Extracorporeal respiratory and cardiac support techniques in the ICU

2016 ◽  
Author(s):  
Claire Westrope ◽  
Giles Peek
Keyword(s):  
Cardiopulmonary Bypass ◽  
Lung Function ◽  
Cardiac Failure ◽  
Life Support ◽  
General Term ◽  
Swine Flu ◽  
Extra Corporeal Membrane Oxygenation ◽  
Temporary Support ◽  
Extracorporeal Therapy ◽  
Mechanical Devices

Extra corporeal life support (ECLS) is an essential tool for the modern intensivist and surgeon. The addition of extracorporeal therapy should be considered in all cases when pathology is potentially reversible and conventional therapy is clearly failing. ECLS is a general term to describe prolonged, but temporary support of heart and lung function using mechanical devices, which has developed as an extension of cardiopulmonary bypass techniques used in the operating theatre. Use in adult severe respiratory and cardiac failure is increasing following significant advances in ECLS techniques learnt from paediatric and neonatal experiences, and successful use of extra corporeal membrane oxygenation in the 2009 and 2001 H1N1 (swine flu) outbreaks. This chapter describes the techniques required for providing successful ECLS in adult respiratory and cardiac failure.

scholarly journals Màng trao đổi oxy ngoài cơ thể (ECMO) trong nhi khoa

1970 ◽  
pp. 14-20
Author(s):  
Trần Minh Điển ◽  
Trịnh Xuân Long
Keyword(s):  
Cardiopulmonary Bypass ◽  
Life Support ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation

Màng trao đổi oxy ngoài cơ thể (ECMO – Extra Corporeal Membrane Oxygenation) hay còn gọi là ECLS (Extra Corporeal Life Support) là kỹ thuật phát triển từ hệ thống hỗ trợ tuần hoàn ngoài cơ thể (Cardiopulmonary bypass) trong phẫu thuật tim mở. ECMO áp dụng hỗ trợ thời gian kéo dài với nhiều bệnh khác nhaucó suy hô hấp và/hoặc suy tuần hoàn nặng, không chỉ cho phẫu thuật tim mà cả các bệnh khác có khả năng hồi phục như sốc, ARDS, chấn thương, sau ghép tim, ghép phổi…Năm 1971, ca ECMO đầu tiên được tiến hành hỗ trợ bệnh nhân 24 tuổi bị ARDS sau chấn thương, sau 75 giờ hỗ trợ, bệnh được cứu sống [1].Năm 1972, bác sỹ ngoại khoa Robert H. Barlett, người Mỹ sử dụng ECMO hỗ trợ 36 giờ cho bệnh nhân sau thủ thuật Mustard điều trị bệnh chuyển gốc động mạch ở trẻ 2 tuổi [2]. Năm 1975, ca ECMO đầu tiên hỗ trợ cho bệnh nhân sơ sinh bị suy hô hấp do hội chứng hít phân su [3]. Đến năm 1982, Barlett và cộng sự tại Đại học Michigan báo cáo nghiên cứu với 45 bệnh nhân sơ sinh bị suy hô hấp được hỗ trợ ECMO và tỷ lệ sống là 65% [4]. Năm 1985, Barlett và cộng sự côngbố nghiên cứu tiến cứu ngẫu nhiên so sánh kết quả điều trị bệnh nhân sơ sinh bị suy hô hấp bằng hỗ trợ ECMO và thở máy thông thường, kết quả tỷ lệ sống do ECMO cao hơn [5]. Sau đó tác giả O’Rourke và cộng sự tiến hành nghiên cứu tương tự trên bệnh nhân sơ sinh bị tăng áp phổi dai dẳng ở trẻ sơ sinh và tỷ lệ sống ở nhóm ECMO là 90% so với nhóm thở máy là 60% [6]. Năm 2013, Trần Minh Điển và cộng sự thông báo hai trường hợp phù phổi cấp/suy tim cấp sau phẫu thuật và suy hô hấp cấp do viêm phổi nặng được thực hiện ECMO thành công tại Bệnh viện Nhi Trung ương [17].Từ kết quả khả quan trên, ECMO được phát triển rộng và hỗ trợ cho bệnh nhân nhi lớn tuổi hơn bị bệnh suy hô hấp và/hoặc tuần hoàn với những kinh nghiệm được phát triển từ những bệnh nhân sơ sinh.

