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.
Peripheral Cannulation for Extracorporeal Membrane Oxygenation Yields Superior Neurologic Outcomes in Adult Patients Who Experienced Cardiac Arrest Following Cardiac Surgery
Peripheral VA-ECMO allows for continuous CPR and systemic perfusion while obtaining vascular access. Compared to central cannulation, a peripheral cannulation strategy is associated with improved neurologic outcomes and decreased likelihood of anoxic brain death.
Outcome and Cost of Nurse-led versus Perfusionist-led Extracorporeal Membrane Oxygenation
Use of a perfusionist-led ECMO model may be more cost-conscious in the context of low utilization, smaller case volume and shorter ECMO duration. However, once annual case volume exceeds 10 and mean ECMO duration exceeds 10 days, the nurse specialist-led model may be more cost-conscious.
Carboxyhemoglobin Elevation, a Marker for Hemolysis, Is Common in Veno-venous Extracorporeal Membrane Oxygenation
Thus, we believe that COHb elevation is a prevalent phenomenon in patients supported on VV ECMO. Causes include but are not limited to excessive negative pressure and high-blood flow.
Management of Adult Patients Supported with Venovenous Extracorporeal Membrane Oxygenation (VV ECMO): Guideline from the Extracorporeal Life Support Organization (ELSO)
In this statement, we provide recommendations for the clinical management of adult patients supported with VV ECMO. Although these recommendations were not developed using a formal, reproducible methodology, we have reviewed English-language publications in PubMed, where available, in developing the guidance provided herein.
Bivalirudin May Reduce the Need for Red Blood Cell Transfusion in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation
Heparin may increase the need for PRBC transfusions and strategies to attenuate bleeding when compared with bivalirudin for children receiving ECMO in PCICU.
Comparison of Circulatory Unloading Techniques for Venoarterial Extracorporeal Membrane Oxygenation
This study identified clinically significant hemodynamic variability between the different circulatory unloading techniques evaluated. However, the applicability of these techniques will vary with different patient disease etiology. Further studies on ECMO unloading will help to quantify hemodynamic benefits and establish treatment guidelines.
Utility of Gas Inlet Pressure Monitoring in Extracorporeal Membrane Oxygenation
This study confirmed that monitoring the gas inlet pressure changes of an oxygenator during ECMO is clinically useful.
Extracorporeal Membrane Oxygenation-Induced Hemolysis: An In Vitro Study to Appraise Causative Factors
Our preliminary results suggested that the choice of anticoagulant and blood donor gender could be critical factors in hemolysis studies, and should be taken into account to improve testing reliability during ECMO.
Platelets and Extra-Corporeal Membrane Oxygenation in Adult Patients: A Systematic Review and Meta-Analysis
Thrombocytopenia and platelet dysfunction are common in ECMO patients, regardless the type of ECMO mode. The underlying mechanisms are multifactorial, and understanding and management are still limited. Further research to design appropriate strategies and protocols for its monitoring, management, or prevention should be matter of thorough investigations.