Acute Kidney Injury During Extracorporeal Membrane Oxygenation: VA ECMO Versus VV ECMO
Although mortality rates related to AKI/severe AKI during VV ECMO are high, the occurrence of AKI/severe AKI during VA ECMO should be given greater attention, as these instances are considered strong indicators of patient deterioration and even death. Additional studies are needed to corroborate these findings.
Cerebral Microemboli during Extracorporeal Life Support: A Single-Centre Cohort Study
Our results indicate that adult ECLS patients are continuously exposed to many gaseous and, frequently, to few solid cerebral microemboli. Prolonged cerebral microemboli formation may contribute to neurological morbidity related to ECLS treatment.
Acute Kidney Injury and Extracorporeal Membrane Oxygenation: Review on Multiple Organ Support Options
The combination of CRRT and ECMO can be considered a form of multiple organ support therapy, but this approach still requires optimization in timing, set-up, anticoagulation, prescription and delivery. The aim of this report is to review the pathophysiology of AKI, the CRRT delivery, anticoagulation strategies and outcomes of patients with AKI treated with ECMO.
Centrifugal and Roller Pumps in Neonatal & Pediatric Extracorporeal Membrane Oxygenation
A total of four studies with 9111 patients were included. There was a statistically significant difference in in-hospital mortality, favoring the groups where roller pumps were used. Roller pumps were associated with fewer episodes of hemolysis, mechanical complications, cardiac complications, renal complications, and less inotropic support. ECMO with roller pumps may be associated with lower mortality in children. Roller pumps were associated with fewer complications, as well as reduced hemolysis and use of inotropes.
Dynamic and Hybrid Configurations for Extracorporeal Membrane Oxygenation
We concluded that dynamic or hybrid ECMO configurations were used in various underlying diseases, in which V-AV was most commonly used. Patients receiving VV ECMO for respiratory support initially, who then converted to other configurations for both respiratory and circulatory support, had significantly worst outcomes among the groups studied. The initial configuration should be selected carefully after thorough assessment of patient condition.
Severe Thrombocytopenia in Adults Undergoing Extracorporeal Membrane Oxygenation is Predictive of Thrombosis
Over a quarter of patients requiring ECMO developed severe thrombocytopenia in our cohort, which was associated with an increased risk of thrombosis and in-hospital mortality. Additional prospective observation is required to clarify the clinical implications of severe thrombocytopenia in the ECMO patient population.
Clinician Ethical Perspectives on Extracorporeal Membrane Oxygenation in Practice
Adequate informed consent for ECMO is a major ethical challenge, and the content of these discussions varies. Use of categorical exclusion criteria and withdrawal of ECMO if a patient cannot be liberated from it differ among departments and institutions.
Veno-Arterial Extracorporeal Membrane Oxygenation with Concomitant Impella Versus Concomitant Intra-Aortic-Balloon-Pump for Cardiogenic Shock
Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.
Use Of Bivalirudin for Anticoagulation in Pediatric Extracorporeal Membrane Oxygenation (ECMO)
This study describes the use of bivalirudin in children on extracorporeal membrane oxygenation (ECMO). Pediatric patients receiving bivalirudin were compared to patients receiving heparin as the anticoagulant on ECMO. Bivalirudin may provide stable and successful anticoagulation in children. Further large, multicenter studies are needed to confirm these finding
Complications of Peripheral Cannulation Site in Obese Patients on Adult Extracorporeal Membrane Oxygenation
There is significant increased risk of bleeding with peripheral VA cannulation of obese patients with BMI > 35. Cannulating surgeon should be aware of this bleeding risk in morbidly obese patient who undergo VA ECMO.
Essential Topics in the Management of Venovenous Extracorporeal Membrane Oxygenation in COVID-19 Acute Respiratory Distress Syndrome
Management of mechanical circulatory support in COVID-19 ARDS requires a highly resourced multidisciplinary ICU team and the ability to nimbly develop protocols for care for this new patient population. Here the authors discuss some unique aspects of care using VV ECMO management in COVID-19 ARDS.
Invasive Hemodynamic and Physiologic Considerations in Patients Undergoing Extracorporeal Membrane Oxygenation
In conclusion, we wish to stress the importance of a thoughtful interpretation of hemodynamic parameters in patients undergoing ECMO support in order to make appropriate management decisions.
