scholarly journals Commentary: Why a routine VA ECMO support strategy is a good idea in lung transplantation

2021 ◽  
Author(s):  
Anders Andreasson ◽  
Konrad Hoetzenecker
Keyword(s):  
Lung Transplantation ◽  
Ecmo Support ◽  
Support Strategy ◽  
Va Ecmo

Procedure Volume and Outcomes in Patients with VA-ECMO Support

2020 ◽  
Author(s):  
M. Becher ◽  
A. Goßling ◽  
B. Schrage ◽  
N. Fluschnik ◽  
M. Seiffert ◽  
...  
Keyword(s):  
Ecmo Support ◽  
Procedure Volume ◽  
Va Ecmo

scholarly journals Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 747
Author(s):  
Rafal Berger ◽  
Hasan Hamdoun ◽  
Rodrigo Sandoval Boburg ◽  
Medhat Radwan ◽  
Metesh Acharya ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Significant Difference ◽  
Va Ecmo ◽  
Ecmo Therapy

Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. Materials and Methods: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. Results: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. Conclusions: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment.

Stroke Complications in Patients Requiring Durable VAD Systems after VA-ECMO Support

2021 ◽  
Author(s):  
D. Saeed ◽  
E. Potapov ◽  
A. Loforte ◽  
M. Morshuis ◽  
D. Schibilsky ◽  
...  
Keyword(s):  
Ecmo Support ◽  
Va Ecmo

ECMO Support in Lung Transplantation

2020 ◽  
pp. 987-993
Author(s):  
Madonna Lee ◽  
Daniel Mansour ◽  
Bryan A. Whitson
Keyword(s):  
Lung Transplantation ◽  
Ecmo Support

High Risk PCI and Aortic Valvuloplasty With VA ECMO Support: A Case of Pre-TAVI Hybrid Therapy

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 843A
Author(s):  
Elie Elmann ◽  
Pranaychandra Vaidya ◽  
Brian Beckord ◽  
Thomas Cocke ◽  
Gabriele Diluozzo ◽  
...  
Keyword(s):  
High Risk ◽  
Ecmo Support ◽  
Hybrid Therapy ◽  
Aortic Valvuloplasty ◽  
Va Ecmo

ECMO and Right Ventricular Failure: Review of the Literature

2020 ◽  
pp. 088506661990050 ◽  
Author(s):  
Christian Grant ◽  
Jeremy B. Richards ◽  
Michael Frakes ◽  
Jason Cohen ◽  
Susan R. Wilcox
Keyword(s):  
Right Ventricular ◽  
Myocardial Function ◽  
Clinical Status ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Pulmonary Vasodilators ◽  
Va Ecmo ◽  
Vv Ecmo

Right ventricular (RV) failure is the inability of the RV to maintain sufficient cardiac output in the setting of adequate preload, due to either intrinsic injury to the RV or increased afterload. Medical treatment of RV failure should include optimizing preload, augmenting contractility with vasopressors and inotropes, and considering inhaled pulmonary vasodilators. However, when medical therapies are insufficient, mechanical circulatory support (MCS) is needed to maintain systemic and RV perfusion. The data on MCS for isolated RV failure are limited, but extracorporeal membrane oxygenation (ECMO) appears to be the most efficient and effective modality. For patients with isolated RV failure from acute hypoxemic respiratory failure, veno-venous (VV) ECMO is an appropriate initial configuration, even if the patient is in shock. With primary RV injury or RV failure with concomitant left ventricle (LV) failure, however, venoarterial (VA) ECMO is indicated. Both modalities provide indirect support to the RV by reducing preload, reducing RV wall tension, and delivering oxygenated blood to the coronary circulation. Peripheral cannulation is required in VV-ECMO and is most commonly used in VA-ECMO, allowing for rapid cannulation even in emergencies. Changes in pulsatility on an arterial catheter waveform can indicate changes in clinical status including changes in myocardial function, inadequate preload, worsening RV failure, and excessive VA-ECMO support leading to an elevated LV afterload. Myocardial function may be improved by titration of inotropes or vasodilators, utilization of an Impella or an intra-aortic balloon counterpulsation support devices, or by changes in VA-ECMO support.

Single-center experience with intraoperative extracorporeal membrane oxygenation use in lung transplantation

2017 ◽  
Vol 41 (2) ◽  
pp. 89-93 ◽  
Author(s):  
Tugba Cosgun ◽  
Sandra Tomaszek ◽  
Isabelle Opitz ◽  
Markus Wilhelm ◽  
Macé M. Schuurmans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Replacement Therapy ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Replacement Therapy ◽  
Support Group ◽  
Ecmo Support ◽  
Independent Risk Factors ◽  
Group 2 ◽  
Group 1

Background: Studies have shown that survival after lung transplantation is impaired if extracorporeal membrane oxygenation (ECMO) support is implemented. We investigated the outcome and potential independent risk factors on survival in recipients undergoing lung transplantation with intraoperative ECMO support. Materials and methods: Medical records of recipients were retrospectively evaluated (January 2000-December 2014). Retransplantation and bridge to transplantation on ECMO were excluded. Recipients (n = 291) were divided into 2 groups: those who needed intraoperative ECMO support (Group 1, n = 134) and those who did not receive intraoperative ECMO support (Group 2, n = 157). Independent risk factors were identified by a stepwise backward regression analysis. Results: 1-year survival was 84.2% in Group 1 vs. 90.4% in Group 2, and 5-year survival was 52.8% in Group 1 vs. 70.5% in Group 2 (p = 0.002). Multivariate analysis indicated that recipient age (p = 0.001), renal replacement therapy (p = 0.001) and intraoperative ECMO support (p = 0.03) were significant risk factors for overall survival. The rate of postoperative early surgical complications was comparable between the two groups (p = 0.09). The number of patients requiring renal replacement therapy and experiencing late pulmonary complications was significantly higher in Group 1 (p = 0.02). Conclusions: Our data showed that lung transplantation with intraoperative ECMO support is associated with poor outcomes.

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