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ECMO

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https://www.readbyqxmd.com/read/29907121/position-of-draining-venous-cannula-in-extracorporeal-membrane-oxygenation-for-respiratory-and-respiratory-circulatory-support-in-adult-patients
#1
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
https://www.readbyqxmd.com/read/29905854/comparison-of-temporary-ventricular-assist-devices-and-extracorporeal-life-support-in-post-cardiotomy-cardiogenic-shock
#2
Prashant N Mohite, Anton Sabashnikov, Achim Koch, Raj Binu, Ashok Padukone, Sundip Kaul, Olaf Maunz, Diana García-Sáez, Bartlomiej Zych, Mubassher Husain, Fabio De Robertis, Aron-Frederik Popov, André R Simon
OBJECTIVES: Post-cardiotomy cardiogenic shock (PCCS) results in substantial morbidity and mortality, whereas refractory cases require mechanical circulatory support (MCS). The aim of the study was to compare extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VADs) utilized in the management of PCCS. METHODS: In total, 56 consecutive patients who developed PCCS from 2005 to 2014 required MCS as a bridge to decision-24 were supported with a VAD and 32 with an ECMO...
June 13, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29863638/characteristics-risk-factors-and-outcomes-of-extracorporeal-membrane-oxygenation-use-in-pediatric-cardiac-icus-a-report-from-the-pediatric-cardiac-critical-care-consortium-registry
#3
Marissa A Brunetti, J William Gaynor, Lauren B Retzloff, Jessica L Lehrich, Mousumi Banerjee, Venugopal Amula, David Bailly, Darren Klugman, Josh Koch, Javier Lasa, Sara K Pasquali, Michael Gaies
OBJECTIVES: Cardiopulmonary failure in children with cardiac disease differs from the general pediatric critical care population, yet the epidemiology of extracorporeal membrane oxygenation support in cardiac ICUs has not been described. We aimed to characterize extracorporeal membrane oxygenation utilization and outcomes across surgical and medical patients in pediatric cardiac ICUs. DESIGN: Retrospective analysis of the Pediatric Cardiac Critical Care Consortium registry to describe extracorporeal membrane oxygenation frequency and outcomes...
June 2018: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/29885002/heart-re-transplantation-in-eurotransplant
#4
Jacqueline M Smits, Michel De Pauw, Uwe Schulz, Johan Van Cleemput, Philip Raake, Ivan Knezevic, Kadir Caliskan, Zeljko Sutlic, Christoph Knosalla, Felix Schoenrath, Zoltan Szabolcs, Jens Gottlieb, Christian Hagl, Andreas Doesch, Davor Baric, Igor Rudez, Agita Strelniece, Erwin De Vries, Dave Green, Undine Samuel, Davor Milicic, Istvan Hartyanszky, Michael Berchtold-Herz, P Christian Schulze, Friedrich Mohr, Bruno Meiser, Axel Haverich, Hermann Reichenspurner, Jan Gummert, Guenter Laufer, Andreas Zuckermann
Internationally 3% of the donor hearts are distributed to re-transplant patients. In Eurotransplant, only patients with a primary graft dysfunction (PGD) within one week after heart transplantation (HTX) are indicated for high urgency (HU) listing. The aim of this study is to provide evidence for the discussion on whether these patients should still be allocated with priority. All consecutive HTX performed in the period 1981- 2015 were included. Multivariate Cox' model was built including: donor and recipient age and gender, ischemia time, recipient diagnose, urgency status and era...
June 8, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/29712611/the-development-of-extracorporeal-membrane-oxygenation
#5
Don K Nakayama
Evolving from the development of heart-lung machines for open-heart surgery, extracorporeal membrane oxygenation has reemerged as a rescue modality for patients with acute respiratory failure that cannot be supported by conventional modes of ventilation. The history of extracorporeal membrane oxygenation begins with the discovery of heparin, fundamental to the success of extracorporeal circulation and membrane lungs. Engineers and scientists created suitable artificial membranes that allowed gas exchange while keeping gas and blood phases separate...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29872632/catheter-directed-thrombolysis-combined-with-ecmo-for-massive-pulmonary-emboli
#6
J Lauren Lindsey, Rajay Jain, Vidula Vachharajani
This case report discusses a previously healthy young male who suffered an in hospital cardiac arrest, found to be secondary to massive pulmonary emboli (PE). This patient was not a candidate for PE dosing of tPA, but continued to have worsening cardiogenic shock and acute hypoxic respiratory failure. The decision was made to initiate venoarterial extracorporeal membrane oxygenation (VA ECMO) in combination with catheter assisted thrombolysis. With time, the sequelae of his disease process changed. Although his cardiogenic shock improved, the hypoxemia worsened, and the patient was transitioned from VA to venovenous (VV) ECMO, while managing further complications due to multiple episodes of cardiac arrest and severe coagulopathy with multiple, acute, life-threatening bleeding events...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/29847341/nutritional-support-in-patients-with-extracorporeal-life-support-and-ventricular-assist-devices
#7
Christian Stoppe, Ekaterina Nesterova, Gunnar Elke
PURPOSE OF REVIEW: Extracorporeal life support (ECLS) including venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD) provide mechanical pulmonary and circulatory support, respectively, in patients with acute pulmonary or cardiovascular failure. This review discusses recently published data regarding specific topics of nutritional support in patients with ECLS and VAD. RECENT FINDINGS: ECLS may aggravate loss of endogenous and exogenous micronutrients and macronutrients...
