Problems and health needs of adult extracorporeal membrane oxygenation patients following hospital discharge: A qualitative study

Heart & Lung ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 147-153 ◽  
Author(s):  
Kang-Hua Chen ◽  
Feng-Chun Tsai ◽  
Chien-Sung Tsai ◽  
Shu-Ling Yeh ◽  
Li-Chueh Weng ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Health Needs ◽  
Membrane Oxygenation

Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

2019 ◽  
Vol 29 (12) ◽  
pp. 1501-1509 ◽  
Author(s):  
Ahmed M. Dohain ◽  
Gaser Abdelmohsen ◽  
Ahmed A. Elassal ◽  
Ahmed F. ElMahrouk ◽  
Osman O. Al-Radi
Keyword(s):  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
University Hospital ◽  
P Value ◽  
Biventricular Repair ◽  
Factors Affecting ◽  
Membrane Oxygenation ◽  
Paediatric Cardiac Surgery ◽  
Neonates And Infants

AbstractBackground:Extracorporeal membrane oxygenation has been widely used after paediatric cardiac surgery due to increasing complex surgical repairs in neonates and infants having complex CHDs.Materials and methods:We reviewed retrospectively the medical records of all patients with CHD requiring corrective or palliative cardiac surgery at King Abdulaziz University Hospital that needed extracorporeal membrane oxygenation support between November 2015 and November 2018.Results:The extracorporeal membrane oxygenation population was 30 patients, which represented 4% of 746 children who had cardiac surgery during this period. The patients’ age range was from 1 day to 20.33 years, with a median age of 6.5 months. Median weight was 5 kg (range from 2 to 53 kg). Twenty patients were successfully decannulated (66.67%), and 12 patients (40%) were survived to hospital discharge. Patients with biventricular repair tended to have better survival rate compared with those with single ventricle palliation (55.55 versus 16.66%, p-value 0.058). During the first 24 hours of extracorporeal membrane oxygenation support, the flow rate was significantly reduced after 4 hours of extracorporeal membrane oxygenation connection in successfully decannulated patients.Conclusion:Survival to hospital discharge in patients requiring extracorporeal membrane oxygenation support after paediatric cardiac surgery was better in those who underwent biventricular repair than in those who had univentricular palliation. Capillary leak on extracorporeal membrane oxygenation could be a risk of mortality in patients after paediatric cardiac surgery.

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.

scholarly journals Left ventricular wall findings in non-electrocardiography-gated contrast-enhanced computed tomography after extracorporeal cardiopulmonary resuscitation

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
Kazuhiro Sugiyama ◽  
Masamichi Takahashi ◽  
Kazuki Miyazaki ◽  
Takuto Ishida ◽  
Mioko Kobayashi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Left Ventricular ◽  
Left Ventricular Wall ◽  
Ventricular Wall ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
Enhanced Computed Tomography

Abstract Background Few studies have reported left ventricular wall findings in contrast-enhanced computed tomography (CE-CT) after extracorporeal cardiopulmonary resuscitation (ECPR). This study examined left ventricular wall CE-CT findings after ECPR and evaluated the association between these findings and the results of coronary angiography and prognosis. Methods We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and subsequently underwent both non-electrocardiography-gated CE-CT and coronary angiography at our center between January 2011 and April 2018. Left ventricular wall CE-CT findings were classified as follows: (1) homogeneously enhanced (HE; the left ventricular wall was homogeneously enhanced), (2) segmental defect (SD; the left ventricular wall was not segmentally enhanced according to the coronary artery territory), (3) total defect (TD; the entire left ventricular wall was not enhanced), and (4) others. Successful weaning from extracorporeal membrane oxygenation, survival to hospital discharge, and predictive ability of significant stenosis on coronary angiography were compared among patients with HE, SD, and TD patterns. Results A total of 74 patients (median age, 59 years) were eligible, 50 (68%) of whom had initial shockable rhythm. Twenty-three (31%) patients survived to hospital discharge. HE, SD, TD, and other patterns were observed in 19, 33, 11, and 11 patients, respectively. The rates of successful weaning from extracorporeal membrane oxygenation (84% vs. 39% vs. 9%, p < 0.01) and survival to hospital discharge (47% vs. 27% vs. 0%, p = 0.02) were significantly different among patients with HE, SD, and TD patterns. In post hoc analysis, patients with HE patterns had a significantly higher success rate of weaning from extracorporeal membrane oxygenation than those with SD and TD patterns. SD predicted significant stenosis with a sensitivity of 74% and specificity of 94%. Conclusions Homogenously enhanced left ventricular wall might be a predictor of good left ventricular function recovery. In contrast, total enhancement defect in the entire left ventricular wall was associated with poor outcomes. Contrast defect matching the coronary artery territory could predict significant coronary artery stenosis with good specificity. The left ventricular wall findings in non-electrocardiography-gated CE-CT after ECPR might be useful for diagnosis and prognostic prediction.