Experience With the Crescent® Cannula for Adult Respiratory VV ECMO: A Case Series
The Crescent® is a safe and effective device by which to deliver VV ECMO support to patients with severe acute respiratory failure.
Similar Frequency of Atrial Perforation Between Atrial and Bicaval Dual Lumen Veno-Venous ECMO Cannulas in A Pediatric Population
There were no significant differences in frequency of pericardial effusions or severe cannula-related complications between the treatment groups across all pediatric patients and within the subgroup of patients under 2 years of age.
Diagnostic Yield of Routine Daily Blood Culture in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation
Although routine daily BCs are less effective than on-demand BCs and expose to contamination and inappropriate antimicrobial therapy, a policy restricted to on-demand BCs would omit a significant proportion of BSIs. This argues for a tailored approach to routine daily BCs on V-A ECMO, based on risk factors for positivity.
Extracorporeal Membrane Oxygenation for COVID-19: Updated 2021 Guidelines from the Extracorporeal Life Support Organization
Given the paucity of available data when prior ECMO guidelines were published, this guideline has been created to summarize currently available literature and offer recommendations to update select areas within the previous guidelines. This document will focus on care specific to COVID-19 patients receiving ECMO and recommended alterations in the utilization of ECMO during a pandemic. We recommend referral to existing guidelines for general ECMO practices.
Can Heparin-Coated ECMO Cannulas Induce Thrombocytopenia in COVID-19 Patients?
Careful consideration of anticoagulant therapy and ECMO circuit, as well as routine HIT antibody testing, may prevent a fatal course in ECMO-supported COVID-19 patients.
Pulsatility Protects the Endothelial Glycocalyx During Extracorporeal Membrane Oxygenation
The maintenance of the PWSS by pulsatility during ECMO possesses beneficial effects on glycocalyx integrity. Moreover, pulsatility prevents EndMT in endothelial cells, and low pulsatility exhibits the best protective effects. The augmentation of pulsatility may be a plausible future direction to improve the clinical outcome in ECMO.
Neonatal Respiratory and Cardiac ECMO in Europe
ECMO is a life support with a potential impact on long-term patients’ outcomes. In the next years, advances in knowledge, technology, and expertise may push neonatal ECMO boundaries towards more premature and increasingly complex infants, with the final aim to reduce the burden of ECMO-related complications and improve overall patients’ outcomes.
CPB and ECMO Cannulation Survey
We are seeking input from clinical perfusionists, cardiac surgeons, and clinicians responsible for the care and placement of femoral cannula in patients’ requiring extracorporeal circulation
Evaluation of Extracorporeal Membrane Oxygenation Therapy as a Bridging Method
Our study suggests bridging ECMO patients to an LVAD before transplantation will result in improved 1-year survival compared with patients bridged to immediate transplantation. With the new heart allocation system, continued evaluation of outcomes is required to inform management strategies.
The Ethics of Extracorporeal Membrane Oxygenation: Revisiting the Principles of Clinical Bioethics
ECMO programs continue to grow in number and capacity. A deep appreciation of the bioethical dimensions of this technology and its application must be pursued, understood and applied to individual patient scenarios.
Does Targeted Temperature Management Improve Neurological Outcome in Extracorporeal Cardiopulmonary Resuscitation (ECPR)?
Among ECPR patients, survival and neurological outcome were not different between those with TTM vs. without TTM. Our study suggests that neurological and survival outcome are improving over time as ECPR therapy is more widely used. Our results were limited by the heterogeneity of included studies and further research with granular temperature data is necessary to assess the benefit and risk of TTM in ECPR population.
Anticoagulation and Transfusion Management During Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Survey of Medical Directors in the United States
Compared with the 2013 pediatric population, extracorporeal membrane oxygenation center anticoagulation and blood transfusion approaches continue to vary widely. Most report continued use of heparin as their primary anticoagulant and follow a combination of monitoring assays with the majority using the antifactor Xa assay in their practices, a significant shift from prior results. Antithrombin activity levels and viscoelastic tests are followed by a growing number of centers. Platelet transfusion thresholds continue to vary widely. Future research is needed to establish optimal anticoagulation and blood transfusion management.