Early vancomycin, amikacin and gentamicin concentrations in pulmonary artery and pulmonary tissue are not affected by VA ECMO (venoarterial extracorporeal membrane oxygenation) in a pig model of prolonged cardiac arrest

2013 ◽  
Vol 26 (6) ◽  
pp. 655-660 ◽  
Author(s):  
Jan Bělohlávek ◽  
Drahomíra Springer ◽  
Mikuláš Mlček ◽  
Michal Huptych ◽  
Tomáš Bouček ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Pulmonary Artery ◽  
Extracorporeal Membrane Oxygenation ◽  
Pig Model ◽  
Pulmonary Tissue ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

AP099 Venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiac support after traumatic cardiac arrest (TCA)

Resuscitation ◽  
2011 ◽  
Vol 82 ◽  
pp. S32
Author(s):  
Vasilios Grosomanidis ◽  
Eleni Argyriadou ◽  
Barbara Fyntanidou ◽  
Omiros Halvatsoulis ◽  
Eleni Geka ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Traumatic Cardiac Arrest ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

scholarly journals Protocol for a multicentre randomised controlled trial evaluating the effects of moderate hypothermia versus normothermia on mortality in patients with refractory cardiogenic shock rescued by venoarterial extracorporeal membrane oxygenation (VA-ECMO) (HYPO-ECMO study)

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031697
Author(s):  
Audrey Jacquot ◽  
Xavier Lepage ◽  
Ludovic Merckle ◽  
Nicolas Girerd ◽  
Bruno Levy
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Organ Failure ◽  
Mortality Data ◽  
Moderate Hypothermia ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
All Cause Mortality ◽  
Va Ecmo

IntroductionVenoarterial extracorporeal membrane oxygenation (VA-ECMO) is widely used to support the most severe forms of cardiogenic shock (CS). Nevertheless, despite extracorporeal membrane oxygenation (ECMO) use, mortality still remains high (50%). Moderate hypothermia (MH) (33°C–34°C) may improve cardiac performance and decrease ischaemia–reperfusion injuries. The use of MH during VA-ECMO is strongly supported by experimental and preliminary clinical data.Methods and analysisThe Hypothermia-Extracorporeal Membrane Oxygenation (HYPO-ECMO) study is a multicentre, prospective, controlled randomised trial between an MH group (33°C≤T°C≤34°C) and normothermia group (36°C≤T°C≤37°C). The primary endpoint is all-cause mortality at day 30 following randomisation. The study will also assess as secondary endpoints the effects of targeted temperature management strategies on (1) mortality rate at different time points, (2) organ failure and supportive treatment use and (3) safety. All intubated adults with refractory CS supported with VA-ECMO will be screened. Exclusion criteria are patients having undergone cardiac surgery for heart transplantation or left or biventricular assist device implantation, acute poisoning with cardiotoxic drugs, pregnancy, uncontrolled bleeding and refractory cardiac arrest.Three-hundred and thirty-four patients will be randomised and followed up to 6 months to detect a 15% difference in mortality. Data analysis will be intention to treat. The differences between the two study groups in the risk of all-cause mortality at day 30 following randomisation will be studied using logistic regression analysis adjusted for postcardiotomy setting, prior cardiac arrest, prior myocardial infarction, age, vasopressor dose, Sepsis-related Organ Failure Assessment (SOFA) score and lactate at randomisation.Ethics and disseminationEthics approval has been granted by the Comité de Protection des Personnes Est III Ethics Committee. The trial has been approved by the French Health Authorities (Agence Nationale de la Sécurité du Médicament et des Produits de Santé). Dissemination of results will be performed via journal articles and presentations at national and international conferences. Since this study is also the first step in the constitution of an ‘ECMO Trials Group’, its results will also be disseminated by the aforementioned group.Trial registration numberNCT 02754193.

scholarly journals Clinical Outcome and Risk Factors for Acute Fulminant Myocarditis Supported by Venoarterial Extracorporeal Membrane Oxygenation: an Analysis of Nationwide CSECLS Database in China Mainland

2021 ◽  
Author(s):  
Tong Hao ◽  
Yu Jiang ◽  
Changde Wu ◽  
Chenglong Li ◽  
Chuang Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Lactate Concentration ◽  
Adult Patients ◽  
Fulminant Myocarditis ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo ◽  
China Mainland