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.

Extracorporeal life support with an integrated left ventricular vent in children with a low cardiac output

2013 ◽  
Vol 24 (4) ◽  
pp. 654-660 ◽  
Author(s):  
Stany Sandrio ◽  
Wolfgang Springer ◽  
Matthias Karck ◽  
Matthias Gorenflo ◽  
Alexander Weymann ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Cardiac Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Neurological Dysfunction ◽  
Left Heart ◽  
Low Cardiac Output ◽  
Cardiac Thrombus ◽  
The Right

AbstractBackground: The aim of this study was to evaluate our experience in central extracorporeal life support with an integrated left ventricular vent in children with cardiac failure. Methods: Eight children acquired extracorporeal life support with a left ventricular vent, either after cardiac surgery (n = 4) or during an acute cardiac illness (n = 4). The ascending aorta and right atrium were cannulated. The left ventricular vent was inserted through the right superior pulmonary vein and connected to the venous line on the extracorporeal life support such that active left heart decompression was achieved. Results: No patient died while on support, seven patients were successfully weaned from it and one patient was transitioned to a biventricular assist device. The median length of support was 6 days (range 5–10 days). One patient died while in the hospital, despite successful weaning from extracorporeal life support. No intra-cardiac thrombus or embolic stroke was observed. No patient developed relevant intracranial bleeding resulting in neurological dysfunction during and after extracorporeal life support. Conclusions: In case of a low cardiac output and an insufficient inter-atrial shunt, additional left ventricular decompression via a vent could help avoid left heart distension and might promote myocardial recovery. In pulmonary dysfunction, separate blood gas analyses from the venous cannula and the left ventricular vent help detect possible coronary hypoxia when the left ventricle begins to recover. We recommend the use of central extracorporeal life support with an integrated left ventricular vent in children with intractable cardiac failure.

Pharmacokinetics and Extracorporeal Membrane Oxygenation in Adults: A Literature Review

2018 ◽  
Vol 29 (3) ◽  
pp. 246-258 ◽  
Author(s):  
Monika Tukacs
Keyword(s):  
Literature Review ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Patient Population ◽  
The Body ◽  
Adult Patients ◽  
Destination Therapy ◽  
Extra Corporeal Membrane Oxygenation ◽  
Bridge To Recovery ◽  
Membrane Oxygenation

Extracorporeal membrane oxygenation is a rapidly emerging treatment for respiratory or cardiac failure and is used as a bridge to recovery, transplant, or destination therapy. Adult patients receiving extracorporeal membrane oxygenation also receive significant amounts of pharmacotherapy. Although the body of literature on extra-corporeal membrane oxygenation in general is extensive, only a few publications focus on pharmacokinetic changes related to extracorporeal membrane oxygenation in adults. Understanding pharmacokinetics in adult patients receiving extracorporeal membrane oxygenation is important to correctly select and dose medications in this patient population. This article reviews published studies of the effects of extracorporeal membrane oxygenation on pharmacokinetics in adults.

Lung Perfusion With Clarithromycin Ameliorates Lung Function After Cardiopulmonary Bypass

2006 ◽  
Vol 81 (3) ◽  
pp. 896-901 ◽  
Author(s):  
Xiangming Fan ◽  
Yinglong Liu ◽  
Qiang Wang ◽  
Cuntao Yu ◽  
Bo Wei ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Lung Function ◽  
Lung Perfusion

O-63 Sevoflurane diminishes lung function deterioration caused by cardiopulmonary bypass

2011 ◽  
Vol 25 (3) ◽  
pp. S27
Author(s):  
Zsófia Csorba ◽  
Dorottya Czövek ◽  
Gábor Bogáts ◽  
Ferenc Peták ◽  
Barna Babik
Keyword(s):  
Cardiopulmonary Bypass ◽  
Lung Function ◽  
O 63
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