A winter to remember! Extracorporeal membrane oxygenation for life‐threatening asthma in children: A case series and review of literature

Extracorporeal membrane oxygenation has been extensively used for cardiopulmonary support in cardiogenic shock. However, its clinical value in the management of pheochromocytoma crisis remains unclear. We report a rare case of life-threatening cardiogenic shock managed with peripheral venoarterial extracorporeal membrane oxygenation combined with endovascular left ventricular venting, in a 40-year-old female patient, in the setting of unknown adrenal pheochromocytoma. We highlight the life-saving role of extracorporeal membrane oxygenation in undiagnosed endocrine emergencies, allowing cardiac and end-organ recovery, and giving time for accurate diagnosis and specific treatment in such unusual situations.

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Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients

Clinical Critical Care ◽

10.54205/ccc.v29i.252413 ◽

2021 ◽

Author(s):

Surat Tongyoo ◽

Suneerat Kongsayreepong

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Janus Kinase ◽

Systemic Steroid ◽

Heparin Infusion ◽

Membrane Oxygenation ◽

Rescue Treatment ◽

Threatening Condition ◽

Life Threatening ◽

The Individual

During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.

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Bronchotracheal Stenting Management by Rigid Bronchoscopy under Extracorporeal Membrane Oxygenation (ECMO) Support: 10 Years of Experience in a Tertiary Center

Canadian Respiratory Journal ◽

10.1155/2021/8822591 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Sabrina Meyer ◽

Anne-Sophie Dincq ◽

Lionel Pirard ◽

Sebahat Ocak ◽

Jean-Paul D’Odémont ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Rigid Bronchoscopy ◽

Ecmo Support ◽

Membrane Oxygenation ◽

Tertiary Center ◽

Airway Stenting ◽

Life Threatening ◽

Venovenous Ecmo ◽

Central Airway

Purpose. Airway stenting offers good palliation and improves the quality of life in patients with inoperable bronchotracheal stenosis. However, in some cases, the management of stenting can be life-threatening. Hence, a strategy for maintaining oxygenation and hemodynamic stability should be anticipated to avoid critical situations. Herein, we report the use of extracorporeal membrane oxygenation (ECMO) in bronchotracheal stenting management to secure oxygenation and facilitate interventions. Methods. We retrospectively reviewed all patients who underwent rigid bronchoscopy under ECMO support for the management of bronchotracheal stenting at CHU UCL Namur hospital (Belgium), between January 2009 and December 2019. Results. We included 14 bronchoscopy cases performed on 11 patients (3 patients underwent 2 bronchoscopies) in this study; 12 were performed on males and 2 on females. The median age was 54 years. There were 11 benign and 3 malignant etiologies for the central airway obstruction/stenosis. Eight cases were supported by venovenous ECMO and six by venoarterial ECMO. The median ECMO time was 267 minutes. The weaning of ECMO support was successful in all cases. In most cases, the procedures were performed effectively and safely. Only two local complications caused by the cannulation of ECMO were reported, and anticoagulation was adapted to avoid bleeding at the operating site and clot formation in the system. Conclusion. Elective ECMO support was helpful and safe for the high-risk management of bronchotracheal stenting with rigid bronchoscopy and was not associated with any additional significant complications.

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Inter-Hospital Transport of Neonatal Patients on Extracorporeal Membrane Oxygenation: Mobile-ECMO

PEDIATRICS ◽

10.1542/peds.95.4.562 ◽

1995 ◽

Vol 95 (4) ◽

pp. 562-566

Author(s):

Mark J. Heulitt ◽

Bonnie J. Taylor ◽

Sherry C. Faulkner ◽

Lorrie L. Baker ◽

Carl W. Chipman ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Case Series ◽

High Frequency Ventilation ◽

Medical Patients ◽

Retrospective Case ◽

Membrane Oxygenation ◽

Limited Series ◽

Frequency Ventilation ◽

Hospital Transport

Objective. To describe the equipment, personnel requirements, training, management techniques, and logistic problems encountered in the design and implementation of a mobile extracorporeal membrane oxygenation (ECMO) program. Design. This is a report of a technique for the transport of patients on ECMO and a description of our retrospective case series. Settings. The study was conducted at a regional referral children's hospital and ECMO unit. Patients. Thirteen neonatal medical patients with acute respiratory failure were transported with mobile-ECMO. Results. Over a 24-month period, we transported 13 neonatal patients with mobile-ECMO. The reason for transport with mobile-ECMO was inability to convert from high-frequency ventilation (4 of 13), patient already on ECMO (1 of 13), and patient deemed too unstable for conventional transport (8 of 13). Eleven of the 13 patients were transported from other ECMO centers. Of the 13, 9 survived. No major complications during transport were reported for any of the patients. Follow-up data were available on all nine survivors of neonatal mobile- ECMO. Eight of these had normal magnetic resonance imaging scans of the brain; the ninth had a small hemorrhage in the left cerebellum. Conclusion. Our limited series shows that patients can be safely transported with mobile-ECMO. This program does not replace the early appropriate transfer for ECMO-eligible patients to an ECMO center.

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