Ethical considerations for post-cardiotomy extracorporeal membrane oxygenation

2012 ◽  
Vol 22 (6) ◽  
pp. 780-786 ◽  
Author(s):  
Constantine Mavroudis ◽  
Constantine D. Mavroudis ◽  
Jeanette Green ◽  
Robert M. Sade ◽  
Jeffrey P. Jacobs ◽  
...  
Keyword(s):  
Decision Making ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Selection Process ◽  
Extracorporeal Life Support ◽  
Best Interests ◽  
Membrane Oxygenation ◽  
Open Heart Procedure ◽  
The Right ◽  
Left Heart Syndrome

AbstractSignificant advances have been made in extracorporeal life support, which has resulted in the increased use of post-cardiotomy extracorporeal membrane oxygenation. Retrospective studies have contributed to the ongoing evolution of selection criteria for post-cardiotomy extracorporeal membrane oxygenation. Current indications include failure to wean from cardiopulmonary bypass, haemodynamic collapse, pulmonary hypertension, post-repair of hypoplastic left heart syndrome, or need for bridge to transplantation. Short- and mid-term results are improving. Ethical concerns still attend the process, however. Moral risks related to post-cardiotomy extracorporeal membrane oxygenation may be encountered before, during, and after the open heart procedure. At each stage of the decision-making process, moral risks are encountered by many factors that may result in decisions that may be contrary to the best interests of the patient, parents, or use of shared societal resources. These moral risks centre around the selection process, informed consent, decision making in the operating room, and post-operative maintenance of extracorporeal membrane oxygenation. Consideration of such risks is affected by questions of haemodynamic stability, haematologic compromise, neurologic status, and family concerns. We conclude that thorough understanding of the relevant scientific literature, heightened awareness of moral risks, and incorporation of ethical tenets in clinical deliberation will guide the clinician to do the right thing.

scholarly journals The role of extracorporeal membrane oxygenation in an acute basal ventricular septal rupture

2019 ◽  
Author(s):  
Daniel Matos ◽  
Marcio Madeira ◽  
Tiago Nolasco ◽  
José Pedro Neves
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Venous Drainage ◽  
Ventricular Septal Rupture ◽  
Membrane Oxygenation ◽  
The Right ◽  
Postinfarction Ventricular Septal Rupture ◽  
Mitral Bioprosthesis

Abstract A 74-year-old man was admitted with a post-acute myocardial infarction basal ventricular septal rupture. Onset of cardiogenic shock led to the implantation of a percutaneous veno-arterial extracorporeal membrane oxygenation (ECMO) system with an additional venous drainage cannula into the right ventricle. The ventricular septal defect was repaired with concomitant tricuspid valvuloplasty and mitral bioprosthesis implantation after 14 days. ECMO support was temporarily converted into a veno-venous system to wean the patient off cardiopulmonary bypass. The patient was discharged 3 weeks after surgery. This case illustrates the role of this extracorporeal life support system in the setting of postinfarction ventricular septal rupture.

Evaluation of a Multimodal Heparin Laboratory Monitoring Protocol in Adult Extracorporeal Membrane Oxygenation Patients

2021 ◽  
pp. 089719002110212
Author(s):  
Kalynn A. Northam ◽  
Bobbie Nguyen ◽  
Sheh-Li Chen ◽  
Edward Sredzienski ◽  
Anthony Charles
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Major Bleeding ◽  
Infusion Rate ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Factor Xa ◽  
Median Number ◽  
Multimodal Approach ◽  
Membrane Oxygenation ◽  
Monitoring Protocol

Background: Anticoagulation monitoring practices vary during extracorporeal membrane oxygenation (ECMO). The Extracorporeal Life Support Organization describes that a multimodal approach is needed to overcome assay limitations and minimize complications. Objective: Compare activated clotting time (ACT) versus multimodal approach (activated partial thromboplastin time (aPTT)/anti-factor Xa) for unfractionated heparin (UFH) monitoring in adult ECMO patients. Methods: We conducted a single-center retrospective pre- (ACT) versus post-implementation (multimodal approach) study. The incidence of major bleeding and thrombosis, blood product and antithrombin III (ATIII) administration, and UFH infusion rates were compared. Results: Incidence of major bleeding (69.2% versus 62.2%, p = 0.345) and thrombosis (23% versus 14.9%, p = 0.369) was similar between groups. Median number of ATIII doses was reduced in the multimodal group (1.0 [IQR 0.0-2.0] versus 0.0 [0.0 -1.0], p = 0.007). The median UFH infusion rate was higher in the ACT group, but not significant (16.9 [IQR 9.6-22.4] versus 13 [IQR 9.6-15.4] units/kg/hr, p = 0.063). Fewer UFH infusion rate changes occurred prior to steady state in the multimodal group (0.9 [IQR 0.3 -1.7] versus 0.1 [IQR 0.0-0.2], p < 0.001). Conclusion: The incidence of major bleeding and thrombosis was similar between groups. Our multimodal monitoring protocol standardized UFH infusion administration and reduced ATIII administration.

