedside emergencies and improves the behavioral skills...
June 2018: Journal of Thoracic Disease
Anil K Pillai, Zagum Bhatti, Andrew J Bosserman, Manoj C Mathew, Kaza Vaidehi, Sanjeeva P Kalva
Extra-corporeal membrane oxygenation (ECMO) is a well-established treatment for cardiopulmonary failure. Based on the requirement for cardiac and or respiratory support different configurations of ECMO circuits are utilized. Vascular complication of ECMO constitutes the most important determinant of treatment outcomes. The complications are primarily related to limb ischemia, vascular injury, hemorrhage, and infection. Endovascular and surgical treatment options are the cornerstone for managing vascular complications of ECMO...
June 2018: Cardiovascular Diagnosis and Therapy
Mark A Roll, Suzanne Kuys, James R Walsh, Oystein Tronstad, Marc D Ziegenfuss, Dan V Mullany
BACKGROUND: The study aims to determine long-term survival, health-related quality of life (HRQoL) and functional and physical outcomes of adult extra corporeal membrane oxygenation (ECMO) patients as there are limited and conflicting data in this area. METHODS: All patients receiving ECMO from April 2009 until June 2014 at The Prince Charles Hospital, Brisbane had Kaplan Meier survival calculated. Quality of life (QoL) was assessed using the Short Form Health Survey (SF-36v2), EQ5D-5L, The Frenchay Activities Index (FAI) and a return to work survey...
July 5, 2018: Heart, Lung & Circulation
Tariq Lescouflair, Ronald Figura, Anthony Tran, Ahmet Kilic
Extracorporeal life support (ECLS)/extracorporeal membrane oxygenation (ECMO) is a powerful tool in the surgeon's armamentarium. The rapid evolution of ECLS over the last four decades has improved survival in patients with cardiopulmonary failure. With the pandemic outbreak of H1N1 in 2009 and onward, the application of ECLS has only risen. Yet, amongst the outcomes reporting and improved survival, the water remains hazy in terms of outcome predictors as well as discovery of the "ideal" system. There remains much room for innovation and research related to circuit construction, ideal flow, myocardial recovery, and additional applications of ECLS...
June 2018: Journal of Thoracic Disease
Marlena V Habal, Lauren Truby, Masahiko Ando, Hirohisa Ikegami, Arthur R Garan, Veli K Topkara, Paolo Colombo, Koji Takeda, Hiroo Takayama, Yoshifumi Naka, Maryjane A Farr
With the impending United Network for Organ Sharing (UNOS) heart allocation policy giving VA-ECMO supported heart transplant (HT) candidates highest priority status (Tier 1), identifying patients in cardiogenic shock (CS) with severe and irreversible heart failure (HF) appropriate for urgent HT, is critically important. In a centre where wait times currently preclude this approach, we retrospectively reviewed 119 patients (ages 18-72) with CS from 1/2014 - 12/2016 who required VA-ECMO for > 24h. Underlying aetiologies included postcardiotomy shock (45), acute coronary syndromes (33), and acute on chronic HF (16)...
July 23, 2018: Clinical Transplantation
Dirk Lunz, Alois Philipp, Christoph Birner
PURPOSE: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used to support conventional unsuccessful resuscitation and it is mandatory to rapidly initiate invasive hemodynamic monitoring, as soon as ECPR therapy is commenced. Commonly, this is achieved by establishing an additional arterial line via the right radial artery for invasive blood pressure measurement, but this can be challenging and risky on the one hand and might lead to erroneous measurements on the other hand...
July 17, 2018: Journal of Critical Care
Paolo Meani, Thijs Delnoij, Giuseppe M Raffa, Nuccia Morici, Giovanna Viola, Alice Sacco, Fabrizio Oliva, Sam Heuts, Jan-Willem Sels, Rob Driessen, Paul Roekaerts, Martijn Gilbers, Elham Bidar, Rick Schreurs, Ehsan Natour, Leo Veenstra, Suzanne Kats, Jos Maessen, Roberto Lorusso
BACKGROUND: Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO. METHODS: Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified...
July 1, 2018: Perfusion
Rasha Al-Bawardy, Kenneth Rosenfield, Jorge Borges, Michael N Young, Mazen Albaghdadi, Rachel Rosovsky, Christopher Kabrhel
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry. METHODS: We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO...
July 1, 2018: Perfusion
Virginie Fouilloux, Célia Gran, Christophe Guervilly, Jean Breaud, Fedoua El Louali, Pierre Rostini
INTRODUCTION: Medical and para-medical education is one of the key points of healthcare strategy. Training and education based on high-fidelity simulation is one of the gold standards in modern healthcare institutions. We describe a model of training dedicated to ICU nurses in charge of patients with ECMO. The aim of our educational tool was to teach ICU nurses ECMO basic knowledge and skills. METHODS: An ECMO Specialist Course Committee implemented the training programme...
July 1, 2018: Perfusion
Tobias Wengenmayer, Daniel Duerschmied, Erika Graf, Marco Chiabudini, Christoph Benk, Sven Mühlschlegel, Alois Philipp, Matthias Lubnow, Christoph Bode, Dawid Leander Staudacher
AIMS: Several scoring systems have been introduced for prognostication after initiating venoarterial extracorporeal membrane oxygenation (VA-ECMO) therapy. However, static scores offer limited guidance once VA-ECMO is implanted, although continued allocation of healthcare resources is critical. Patients requiring continued VA-ECMO support are extremely unstable, with minimal heart function and multi-organ failure in most cases. The aim of the present study was to develop and validate a dynamic prognostic model for patients treated with VA-ECMO...
