Veno-Venous Extracorporeal Membrane Oxygenation (VV ECMO) for Acute Respiratory Failure Following Injury: Outcomes in a High-Volume Adult Trauma Center with a Dedicated Unit for VV ECMO

2018 ◽  
Vol 42 (8) ◽  
pp. 2398-2403 ◽  
Author(s):  
Jay Menaker ◽  
Ronald B. Tesoriero ◽  
Ali Tabatabai ◽  
Ronald P. Rabinowitz ◽  
Christopher Cornachione ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Trauma Center ◽  
High Volume ◽  
Membrane Oxygenation ◽  
Injury Outcomes ◽  
Vv Ecmo

Evaluation of Bivalirudin as the Primary Anticoagulant in Patients Receiving Extracorporeal Membrane Oxygenation for SARS-CoV-2–Associated Acute Respiratory Failure

2021 ◽  
pp. 106002802110361
Author(s):  
Brittany D. Bissell ◽  
Taylor Gabbard ◽  
Erica A. Sheridan ◽  
Maher A. Baz ◽  
George A. Davis ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Retrospective Chart Review ◽  
Venous Thromboembolic Event ◽  
Membrane Oxygenation ◽  
Published Report ◽  
Starting Dose ◽  
Venous Thromboembolic ◽  
Polymerase Chain

Background Extracorporeal membrane oxygenation (ECMO) is a potential option for the management of severe acute respiratory failure secondary to COVID-19. Conflicting the use of this therapy is the known coagulopathy within COVID-19, leading to an incidence of venous thrombotic events of 25% to 49%. To date, limited guidance is available on optimal anticoagulation strategies in this population. Objective The purpose of this study was to evaluate the utilization of a pharmacist-driven bivalirudin dosing protocol for anticoagulation in the setting of ECMO for COVID-19–associated respiratory failure. Methods This was a single-center retrospective chart review over a 9-month period of patients receiving bivalirudin while on ECMO. All patients with acute respiratory failure requiring ECMO with a positive SARS-CoV-2 polymerase chain reaction were included. Bivalirudin was dosed via aPTT monitoring after a starting dose of 0.2 or 0.3 mg/kg/h. Results There were 33 patients included in this study, all receiving mechanical ventilation. The most common starting dose of bivalirudin was 0.2 mg/kg/h, with an average time to therapeutic range of 20 hours. Compared to previous reports, rates of bleeding were low at 15.1%, and 6.1% of patients developed a new venous thromboembolic event while on ECMO. ECMO survival was 51.5%, with an ICU mortality rate of 48.5%. Conclusion and Relevance In the first published report of its use within this population, bivalirudin was found to be a viable choice for anticoagulation in those patients on ECMO for severe respiratory failure secondary to COVID-19.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110128
Author(s):  
Ismael A Salas De Armas ◽  
Bindu Akkanti ◽  
Pratik B Doshi ◽  
Manish Patel ◽  
Sachin Kumar ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Trauma Service ◽  
Proper Patient Selection ◽  
Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

Current Status of Prolonged Extracorporeal Membrane Oxygenation for Acute Respiratory Failure

CHEST Journal ◽  
1973 ◽  
Vol 63 (5) ◽  
pp. 773-782 ◽  
Author(s):  
Edward A. Lefrak ◽  
Paul M. Stevens ◽  
George P. Noon ◽  
Michael E. DeBakey
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Current Status ◽  
Membrane Oxygenation

Extracorporeal membrane oxygenation in adult patients with severe acute respiratory failure

2012 ◽  
Vol 57 (3) ◽  
pp. 303-311 ◽  
Author(s):  
C. LINDSKOV ◽  
R. H. JENSEN ◽  
P. SPROGOE ◽  
K. E. KLAABORG ◽  
H. KIRKEGAARD ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Adult Patients ◽  
Membrane Oxygenation

Long-term outcomes of adults with acute respiratory failure treated with veno-venous extracorporeal membrane oxygenation

2021 ◽  
pp. 0310057X2110423
Author(s):  
Emma L Gray ◽  
Paul Forrest ◽  
Timothy J Southwood ◽  
Richard J Totaro ◽  
Brian T Plunkett ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Respiratory Failure ◽  
Standard Deviation ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Body Mass ◽  
Multiple Logistic Regression Analysis ◽  
Membrane Oxygenation ◽  
Retrospective Audit

Veno-venous extracorporeal membrane oxygenation is increasingly used for severe but potentially reversible acute respiratory failure in adults; however, there are limited data regarding long-term morbidity. At our institution, most patients requiring veno-venous extracorporeal membrane oxygenation have been followed up by a single physician. Our primary aim was to describe the serial long-term morbidity for respiratory, musculoskeletal and psychological functioning. A retrospective audit of inpatient and outpatient medical records was conducted. A total of 125 patients treated with veno-venous extracorporeal membrane oxygenation for primary respiratory failure were included. The patients were young (mean (standard deviation) age 43.7 (4.1) years), obese (mean (standard deviation) body mass index 30.8 (10.4) kg/m2), and mostly were male (59%). Most patients (60%) had no comorbidities. The survival rate to discharge was 70%, with body mass index and the number of comorbidities being independent predictors of survival on multiple logistic regression analysis. Over half (57%) of the Australian survivors had regular outpatient follow-up. They had a median of three reviews (range 1–9) over a median of 11.8 months (range 1.5-79) months. Breathlessness and weakness resolved in most within six months, with lung function abnormalities taking longer to resolve. Over half (60%) returned to employment within six months of discharge. Over a quarter (29%) displayed symptoms of anxiety, depression or post-traumatic stress disorder.

scholarly journals Mobile extracorporeal membrane oxygenation service for severe acute respiratory failure – A review of five years of experience

2019 ◽  
Vol 21 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Ada M Krzak ◽  
Jo-Anne Fowles ◽  
Alain Vuylsteke
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Qualitative Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Equipment Failure ◽  
Quality And Safety ◽  
Regular Reflection ◽  
Membrane Oxygenation

Provision of extracorporeal membrane oxygenation as part of support escalation in severe refractory acute respiratory failure in England is provided by five specialist centres that operate within a well-defined quality and safety framework. We conducted a qualitative study of the extracorporeal membrane oxygenation retrieval service provided by one of the five centres. We analysed 176 consecutive debrief reports written between October 2013 and April 2018 by the consultant. Main identified issues were short delays in retrieval predominantly due to insufficient communication or equipment failure. All issues were addressed in subsequent practice. Our results suggest a need for improved communication between the referring intensive care unit and retrieving team. Our findings highlight the value of regular reflection-based evaluation to ensure continued provision of safe and efficient service.

Repair of iatrogenic tracheal injury in acute respiratory failure with veno-venous extracorporeal membrane oxygenation

Perfusion ◽  
2020 ◽  
Vol 36 (1) ◽  
pp. 100-102
Author(s):  
Pauline H Go ◽  
Albert Pai ◽  
Sharon B Larson ◽  
Kalpaj Parekh
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Severe Respiratory Failure ◽  
Tracheal Injury ◽  
Lung Isolation ◽  
Membrane Oxygenation

Iatrogenic tracheal injuries are rare but potentially serious complications of endotracheal intubation that frequently require lung isolation to repair. This is not tolerated in patients with severe respiratory failure. We describe a case in a patient with acute respiratory distress syndrome, repaired using veno-venous extracorporeal membrane oxygenation.

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