May 29, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29852149/increasing-opportunity-for-lung-transplant-in-interstitial-lung-disease-with-pulmonary-hypertension
#8
Scott Chicotka, Felipe E Pedroso, Cara L Agerstrand, Erika B Rosenzweig, Darryl Abrams, Tom Benson, Aimee Layton, Daniel Burkhoff, Daniel Brodie, Matthew D Bacchetta
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) for end-stage interstitial lung disease (ILD) and pulmonary hypertension (PH) has varying results based on ECMO configuration. We compare our experience using venovenous (VV) and venoarterial (VA) ECMO BTT for ILD with PH on survival to successful transplantation. METHODS: A single center retrospective review of patients with ILD and secondary PH who were placed on either VV or VA ECMO as BTT from 2010 to 2016...
May 28, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29788836/intracranial-hemorrhage-in-adults-on-ecmo
#9
Yiorgos Alexandros Cavayas, Lorenzo Del Sorbo, Eddy Fan
RATIONALE: Extracorporeal membrane oxygenation (ECMO) use has exploded over the last decade. However, it remains invasive and associated with significant complications, including tamponade, infection, thrombosis, gas embolism and bleeding. The most dreaded complication is intracranial hemorrhage (ICH). In this article, we review the literature on the incidence, diagnosis, risk factors, pathophysiology, prognosis, prevention and management of ICH in adults on ECMO. MAIN FINDINGS: We found a high incidence of ICH in the literature with a poor prognosis...
May 2018: Perfusion
https://www.readbyqxmd.com/read/29789779/outcomes-in-cardiogenic-shock-patients-with-extracorporeal-membrane-oxygenation-use-a-matched-cohort-study-in-hospitals-across-the-united-states
#10
Rayan El Sibai, Rana Bachir, Mazen El Sayed
Background: ECMO is increasingly used for patients with critical illnesses. This study examines ECMO use in patients with cardiogenic shock in US hospitals and associated outcomes (mortality, hospital length of stay, and total hospital charges). Methods: A matched cohort retrospective study was conducted using the 2013 Nationwide Emergency Department Sample. Cardiogenic shock visits were matched (1 : 1) and compared based on ECMO use. Results: Patients with ECMO ( N = 802) were compared to patients without ECMO ( N = 805)...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29791822/extracorporeal-membrane-oxygenation-for-severe-acute-respiratory-distress-syndrome
#11
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/29792510/in-reply-to-intra-aortic-balloon-pump-protects-against-hydrostatic-pulmonary-oedema-during-peripheral-venoarterial-extracorporeal-membrane-oxygenation
#12
Jamie R Privratsky, Sebastian Diaz, Alina Nicoara, Mani A Daneshmand
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly utilized life-saving measure. However, left-ventricular distention from inadequate left-ventricular off-loading can lead to unwanted pulmonary and cardiac complications. We are writing to indicate our agreement with a recent article by Brechot et al. published in the June 2017 issue where the authors demonstrated that intra-aortic balloon pump provides mechanical support to off-load the left ventricle during VA-ECMO, which prevents pulmonary edema...
May 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29792775/a-narrative-review-of-the-technical-standards-for-extracorporeal-life-support-devices-pumps-and-oxygenators-in-europe
#13
Matteo Di Nardo, Leen Vercaemst, Justyna Swol, Nicholas Barret, Fabio S Taccone, Maximilian V Malfertheiner, Lars M Broman, Federico Pappalardo, Jan Belohlavek, Thomas Mueller, Roberto Lorusso, Margherita Lonero, Mirko Belliato
This review summarizes the European rules to control the market when introducing new products. In particular, it shows all the steps to achieve the European Conformity (CE Mark), a certification that all new medical products must achieve before being used in Europe. Extracorporeal membrane oxygenation (ECMO) devices are exposed to the same procedures. Hereby, we present some regulatory issues regarding pumps and oxygenators, providing technical details as released by the manufacturers on their websites and information charts...
