Extracorporeal membrane oxygenation cannulation trends for pediatric respiratory failure and central nervous system injury

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.

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The Evolution of the Use of Extracorporeal Membrane Oxygenation in Respiratory Failure

Membranes ◽

10.3390/membranes11070491 ◽

2021 ◽

Vol 11 (7) ◽

pp. 491

Author(s):

Danielle Feldhaus ◽

Daniel Brodie ◽

Philippe Lemaitre ◽

Joshua Sonett ◽

Cara Agerstrand

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Influenza A ◽

Distress Syndrome ◽

Rapid Expansion ◽

Membrane Oxygenation ◽

Influenza A H1n1 ◽

Large Randomized Clinical Trial ◽

Ventilator Management ◽

Large Randomized Trial

Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support patients with acute respiratory failure, most commonly, and severe forms of acute respiratory distress syndrome (ARDS). The marked increase in the global use of ECMO followed the publication of a large randomized trial in 2009 and the experience garnered during the 2009 influenza A (H1N1) pandemic, and has been further supported by the release of a large, randomized clinical trial in 2018, confirming a benefit from using ECMO in patients with severe ARDS. Despite a rapid expansion of ECMO-related publications, optimal management of patients receiving ECMO, in terms of patient selection, ventilator management, anticoagulation, and transfusion strategies, is evolving. Most recently, ECMO is being utilized for an expanding variety of conditions, including for cases of severe pulmonary or cardiac failure from coronavirus disease 2019 (COVID-19). This review evaluates modern evidence for ECMO for respiratory failure and the current challenges in the field.

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Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

Respiratory Research ◽

10.1186/s12931-021-01796-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Tak Kyu Oh ◽

Hyoung-Won Cho ◽

Hun-Taek Lee ◽

In-Ae Song

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Lung Disease ◽

Respiratory Disease ◽

Chronic Respiratory Disease ◽

Newly Diagnosed ◽

Membrane Oxygenation ◽

Obstructive Sleep ◽

All Cause Mortality ◽

Ecmo Therapy

Abstract Background Quality of life following extracorporeal membrane oxygenation (ECMO) therapy is an important health issue. We aimed to describe the characteristics of patients who developed chronic respiratory disease (CRD) following ECMO therapy, and investigate the association between newly diagnosed post-ECMO CRDs and 5-year all-cause mortality among ECMO survivors. Methods We analyzed data from the National Health Insurance Service in South Korea. All adult patients who underwent ECMO therapy in the intensive care unit between 2006 and 2014 were included. ECMO survivors were defined as those who survived for 365 days after ECMO therapy. Chronic obstructive pulmonary disease (COPD), asthma, interstitial lung disease, lung cancer, lung disease due to external agents, obstructive sleep apnea, and lung tuberculosis were considered as CRDs. Results A total of 3055 ECMO survivors were included, and 345 (11.3%) were newly diagnosed with CRDs 365 days after ECMO therapy. The prevalence of asthma was the highest at 6.1% (185). In the multivariate logistic regression, ECMO survivors who underwent ECMO therapy for acute respiratory distress syndrome (ARDS) or respiratory failure had a 2.00-fold increase in post-ECMO CRD (95% confidence interval [CI]: 1.39 to 2.89; P < 0.001). In the multivariate Cox regression, newly diagnosed post-ECMO CRD was associated with a 1.47-fold (95% CI: 1.17 to 1.86; P = 0.001) higher 5-year all-cause mortality. Conclusions At 12 months after ECMO therapy, 11.3% of ECMO survivors were newly diagnosed with CRDs. Patients who underwent ECMO therapy for ARDS or respiratory failure were associated with a higher incidence of newly diagnosed post-ECMO CRD compared to those who underwent ECMO for other causes. Additionally, post-ECMO CRDs were associated with a higher 5-year all-cause mortality. Our results suggest that ECMO survivors with newly diagnosed post-ECMO CRD might be a high-risk group requiring dedicated interventions.

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Extracorporeal membrane oxygenation in critically ill neonatal and pediatric patients with acute respiratory failure: a guide for the clinician

Expert Review of Respiratory Medicine ◽

10.1080/17476348.2021.1932469 ◽

2021 ◽

Author(s):

Briana L. Scott ◽

Desiree Bonadonna ◽

Caroline P. Ozment ◽

Kyle J. Rehder

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Critically Ill ◽

Pediatric Patients ◽

Membrane Oxygenation

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Use of extracorporeal membrane oxygenation in postpartum patients with refractory shock or respiratory failure

Scientific Reports ◽

10.1038/s41598-020-80423-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ryoung-Eun Ko ◽

Chi Ryang Chung ◽

Jeong Hoon Yang ◽

Kyeongman Jeon ◽

Gee Young Suh ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Major Bleeding ◽

Discharge Rate ◽

Median Number ◽

Survival Outcomes ◽

Refractory Shock ◽

Membrane Oxygenation ◽

Study Population ◽

Level Of Experience

AbstractAlthough extracorporeal membrane oxygenation (ECMO) is increasingly utilized, only a limited level of experience has been reported in postpartum cardiopulmonary failure. Ten critically ill postpartum patients who received ECMO were included between January 2010 and December 2018 in this retrospective observational study. The main indication for ECMO support was peripartum cardiomyopathy (n = 5), followed by postpartum hemorrhage (n = 2). Nine patients initially received veno-arterial ECMO, and one patient received veno-venous ECMO. Major bleeding occurred in six patients. The median number of units of red blood cells (RBC) transfused during ECMO was 14.5 units (interquartile range 6.8–37.8 units), and most RBC transfusions occurred on the first day of ECMO. The survival-to-discharge rate was 80%. Compared to the survival outcomes in female patients of similar age who received ECMO, the survival outcomes were significantly better in the study population (56% versus 80%, P = 0.0004). Despite the high risk of major bleeding, ECMO for patients with postpartum cardiac or respiratory failure showed excellent survival outcomes. ECMO is feasible in these patients and can be carried out with good outcomes in an experienced centre.

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