Extracorporeal membrane oxygenation outcomes in children with hemophagocytic lymphohistiocytosis

Perfusion ◽  
2016 ◽  
Vol 32 (2) ◽  
pp. 151-156 ◽  
Author(s):  
Katherine Cashen ◽  
Roland L Chu ◽  
Justin Klein ◽  
Peter T Rycus ◽  
John M Costello
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Hemorrhagic Complication ◽  
Membrane Oxygenation ◽  
Va Ecmo

Introduction: Pediatric patients with hemophagocytic lymphohistiocytosis (HLH) may develop refractory respiratory or cardiac failure that warrants consideration for extracorporeal membrane oxygenation (ECMO) support. The purposes of this study were to describe the use and outcomes of ECMO in pediatric HLH patients, to identify risk factors for hospital mortality and to compare their ECMO use and outcomes to the ECMO population as a whole. Methods: Pediatric patients (⩽ 18 years) with a diagnosis of HLH in the Extracorporeal Life Support Organization (ELSO) Registry were included. Results: Between 1983 and 2014, data for 30 children with HLH were available in the ELSO registry and all were included in this study. All cases occurred in the last decade. Of the 30 HLH patients, 24 (80%) had a respiratory indication for ECMO and six (20%) had a cardiac indication (of which 4 were E-CPR and 2 cardiac failure). Of the 24 respiratory ECMO patients, 63% were placed on VA ECMO. Compared with all pediatric patients in the ELSO registry during the study period (n=17,007), HLH patients had worse hospital survival (non-HLH 59% vs HLH 30%, p=0.001). In pediatric HLH patients, no pre-ECMO risk factors for mortality were identified. The development of a hemorrhagic complication on ECMO was associated with decreased mortality (p=0.01). Comparing HLH patients with respiratory failure to patients with other immune compromised conditions, the overall survival rate is similar (HLH 38% vs. non-HLH immune compromised 31%, p=0.64). Conclusions: HLH is an uncommon indication for ECMO and these patients have increased mortality compared to the overall pediatric ECMO population. These data should be factored into decision-making when considering ECMO for pediatric HLH patients.

scholarly journals Hollow Fiber Oxygenator Composition Has a Significant Impact on Failure Rates in Neonates on Extracorporeal Membrane Oxygenation: A Retrospective Analysis

2017 ◽  
Vol 07 (01) ◽  
pp. 007-013 ◽  
Author(s):  
Philip Bernard ◽  
Sean Skinner ◽  
Prasad Bhandary ◽  
Ana Ruzic ◽  
Matthew Bacon ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Analysis ◽  
Hollow Fiber ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Clinical Use ◽  
Failure Rates ◽  
Membrane Oxygenation

AbstractIn extracorporeal life support (ECLS), there are two main types of oxygenators in clinical use for neonates: polymethylpentene (PMP) hollow fiber and polypropylene (PP) hollow fiber. A retrospective study was performed on neonates (n = 44) who had undergone ECLS for noncardiac indications from 2009 to 2015. Between the two groups (PMP n = 21, PP n = 23), the PP oxygenators failed 91% of the time, whereas the PMP oxygenators failed 43% of the time (p < 0.05). Analysis suggests PMP oxygenators are less prone to failure than PP oxygenators, and they require fewer number of oxygenator changes during a neonatal ECLS.

Extracorporeal Membrane Oxygenation

2018 ◽  
Author(s):  
Julian Villar ◽  
Stephen Ruoss ◽  
Richard HA ◽  
Joe Hsu
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Key Words Complications ◽  
Risk Of Death ◽  
Membrane Oxygenation ◽  
Circulatory Assist Devices ◽  
Tissue Oxygen Delivery ◽  
Gas Exchange System

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, is the practice of using circulatory assist devices and a gas exchange system to maintain sufficient tissue oxygen delivery, supplementing pulmonary and/or cardiac function in patients whose native physiology is too severely altered to be successfully supported solely by conventional life support techniques (eg, mechanical ventilation and inotropic and vasopressor drugs). ECMO should be considered in patients who are at a high risk of death due to a potentially reversible etiology of cardiopulmonary collapse. Indications for ECMO can be broadly divided into profound respiratory failure and/or cardiogenic shock. The indications include acute respiratory distress syndrome, heart failure, postoperative cardiogenic shock, and as an adjunct to cardiopulmonary resuscitation in patients with cardiac arrest. ECMO is currently experiencing a renaissance, and familiarity with its concepts is important for all critical care practitioners. This review contains 8 figures, 8 tables and 34 references Key Words: complications, equipment, indications, management basics, outcomes

scholarly journals Outcomes of Pediatric Patients with Abdominal Sepsis Requiring Surgery and Extracorporeal Membrane Oxygenation Using the Extracorporeal Life Support Organization Database

2015 ◽  
Vol 81 (3) ◽  
pp. 245-251 ◽  
Author(s):  
Michael R. Phillips ◽  
Amal L. Khoury ◽  
Briana J. K. Stephenson ◽  
Lloyd J. Edwards ◽  
Anthony G. Charles ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Abdominal Sepsis ◽  
Bleeding Complications ◽  
Extracorporeal Life Support Organization ◽  
Membrane Oxygenation ◽  
Support Organization

No study describes the use of extracorporeal membrane oxygenation (ECMO) in pediatric patients with abdominal sepsis (AS) requiring surgery. A description of outcomes in this patient population would assist clinical decision-making and provide a context for discussions with patients and families. The Extracorporeal Life Support Organization database was queried for pediatric patients (30 days to 18 years) with AS requiring surgery. Forty-five of 61 patients survived (73.8%). Reported bleeding complications (57.1 vs 48.8%), the number of pre-ECMO ventilator hours (208.1 vs 178.9), and the timing of surgery before (50 vs 66.7%) and on-ECMO (50 vs 26.7%) were similar in survivors and nonsurvivors. Decreased pre-ECMO mean pH (7.1 vs 7.3) was associated with increased mortality (odds ratio, 1.49; 95% confidence interval, 1.04 to 2.14). ECMO use for pediatric patients with AS requiring surgery is associated with increased mortality and an increased rate of bleeding complications compared with all pediatric patients receiving ECMO support. Acidemia predicts mortality and provides a potential target of examination for future studies.

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