April 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29779449/continuous-cytokine-haemoadsorption-incorporated-into-a-venoarterial-ecmo-circuit-for-the-management-of-postcardiotomy-cardiogenic-and-septic-shock-a-case-report
#14
Endre Nemeth, Szabolcs Szigeti, Tamas Varga, Laszlo Daroczi, Zoltan Barati, Bela Merkely, Janos Gal
INTRODUCTION: The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory processes. Cytokine haemoadsorption is an extracorporeal technique which has benefits reported in haemodynamic stability and inflammatory response. CASE REPORT: A 46-year-old male patient underwent emergency cardiac surgery due to progressive IE. Postcardiotomy cardiogenic shock associated with cardiac surgery required the implantation of venoarterial (VA)-ECMO...
May 1, 2018: Perfusion
https://www.readbyqxmd.com/read/29774551/in-vitro-hemodynamic-evaluation-of-an-adult-pulsatile-extracorporeal-membrane-oxygenation-system
#15
Shigang Wang, Morgan Moroi, Christoph E Brehm, Allen R Kunselman, Akif Ündar
The objective of this study was to evaluate a pulsatile extracorporeal membrane oxygenation (ECMO) system in terms of hemodynamic energy generation and transmission under various pulsatile amplitudes, flow rates, and pseudopatient pressures in a simulated adult ECMO circuit. Surplus hemodynamic energy (SHE), a measure of the quality of pulsatility, was used to quantify pulsatile flow. The circuit consisted of an i-cor diagonal pump, an adult XLung oxygenator, a 21 Fr Medtronic Biomedicus femoral arterial cannula, a 23/25 Fr Sorin RAP femoral venous cannula, and 3/8 in ID tubing for both arterial and venous lines...
May 17, 2018: Artificial Organs
https://www.readbyqxmd.com/read/29768983/anticoagulation-monitoring-under-ecmo-support-a-comparative-study-between-the-activated-coagulation-time-and-the-anti-xa-activity-assay
#16
Clément Delmas, Aemilia Jacquemin, Fanny Vardon-Bounes, Bernard Georges, Felipe Guerrero, Nicolas Hernandez, Bertrand Marcheix, Thierry Seguin, Vincent Minville, Jean-Marie Conil, Stein Silva
PURPOSE: Extra Corporeal Membrane Oxygenation (ECMO) is used in cases of severe respiratory and/or circulatory failure over periods of several days to several weeks. Its circuitry requires a closely monitored anticoagulation therapy that is empirically supported by activated clotting time (ACT)-a method often associated with large inter- and intraindividual variability. We aimed to compare the measurement of heparin activity with ACT and the direct measurement of the heparin activity (anti-Xa) in a large ECMO population...
January 1, 2018: Journal of Intensive Care 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
#17
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/29757910/ishlt-primary-graft-dysfunction-incidence-risk-factors-and-outcome-a-uk-national-study
#18
Sanjeet Singh Avtaar Singh, Nicholas R Banner, Sally Rushton, Andre R Simon, Colin Berry, Nawwar Al-Attar
BACKGROUND: Heart transplantation (HTx) remains the most effective long-term treatment for advanced heart failure. Primary graft dysfunction (PGD) continues to be a potentially life-threatening early complication. In 2014, a consensus statement released by ISHLT established diagnostic criteria for PGD. We studied the incidence of PGD across the UK. METHODS: We analysed the medical records of all adult patients who underwent heart transplantation between October 2012-October 2015 in the 6 UK heart transplant centers Preoperative donor and recipient characteristics, intraoperative details and posttransplant complications were compared between the PGD and non PGD groups using the ISHLT definition...
May 1, 2018: Transplantation
https://www.readbyqxmd.com/read/29753504/extracorporeal-life-support-for-adults-with-refractory-septic-shock
#19
Sun Kyun Ro, Wan Kee Kim, Ju Yong Lim, Jae Suk Yoo, Sang-Bum Hong, Joon Bum Kim
OBJECTIVE: Although the use of extracorporeal membrane oxygenation (ECMO) in shock patients is increasing worldwide, studies concerning this treatment for adult septic shock are limited. This study aimed to analyze the outcome of venoarterial ECMO in adult patients with septic shock refractory to conventional treatment. METHODS: A total of 71 consecutive patients who presented with septic shock and underwent venoarterial ECMO were reviewed. Clinical parameters were compared between survivors and nonsurvivors...
April 7, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29746314/impact-of-anticoagulation-and-circuit-technology-on-complications-during-extracorporeal-membrane-oxygenation
#20
Robert A Niebler, Hinah Parker, George M Hoffman
The objective of this study is to evaluate the impact a change in anticoagulation protocol and circuit technology had on bleeding and thrombotic complications in patients supported on extracorporeal membrane oxygenation (ECMO). A retrospective review at a tertiary, academic pediatric intensive care unit was undertaken. The anticoagulation protocol changed from targeting an activated clotting time (ACT) to anti-Xa level. Significant changes in the ECMO circuit were undertaken concurrently. One-hundred and fifty-two ECMO runs in 129 patients in the ACT target group were compared with 122 ECMO runs in 101 patients in the anti-Xa target group...
May 8, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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