The first five years of neonatal and pediatric transports on extracorporeal membrane oxygenation in the center and south of Italy: The pediatric branch of the Italian “Rete Respira” network

Perfusion ◽  
2018 ◽  
Vol 33 (1_suppl) ◽  
pp. 24-30 ◽  
Author(s):  
Matteo Di Nardo ◽  
Margherita Lonero ◽  
Elisabetta Pasotti ◽  
Federica Cancani ◽  
Daniela Perrotta ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
High Risk ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Severity Of Illness ◽  
Clinical Situation ◽  
Membrane Oxygenation ◽  
Dedicated Team

Introduction: Neonatal and pediatric ECMO is a high-risk procedure that should be performed only in expert centers. Children who are eligible for ECMO and are managed in hospitals without ECMO capabilities should be referred to the closest ECMO center before the severity of illness precludes safe conventional transport. When the clinical situation precludes safe conventional transport, ECMO should be provided on site with the patient transported on ECMO. Methods: We retrospectively reviewed our institutional database of all ECMO transports for neonatal and pediatric respiratory failure from February 2013 to February 2018. Results: Over the last 5 years, we provided 24 transports covering all requests from the center and south of Italy except for the islands. Of these transports, 20 were performed on ECMO and 4 without ECMO. No patient died during transportation. Five complications were reported only during the ECMO transports, and all of these were managed without compromising the patient’s safety. The preferred modes of transport were by ambulance (70%) and ambulance transported into the fixed wing aircraft (30%) for longer national distances. The survival to hospital discharge of the patients transported with ECMO was 75% among the neonatal transports and 83.3% among the pediatric transports. The survival to hospital discharge of the four patients transported without ECMO was 100% for both neonates and children. Conclusions: Neonatal and pediatric ECMO transports can be safely performed with a dedicated team that maintains stringent adherence to well-designed management protocols.

scholarly journals LO68: Extracorporeal membrane oxygenation in the emergency department for resuscitation of out-of-hospital cardiac arrest patients: a systematic review

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S51
Author(s):  
M.M. Beyea ◽  
B.W. Tillmann ◽  
A.E. Lansavichene ◽  
V. Randhawa ◽  
K. Van Aarsen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cohort Studies ◽  
Hospital Discharge ◽  
Case Series ◽  
Inclusion Criteria ◽  
Neurologic Recovery ◽  
Membrane Oxygenation ◽  
Hospital Cardiac Arrest

Introduction: With one person in Canada suffering an out-of-hospital cardiac arrest (OHCA) every 12 minutes and an estimated survival to hospital discharge with good neurologic function ranging from 3 to 16%, OHCA represents a major source of morbidity and mortality. An evolving adjunct for resuscitation of OHCA patients is the use of extracorporeal membrane oxygenation-assisted CPR (ECPR). The purpose of this systematic review is to investigate the survival to hospital discharge with good neurologic recovery in patients suffering from OHCA treated with ECPR compared to those who received standard advanced cardiac life support with conventional CPR (CCPR) alone. Methods: A systematic database search of both MEDLINE &amp; EMBASE was performed up until September 2016 to identify studies with ≥5 patients reporting ECPR use in adults (age ≥16 years) with OHCA. Only studies reporting survival to hospital discharge were included. All identified studies were assessed independently using pre-determined inclusion criteria by two reviewers. Study quality and risk of bias were evaluated using the Newcastle Ottawa regulations assessment scale. Results: Of the 1065 records identified, 54 studies met all inclusion criteria. Inter-rater reliability was high with a kappa statistic of 0.85. The majority of studies were comprised of case series (n=45) of ECPR with 5 to 83 patients/study. Out of the 45 case series, 37 presented neurologic data at hospital discharge and demonstrated a broad range of patients surviving with good neurologic outcome (0 to 71.4%). Only 9 cohort studies with relevant control group (CCPR) were identified (38 to 21750 patients/study). Preliminary analysis demonstrated that 6 cohort studies were sufficient quality to compare ECPR to CCPR. All 6 studies showed significantly increased survival to hospital discharge with good neurologic recovery (ECPR 10.6 to 41.6% vs CCPR 1.5 to 7.7%, respectively). Conclusion: Given the paucity of studies using appropriate comparators to evaluate the impact of ECMO, our confidence in a clinically relevant difference in outcomes compared to current standards of care for OHCA remains weak. Interestingly, a limited number of studies with suitable controls demonstrated a potential benefit associated with ECPR in the management of OHCA in selected patients. In this state of equipoise, high quality RCT data is urgently needed.

