Extracorporeal Membrane Oxygenation

2019 ◽  
pp. 228-236
Author(s):  
Michael E. Lowe ◽  
Joseph D. Roberts ◽  
Mark A. Chaney
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Disease ◽  
Clinical Efficacy ◽  
Pump System ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation ◽  
Mechanical Devices ◽  
Over Time

Percutaneous mechanical devices are used in the treatment of severe cardiac or respiratory disease. These devices include extracorporeal membrane oxygenation, intra-aortic balloon pump, TandemHeart™, and Impella®. The use of these devices has increased over time as their clinical efficacy has been established and technological advancements have made their use more practical and accessible. Technological advancements have helped improve the morbidity of ECMO. Two of the major improvements have been to the oxygenator and to the pump system. As these devices become more commonplace, it is important to have a thorough understanding of how each device works, their indications, and potential complications.

Veno-arterial extracorporeal membrane oxygenation with concomitant Impella versus concomitant intra-aortic-balloon-pump for cardiogenic shock

Perfusion ◽  
2021 ◽  
pp. 026765912110339
Author(s):  
Shek-yin Au ◽  
Ka-man Fong ◽  
Chun-Fung Sunny Tsang ◽  
Ka-Chun Alan Chan ◽  
Chi Yuen Wong ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Mechanical Circulatory Support ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Queen Elizabeth Hospital ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Va Ecmo

Introduction: The intra-aortic balloon pump (IABP) and Impella are left ventricular unloading devices with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) in place and later serve as bridging therapy when VA-ECMO is terminated. We aimed to determine the potential differences in clinical outcomes and rate of complications between the two combinations of mechanical circulatory support. Methods: This was a retrospective, single institutional cohort study conducted in the intensive care unit (ICU) of Queen Elizabeth Hospital, Hong Kong. Inclusion criteria included all patients aged ⩾18 years, who had VA-ECMO support, and who had left ventricular unloading by either IABP or Impella between January 1, 2018 and October 31, 2020. Patients <18 years old, with central VA-ECMO, who did not require left ventricular unloading, or who underwent surgical venting procedures were excluded. The primary outcome was ECMO duration. Secondary outcomes included length of stay (LOS) in the ICU, hospital LOS, mortality, and complication rate. Results: Fifty-two patients with ECMO + IABP and 14 patients with ECMO + Impella were recruited. No statistically significant difference was observed in terms of ECMO duration (2.5 vs 4.6 days, p = 0.147), ICU LOS (7.7 vs 10.8 days, p = 0.367), and hospital LOS (14.8 vs 16.5 days, p = 0.556) between the two groups. No statistically significant difference was observed in the ECMO, ICU, and hospital mortalities between the two groups. Specific complications related to the ECMO and Impella combination were also noted. Conclusions: Impella was not shown to offer a statistically significant clinical benefit compared with IABP in conjunction with ECMO. Clinicians should be aware of the specific complications of using Impella.

scholarly journals Chronic respiratory disease and survival outcomes after extracorporeal membrane oxygenation

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.

scholarly journals Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time

ASAIO Journal ◽  
2021 ◽  
Vol 67 (5) ◽  
pp. 496-502
Author(s):  
Jeffrey p. Jacobs ◽  
Alfred H. Stammers ◽  
James St. Louis ◽  
J.W. Awori Hayanga ◽  
Michael S. Firstenberg ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Institutional Analysis ◽  
Membrane Oxygenation ◽  
Trends Over Time ◽  
Over Time

Spallation performance of extracorporeal membrane oxygenation tubing

Perfusion ◽  
2000 ◽  
Vol 15 (5) ◽  
pp. 457-466 ◽  
Author(s):  
Giles J Peek ◽  
Andrew Thompson ◽  
Hilliary M Killer ◽  
Richard K Firmin
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Laser Diode ◽  
Weak Correlation ◽  
Roller Pump ◽  
Pump Speed ◽  
Membrane Oxygenation ◽  
Particle Counting ◽  
Tygon Tubing ◽  
On Line ◽  
Over Time