Abstract Purpose: To assess the outcomes and risk factors for adult patients with acute fulminant myocarditis supported with venoarterial extracorporeal membrane oxygenation (VA ECMO) in China mainland. Methods: Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Data from adult patients who were diagnosed with acute myocarditis and needed VA ECMO in the database were retrospectively analyzed. The primary outcome was 90-day mortality after ECMO initiation in patients with acute fulminant myocarditis supported with VA ECMO. Cox proportional hazard regression model was used to examine the risk factors associated with 90-day mortality. Results: Among 221 patients enrolled, 186 (84.2%) patients weaned from ECMO and 159 (71.9%) patients survived to 90 days. The median age was 38 years (IQR 29-49) and males (n=115) accounted for 52.0% of the patients. The median ECMO duration was 134 hours (IQR 96-177hrs). The main adverse events during ECMO course was bleeding (16.3%), followed by infection (15.4%). In the multivariate Cox model, cardiac arrest prior to ECMO initiation (adjusted HR 2.529; 95%CI: 1.341-4.767, p =0.004), lower pH value (adjusted HR 0.016; 95%CI: 0.010-0.059, p <0.001) and higher lactate concentration at 24 hours after ECMO initiation (adjusted HR 1.146; 95%CI: 1.075-1.221, p <0.001) was associated with 90day mortality. Conclusions: In our study, 71.9% patients with acute fulminant myocarditis supported with VA ECMO survived to 90 days. Cardiac arrest prior to ECMO, lower pH and higher lactate concentration at 24 hours after ECMO initiation were correlated with 90-day mortality closely.ClinicalTrials.gov registration number: NCT04158479, Registered 8 November 2019, https://clinicaltrials.gov/ct2/show/NCT04158479?term=hou+xiaotong&draw=2&rank=2.

scholarly journals Biventricular Unloading with Impella and Venoarterial Extracorporeal Membrane Oxygenation in Severe Refractory Cardiogenic Shock: Implications from the Combined Use of the Devices and Prognostic Risk Factors of Survival

2021 ◽  
Vol 10 (4) ◽  
pp. 747
Author(s):  
Georgios Chatzis ◽  
Styliani Syntila ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Nikolaos Patsalis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Risk Scores ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Lactate Levels ◽  
Va Ecmo

Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels.

scholarly journals Efficacy of left ventricular unloading strategies during venoarterial extracorporeal membrane oxygenation in patients with cardiogenic shock: a protocol for a systematic review and Bayesian network meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e047046
Author(s):  
Pengbin Zhang ◽  
Shilin Wei ◽  
Kerong Zhai ◽  
Jian Huang ◽  
Xingdong Cheng ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Bayesian Network ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Cochrane Library ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Patient Consent ◽  
Va Ecmo

IntroductionVenoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for patients with refractory cardiogenic shock. A common side effect of this technic is the resultant increase in left ventricular (LV) afterload which could potentially aggravate myocardial ischaemia, delay ventricular recovery and increase the risk of pulmonary congestion. Several LV unloading strategies have been proposed and implemented to mitigate these complications. However, it is still indistinct that which one is the best choice for clinical application. This Bayesian network meta-analysis (NMA) aims to compare the efficacy of different LV unloading strategies during VA-ECMO.Methods and analysisPubMed, Embase, the Cochrane Library and the International Clinical Trials Registry Platform will be explored from their inception to 31 December 2020. Random controlled trials and cohort studies that compared different LV unloading strategies during VA-ECMO will be included in this study. The primary outcome will be in-hospital mortality. The secondary outcomes will include neurological complications, haemolysis, bleeding, limb ischaemia, renal failure, gastrointestinal complications, sepsis, duration of mechanical ventilation, length of intensive care unit and hospital stays. Pairwise and NMA will respectively be conducted using Stata (V.16, StataCorp) and Aggregate Data Drug Information System (V.1.16.5), and the cumulative probability will be used to rank the included LV unloading strategies. The risk of bias will be conducted using the Cochrane Collaboration’s tool or Newcastle-Ottawa Quality Assessment Scale according to their study design. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed. The Grading of Recommendations Assessment, Development and Evaluation will be conducted to explore the quality of evidence.Ethics and disseminationEither ethics approval or patient consent is not necessary, because this study will be based on literature. The results will be disseminated through peer-reviewed publications and conference presentations.PROSPERO registration numberCRD42020165093.

scholarly journals Impact of arterial and venous cannula diameter in venoarterial extracorporeal membrane oxygenation (VA-ECMO)

Resuscitation ◽  
2018 ◽  
Vol 130 ◽  
pp. e32
Author(s):  
Alex Supady ◽  
Tobias Wengenmayer ◽  
Florentine Schroth ◽  
Daniel Duerschmied ◽  
Christoph Benk ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Venous Cannula ◽  
Va Ecmo
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