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Evaluation, Treatment, and Impact of Neurologic Injury in Adult Patients on Extracorporeal Membrane Oxygenation: a Review

Extracorporeal membrane oxygen (ECMO) is increasingly used as an advanced form of life support for cardiac and respiratory failure. Unfortunately, in infrequent instances, circulatory and/or respiratory recovery is overshadowed by neurologic injury that can occur in patients who require ECMO. As such, knowledge of ECMO and its implications on diagnosis and treatment of neurologic injuries is indispensable for intensivists and neurospecialists.

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ECMO Combined with Prone Positioning Strategies In COVID-19 Respiratory Distress Syndrome

Previous evidence from similar patient populations proved that carefully selected patients with severe ARDS who did not benefit from conventional treatment might be successfully supported with Veno-Venous extracorporeal membrane oxygenation (V-V ECMO). We now share the case reports of COVID-19 patients with ECMO combined prone position strategies.

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Red Blood Cell Transfusion Requirements for Patients on Extracorporeal Membrane Oxygenation

Patients without clinical bleeding still required transfusion, with higher rates observed with VA- than VV-ECMO. Transfusion requirements dramatically increased when patients developed various bleeding complications and had a significant impact on 30-day mortality rate.

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Insight into ECMO, Mortality and ARDS: A Nationwide Analysis of 45,647 ECMO Runs

The choice of support mode depends largely on the indication. Patients with respiratory failure are predominantly treated with a venovenous (VV) approach. We hypothesized that mortality in Germany in ECLS therapy did not differ from previously reported literature

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Using A Roller Pump for Establishing Extra-Corporal Membrane Oxygenation (ECMO) – Technical Considerations for Times of Crisis

Roller pumps with silicone tubing but not PVC tubing may be used for running ECMO circuits. Silicone tubing may endure the roller pump shear forces for up to 1 week. Thus, repeated tubing repositioning may be a solution. Circuit heating and substantial limitations in flow detection should increase attention if clinical use in situations of crisis is considered.

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Concomitant Respiratory Failure Can Impair Myocardial Oxygenation in Patients with Acute Cardiogenic Shock Supported by VA-ECMO

These results illustrate the conditions where NSS will develop and the relative cardiac function that will lead to organ-specific hypoxia.

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Extracorporeal Life Support in COVID-19-related Acute Respiratory Distress Syndrome – a EuroELSO international survey

ECLS has been utilized successfully during the COVID‐19 pandemic to stabilize CARDS patients in hypoxemic or hypercapnic lung failure. Age and multimorbidity limited the use of ECLS. Triage situations were rarely a concern. ECLS providers stated that patients with severe COVID‐19 benefitted from ECLS.

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Association of D-dimer and Fibrinogen With Hypercoagulability in COVID-19 Requiring Extracorporeal Membrane Oxygenation

In critically ill patients with COVID-19 treated with ECMO, D-dimer concentration had an inverse relationship with degree of hypercoagulability as measured by TEG MA. D-dimer elevation may potentially reflect hemostatic perturbation in patients on ECMO or the severity of COVID-19 related sepsis rather than designate patients likely to benefit from anticoagulation. Fibrinogen concentration may represent a more useful marker of hypercoagulability in this population.

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Venovenous Versus Venoarterial Extracorporeal Membranous Oxygenation in Inotrope Dependent Pediatric Patients With Respiratory Failure

This retrospective multicenter study compared outcomes for 103 pediatric patients, with hemodynamic compromise, placed on VV ECMO for respiratory failure to those placed on VA ECMO.

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Efficacy of Prophylactic Antibiotics during Extracorporeal Membrane Oxygenation: A Nationwide Cohort Study

Extracorporeal membrane oxygenation (ECMO) is widely used worldwide, and many hospitals consider using antibiotics to prevent nosocomial infection in ECMO patients. However, the efficacy of antimicrobial prophylaxis for patients receiving ECMO remains unclear.

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A Computational Fluid Dynamics Study of the Extracorporeal Membrane Oxygenation-Failing Heart Circulation

Using an idealized geometry of the aorta and its major branches and a peripherally inserted return cannula terminating in the iliac artery, computational fluid dynamic simulations were performed to (1) quantify perfusion as function of relative ECMO flow and (2) describe the watershed region produced by the collision of antegrade flow from the heart and retrograde ECMO flow.