During the prolonged roller pump use of extracorporeal membrane oxygenation (ECMO), tubing wear generates spallation. The spallation performance of Tygon® S-65-HL was measured and compared with a potential new ECMO tubing, LVA (Portex 800-500-575). Spallation was measured by on-line laser diode particle counting (HIAC) during simulated ECMO. The effects of differing levels of occlusion and pump speed were examined, as was the effect of spallation over time. The spallation produced by Tygon S-65-HL was less than that seen with LVA during 24 h of simulated ECMO ( p < 0.001), and after 72 h had fallen almost to zero. Spallation with Tygon tubing increases with increasing pump speed and decreases over time. There appears to be only a weak correlation with occlusion, which is surprising. The spallation performance of Tygon S-65-HL was variable and under some conditions exceeded that of LVA. Overall, however, Tygon S-65-HL produced less spallation than LVA. Therefore, LVA cannot be recommended for clinical ECMO use.

Role of Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation

2016 ◽  
Vol 40 (8) ◽  
pp. E136-E145 ◽  
Author(s):  
Antonio Loforte ◽  
Giacomo Murana ◽  
Mariano Cefarelli ◽  
Giuliano Jafrancesco ◽  
Mario Sabatino ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Graft Failure ◽  
Cardiac Transplantation ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation ◽  
Early Graft ◽  
Early Graft Failure

Influence of Extracorporeal Membrane Oxygenation Circuit on Nutritional Supplements

2020 ◽  
Vol 3 (5) ◽  
pp. 01-09
Author(s):  
AS Thiara
Keyword(s):  
Vitamin A ◽  
Extracorporeal Membrane Oxygenation ◽  
Ex Vivo ◽  
Nutritional Supplements ◽  
Ecmo Support ◽  
Blood Pump ◽  
Ecmo Circuit ◽  
Membrane Oxygenation ◽  
Over Time ◽  
Control Samples

Background The main function of extracorporeal membrane oxygenation (ECMO) is to provide systemic perfusion and gas exchange for patients with severe, acute respiratory or cardiac illness. The ECMO system consists of blood pump and a membrane oxygenator. ECMO oxygenator fibers, blood pump and tubing may bind circulating compounds such as drugs and nutritional components during ECMO support. Any loss of vital nutrients due to adsorption to the ECMO circuits may lead to further nutritional debilitation in critical ill patients. Objective The purpose of study is to analyze the amount of nutritional supplements adsorbed to the ECMO circuit under controlled ex vivo conditions Methods Six identical ECMO circuits were primed with fresh human whole blood and maintained under physiological conditions at 36°C for 24 hours. A dose of nutritional supplement calculated for a 70 kg patient was added. 150 mL volume was drawn from priming bag for control samples and kept under similar conditions. Blood samples were obtained at predetermined time points and analyzed for concentrations of vitamins, minerals, lipids, and proteins. Statistical analyses were performed using mixed models with robust standard errors, which allows for repeated samples within each setup and incomplete data. Results No significant differences were found between the ECMO circuits and controls for any of the measured variables: cobalamin, folate, vitamin A, glucose, concentration of minerals, HDL cholesterol, LDL cholesterol, total cholesterol, triglycerides, and total proteins. There was an initial decrease and then and increase in the concentration of cobalamin and folate. Vitamin A concentrations decreased in both groups over time. There was a decrease in concentration of glucose and an increased concentration of lactate dehydrogenase over time in both groups. Conclusion There were no changes in the concentrations of nutritional supplements in an ex vivo ECMO circuit compared to control samples, indicating that parenteral nutrition can be given during ECMO support. However, the time span of this study was limited, and the design made it impossible to investigate any functional and structural changes over time in nutritional supplements which lead to diminished effects through the ECMO circuit.

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