Extracorporeal membrane oxygenation in an HIV-positive man with severe acute respiratory distress syndrome secondary to pneumocystis and cytomegalovirus pneumonia

2017 ◽  
Vol 29 (2) ◽  
pp. 198-202 ◽  
Author(s):  
Deirdre Morley ◽  
Almida Lynam ◽  
Edmund Carton ◽  
Ignacio Martin-Loeches ◽  
Gerard Sheehan ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Hospital Discharge ◽  
Distress Syndrome ◽  
Case Reports ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Membrane Oxygenation

The management of critically ill human immunodeficiency virus (HIV)-positive patients is challenging; however, intensive care unit-related mortality has declined significantly in recent years. There are 10 case reports in the literature of extracorporeal membrane oxygenation (ECMO) use in HIV-positive patients, of whom seven survived to hospital discharge. We describe a 33-year-old Brazilian man who presented with Pneumocystis jirovecii pneumonia and severe hypoxic respiratory failure. He developed refractory acute respiratory distress syndrome (ARDS) and was commenced on veno-venous ECMO. He was successfully decannulated following 21 days of ECMO and survived to hospital discharge. Despite poor evidence surrounding the use of ECMO in immunocompromised patients, it is evident that ECMO could represent an important rescue therapy in HIV-positive patients with refractory ARDS.

Risk factors and outcomes of pediatric extracorporeal membrane oxygenation

2021 ◽  
pp. 021849232199737
Author(s):  
Hiroshi Taka ◽  
Yasuhiro Kotani ◽  
Yosuke Kuroko ◽  
Susumu Iwadou ◽  
Tatsuo Iwasaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Urine Output ◽  
Multivariable Analysis ◽  
Cerebral Performance Category ◽  
Neurologic Complication ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation

Background Congenital heart disease (CHD) is the most common neonatal and pediatric cardiac indication for extracorporeal membrane oxygenation (ECMO). Risk factors of survival and neurologic complication were different in many centers. We sought to evaluate survival and neurological outcome after ECMO in patients with CHD. Methods We retrospectively reviewed the medical records of 37 patients (<16 years old) who received ECMO. Indications for ECMO were failure to wean from cardiopulmonary bypass in 18 patients, extracorporeal cardiopulmonary resuscitation (ECPR) in 13 patients, and others in 6 patients. The median cardiopulmonary resuscitation (CPR) duration in ECPR patients was 48 min (interquartile range: 38–53 min). Neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) scale one year after hospital discharge. Results The median ECMO duration was 160 (91–286) h. Twenty-nine patients (78%) were successfully weaned off ECMO. Overall survival to hospital discharge was 59%. Risk factors of mortality were as follows: ECMO duration >1 week and urine output <1 mL/kg/h in the first 24 h after ECMO induction by multivariable analysis. Of the 22 survivors, 15 (68%) patients had a favorable outcome (PCPC ≤2). Risk factors for unfavorable outcomes (PCPC ≥3) included ECPR as indication and CPR of longer than 40 min. Conclusions Longer ECMO duration and lower urine output were associated with increased mortality. Neurologic outcomes were not satisfactory when CPR was required for a longer period before ECMO establishment.

Abstract 10: Outcome Of Pediatric In-hospital Cardiac Arrest By Extracorporeal Membrane Oxygenation Implementation During Active Cardiopulmonary Resuscitation

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Enting Wu ◽  
Shuchien Huang ◽  
Wenje Ko ◽  
YihSharng Chen
Keyword(s):  
Renal Failure ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Discharge ◽  
Pediatric Patients ◽  
Secondary Outcome ◽  
Neurological Outcomes ◽  
Membrane Oxygenation ◽  
Hospital Cardiac Arrest

Background: To achieve intact neurological survival is a challange for pediatric cardiac arrest. Here we describe the outcome and identify the factors associated with survival among pediatric patients following extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital pediatric cardiac arrest. Method: Retrospective study of 27 pediatric in-hospital cardiac arrest who received extracorporeal membrane oxygenation during active cardiopulmonary resuscitation-.The primary outcome was survival to hospital discharge. The secondary outcome was neurological status after ECPR at hospital discharge and late follow-up. Continuous variables were expressed as medians (inter-quartile range) Results: . We identified 27 ECPR events. The survival rate to hospital discharge was 41% (11/27). The non-survivors had higher serum lactate levels (14 [10.2–19.6] mmol/L vs 8.5 [4.4 –12.6] mmol/L, p < 0.01), longer durations of cardiopulmonary resuscitation (CPR) (60 [37– 81] minutes vs 45 [25–50] minutes, p < 0.05) with longer activating time for ECMO (12.5 [7.5–33.8] minutes vs 5 [0 –10] minutes, p<0.01),and more renal failure after ECPR (68% 11 / 16 vs 9% 1 / 11 , p < 0.01). By multivariate analysis, the earlier cohort and renal failure after ECPR were independent risk factors for mortality. Among the11 survivors, 10 of them had good neurological outcomes. Conclusions: ECPR successfully rescued some pediatric patients who failed rescue with conventional in-hospital CPR. Good neurological outcomes were achieved in the majority of the survivors. Early cohort and post-ECPR renal failure were associated with poor outcomes. Early activation of the ECMO team could possibly shorten the CPR duration and improve the ECPR results.

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