July 1, 2018: European Heart Journal. Acute Cardiovascular Care
Christopher J Tignanelli, Allison Weinberg, Lena M Napolitano
Ambulation while on extracorporeal membrane oxygenation (ECMO) is critical to facilitate native pulmonary recovery for patients with acute respiratory failure and is a prerequisite for listing for lung transplantation to achieve optimal outcomes. The development of a bicaval dual-lumen cannula capable of providing venovenous (VV) ECMO support via the internal jugular vein has greatly facilitated ambulation and rehabilitation programs. But cannula dislodgement is a serious concern with ambulation and rehabilitation, especially when minor cannula migration can significantly impact VV-ECMO flow...
July 12, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Mary E Keebler, Elias V Haddad, Chun W Choi, Stuart McGrane, Sandip Zalawadiya, Kelly H Schlendorf, D Marshall Brinkley, Matthew R Danter, Mark Wigger, Jonathan N Menachem, Ashish Shah, JoAnn Lindenfeld
Venoarterial extracorporeal membrane oxygenation has emerged as a viable treatment for patients in cardiogenic shock with biventricular failure and pulmonary dysfunction. Advances in pump and oxygenator technology, cannulation strategies, patient selection and management, and durable mechanical circulatory support have contributed to expanded utilization of this technology. However, challenges remain that require investigation to improve outcomes.
June 2018: JACC. Heart Failure
Nao Umei, Shingo Ichiba, Atsuhiro Sakamoto
According to the Extracorporeal Life Support Organization, the average duration of veno-venous extracorporeal membrane oxygenation (V-V ECMO) in adults with acute respiratory failure is 10.5-13.5 days. Some patients on V-V ECMO may not recover in such a short period of time, and recently, there have been more reports of prolonged V-V ECMO. However, we do not know how long it is feasible to wait for native lung recovery or lung transplant (LTx) with the use of ECMO. We describe a patient with acute exacerbation of idiopathic pulmonary fibrosis supported by ECMO for 403 days while waiting for a LTx...
2018: Respiratory Medicine Case Reports
Giuseppe Maria Raffa, Mariusz Kowalewski, Daniel Brodie, Mark Ogino, Glenn Whitman, Paolo Meani, Michele Pilato, Antonio Arcadipane, Thijs Delnoj, Eshan Natour, Sandro Gelsomino, Jos Maessen, Roberto Lorusso
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) application in post-cardiotomy shock (PCS) and non-PCS is increasing. VA-ECMO plays a critical role in the management of these patients, yet may be associated with serious complications. METHODS: A systematic review of all available reports in the literature of patients receiving VA-ECMO, either directly or indirectly comparing central cannulation (right atrial to ascending aorta) versus peripheral cannulation (femoral vein to femoral artery or axillary artery) were analyzed...
June 27, 2018: Annals of Thoracic Surgery
Feng Yang, Dengbang Hou, Jinhong Wang, Yongchao Cui, Xiaomeng Wang, Zhichen Xing, Chunjing Jiang, Xing Hao, Zhongtao Du, Xiaofang Yang, Yu Jiang, Xiaotong Hou
BACKGROUND: The rate, prognostic impacts, and predisposing factors of major vascular complications (MVCs) in patients underwent venoarterial extracorporeal membrane oxygenation (VA-ECMO) by surgical cut-down are poorly understood. The purpose of this study was to identify these parameters in adult VA-ECMO patients. METHODS: Adult postcardiotomy cardiogenic shock (PCS) patients receiving VA-ECMO by femoral surgical cut-down cannulation from January 2004 to December 2015 were enrolled in this study...
June 19, 2018: Annals of Intensive Care
Ashley B Hodge, Matthew A Deitemyer, Victoria L Duffy, Dmitry Tumin, Dorothy A Garbin, Kathleen K Nicol, Don Hayes, Mary J Cismowski, Andrew R Yates
Hemolysis is a known consequence of extracorporeal membrane oxygenation (ECMO) resulting from shear force within the different components of the extracorporeal circuit. The primary aim of this study was to evaluate the EOS PMP™ oxygenator for generation of plasma free hemoglobin (PfHg) over 24 hours at nominal operating range flow rates. The EOS ECMO™ (LivaNova, Inc.; formerly Sorin, Arvada, CO) is equipped with a plasma tight polymethylpentene (PMP) hollow fiber oxygenator. We hypothesized that PfHg generation would be elevated in circuits with higher flow rates, because of the significant pressure drop across the oxygenator according to manufacturer provided flow charts...
June 2018: Journal of Extra-corporeal Technology
Jacob McNinch, Bruce Searles, Edward Darling
Extracorporeal membrane oxygenation (ECMO) is often managed using minimal anticoagulation. This can make the circuitry susceptible to thrombosis. The ECMO cannula may be particularly vulnerable to thrombosis if flow is interrupted for an undetermined but prolonged period of time. Therefore, under conditions where cannula blood flow stasis may be prolonged and flashing, the cannulae is not an option (e.g., air in circuit) it is imperative to have an emergency plan available, which can be rapidly implemented that will provide a means of cannula patency preservation...
June 2018: Journal of Extra-corporeal Technology
B Frenckner, M Broman, M Broomé
Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients with severe pulmonary and/or cardiac failure. Blood is drained from the venous system and pumped through a membrane oxygenator where it is oxygenated. For pulmonary support, the blood is returned to the patient via a vein (veno-venous ECMO) and for pulmonary/circulatory support it is returned via an artery (veno-arterial ECMO).Veno-venous ECMO can be performed either with a single dual-lumen cannula or with two separate single-lumen cannulas...
June 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
2018-06-18 16:55:38
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