Spirometry testing for extracorporeal membrane oxygenation (ECMO) bridge to transplant patients

This chapter examines the indications, applications, and complications of modern extracorporeal membrane oxygenation (ECMO). The safety profile of ECMO has improved through advancements in devices, components, and routine management, resulting in improved outcomes and an expanded range of applications. Currently, ECMO can provide cardiopulmonary support in reversible conditions, such as post-cardiotomy shock, acute respiratory failure, extracorporeal cardiopulmonary resuscitation, bridge to transplant, complex airway repairs, and massive pulmonary embolism, among others. The chapter focuses on the primary factors involved in using ECMO successfully: appropriate patient selection, optimal cannulation strategy, and availability of comprehensive medical resources (or a referral agreement with a comprehensive ECMO center) to handle emergent ECMO complications and to absorb the substantial resource requirements of treating patients with ECMO.

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Outcomes of pediatric oncology and hematopoietic cell transplant patients receiving extracorporeal membrane oxygenation

Perfusion ◽

10.1177/0267659119842471 ◽

2019 ◽

Vol 34 (7) ◽

pp. 598-604

Author(s):

Danielle K Maue ◽

Michael J Hobson ◽

Matthew L Friedman ◽

Elizabeth AS Moser ◽

Courtney M Rowan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Extracorporeal Membrane Oxygenation ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Hematopoietic Cell Transplant ◽

Membrane Oxygenation ◽

Transplant Patients

Background/objectives: There is controversy regarding the utilization of extracorporeal membrane oxygenation in pediatric patients with an underlying oncologic diagnosis or who have undergone hematopoietic cell transplant. We hypothesized that these patients have higher mortality, more bleeding complications, more blood product utilization, and a higher rate of new infections than the general pediatric intensive care unit population supported with extracorporeal membrane oxygenation. Design/methods: This is a retrospective chart review at a single center quaternary care pediatric hospital including all pediatric intensive care unit extracorporeal membrane oxygenation patients from 2011 to 2016. Patients were categorized as either oncology/hematopoietic cell transplant or general pediatric intensive care unit. Patients from the cardiovascular intensive care unit or the neonatal intensive care unit were excluded. Results: A total of 38 patients met inclusion criteria of which 7 were oncology/hematopoietic cell transplant patients. The oncology/hematopoietic cell transplant group had lower platelets at the start of extracorporeal membrane oxygenation (p = 0.02) but other pre-extracorporeal membrane oxygenation characteristics were similar. Extracorporeal membrane oxygenation survival was lower in the oncology/hematopoietic cell transplant group (29% vs 77%, p = 0.02). The incidence of bleeding complications and new infections did not differ. The oncology/hematopoietic cell transplant group received more platelets (median of 15.9 mL/kg/day (interquartile range 8.4, 36.6) vs 7.9 mL/kg/day (3.3, 21.9), p = 0.04) and fresh frozen plasma (14.0 mL/kg/day (3, 15.7) vs 1.8 mL/kg/day (0.5, 5.9), p = 0.04). Conclusion: Oncology and hematopoietic cell transplant patients had a higher mortality and received more blood products while on extracorporeal membrane oxygenation than the general pediatric intensive care unit patients despite similar pre-extracorporeal membrane oxygenation characteristics. Physicians should use caution when deciding whether or not to utilize extracorporeal membrane oxygenation in this population.

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Extracorporeal Membrane Oxygenation (ECMO) as Bridge to Transplant in Pulmonary Vascular Diseases: Analysis of United Network for Organ Sharing (UNOS) Database

10.1164/ajrccm-conference.2019.199.1_meetingabstracts.a5847 ◽

2019 ◽

Author(s):

J. Sethi ◽

G.A. Garrido Rosa ◽

K. Patel ◽

N.S. Sharma

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Vascular Diseases ◽

Bridge To Transplant ◽

Membrane Oxygenation ◽

Pulmonary Vascular Diseases ◽

United Network

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Cadaveric donor lobar lung transplantation for patients on extracorporeal membrane oxygenation as bridge-to-transplant

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-013-0220-x ◽

2013 ◽

Vol 61 (4) ◽

pp. 197-200 ◽

Cited By ~ 1

Author(s):

Yoshiya Toyoda

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Lung Transplantation ◽

Cadaveric Donor ◽

Bridge To Transplant ◽

Membrane Oxygenation

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A Review of Pulmonary Arterial Hypertension Treatment in Extracorporeal Membrane Oxygenation: A Case Series of Adult Patients

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/10742484211069005 ◽

2022 ◽

Vol 27 ◽

pp. 107424842110690

Author(s):

Heather Torbic ◽

Benjamin Hohlfelder ◽

Sudhir Krishnan ◽

Adriano R. Tonelli

Keyword(s):

Pulmonary Arterial Hypertension ◽

Extracorporeal Membrane Oxygenation ◽

Arterial Hypertension ◽

Case Series ◽

Retrospective Case ◽

Bridge To Transplant ◽

Membrane Oxygenation ◽

Drug Concentrations ◽

Pulmonary Arterial ◽

Va Ecmo

Background: Little data is published describing the use of medications prescribed for pulmonary arterial hypertension (PAH) in patients receiving extracorporeal membrane oxygenation (ECMO). Even though many patients with PAH may require ECMO as a bridge to transplant or recovery, little is reported regarding the use of PAH medications in this setting. Methods: This retrospective case series summarizes the clinical experience of 8 patients with PAH receiving ECMO and reviews medication management in the setting of ECMO. Results: Eight PAH patients, 5 of whom were female, ranging in age from 21 to 61 years old, were initiated on ECMO. Veno-arterial (VA) ECMO was used in 4 patients, veno-venous (VV) ECMO and hybrid ECMO configurations in 2 patients respectively. Common indications for ECMO included cardiogenic shock, bridge to transplant, and cardiac arrest. All patients were on intravenous (IV) prostacyclin therapy at baseline. Refractory hypotension was noted in 7 patients of whom 5 patients required downtitration or discontinuation of baseline PAH therapies. Three patients had continuous inhaled epoprostenol added during their time on ECMO. In patients who were decannulated from ECMO, PAH therapies were typically resumed or titrated back to baseline dosages. One patient required no adjustment in PAH therapy while on ECMO. Two patients were not able to be decannulated from ECMO. Conclusion: The treatment of critically ill PAH patients is challenging given a variety of factors that could affect PAH drug concentrations. In particular, PAH patients on prostacyclin analogues placed on VA ECMO appear to have pronounced systemic vasodilation requiring vasopressors which is alleviated by temporarily reducing the intravenous prostacyclin dose. Patients should be closely monitored for potential need for rapid titrations in prostacyclin therapy to maintain hemodynamic stability.

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