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Dual Veno-Arterial Extra-Corporeal Membrane Oxygenation Support in A Patient with Refractory Hyperdynamic Septic Shock: A Case Report

The commencement of a second jugulo-axillary VA ECMO secured a total blood flow of 14.3 L/min, which restored perfusion pressure and successfully bridged patient over the period of critical haemodynamic instability and ultimately may have facilitated recovery.

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Survival of Pregnant Coronavirus Patient on Extracorporeal Membrane Oxygenation

She was discharged to home and gave birth to a healthy baby girl at 39 weeks’ gestation. Using VV-ECMO, this patient and her fetus survived acute hypoxemic respiratory failure due to COVID-19.

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Use of ECMO in Patients With Coronavirus Disease 2019: Does the Evidence Suffice?

In conclusion, these authors recommend ECMO use in COVID-19 but with caution and in compliance with current guidelines. While evidence advocating ECMO use in COVID-19 is not substantial, ongoing studies may provide new insight in ECMO use in COVID-19 patients in critical cases. To ensure optimal patient care, a case-by-case approach should be implemented, with risk-benefit analysis conducted for each patient

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Hemoadsorption Eliminates Remdesivir from the Circulation: Implications for the Treatment of COVID-19

Both antiviral treatment with remdesivir and hemoadsorption using a CytoSorb® adsorption device are applied in the treatment of severe COVID-19. The CytoSorb® adsorber consists of porous polymer beads that adsorb a broad range of molecules, including cytokines but also several therapeutic drugs. In this study, we evaluated whether remdesivir and its main active metabolite GS-441524 would be adsorbed by CytoSorb®.

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Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial

Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days.

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Outcomes of Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome due to COVID-19: The Lessons Learned from the First Wave of COVID-19

Extracorporeal membrane oxygenation (ECMO) has been used as a refractory treatment for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19), but there has been little evidence of its efficacy. We conducted this study to share our experience using ECMO as a bridge to recovery for ARDS due to COVID-19.

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Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome: How do we Expand Capacity in the COVID-19 Era?

Despite advances in medical technology, the mortality rate for severe acute respiratory distress syndrome (ARDS) remains high at around 40%. In recent years, multiple studies, systematic reviews, and meta-analyses, including the study in this issue of Heart, Lung and Circulation published by Wang and colleagues, have indicated that treatment with veno-venous extracorporeal membrane oxygenation (VV-ECMO) may be associated with better outcomes in severe ARDS than conventional mechanical ventilation.

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Recirculation in Extracorporeal Membrane Oxygenation: The Warning Comes From the Cannula

In conclusion, poor oxygenation under ECMO with alternation of bright red and dark red blood in the drainage cannula must refer to recirculation by cannula misplacement. Transesophageal echocardiography must be performed first when there is a lack of oxygenation during venovenous ECMO.

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Prone Positioning during Venovenous Extracorporeal Membrane Oxygenation in Acute Respiratory Distress Syndrome. A Multicenter Cohort Study and Propensity-matched Analysis

The aim of the study was to assess the feasibility, safety, and effect on oxygenation and lung mechanics of PP during ECMO. As a secondary exploratory aim, we assessed the association between PP and hospital mortality.

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Impact of CytoSorb on Kinetics of Vancomycin and Bivalirudin in Critically ill Patients

CytoSorb is effective in mitigating the systemic inflammatory response and safe with respect to vancomycin and bivalirudin administration. These preliminary data further support the use of CytoSorb as adjunct therapy in critically ill patients.

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Outcome Prediction in Patients with Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation-A Retrospective International Multicenter Study

In this study, we assess survival in an international multicenter cohort of COVID-19 patients treated with V-V ECMO and evaluate the performance of several clinical scores to predict 30-day survival.

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Efficacy of Multidisciplinary Team Approach with Extracorporeal Membrane Oxygenation for COVID-19 in Low Volume ECMO Center

Veno-venous extracorporeal membrane oxygenation (VV ECMO) is an effective and proven adjunct support for various severe respiratory failure requiring invasive mechanical ventilation and cardiovascular support. In response to the rapidly increasing number of COVID-19 patients in Japan, we launched an ECMO support team comprised of multidisciplinary experts including physicians, nurses, perfusionists, and bioethicists in preparation for the threat of a pandemic.

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Comparison of Anticoagulation Strategies in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: Heparin Versus Bivalirudin

We sought to compare extracorporeal membrane oxygenation circuit thrombosis and bleeding-related outcomes in respiratory failure patients receiving either unfractionated heparin or bivalirudin for anticoagulation on venovenous extracorporeal membrane oxygenation support.