205: COMPARISON OF VV ECMO AND NON-ECMO PATIENT MORTALITY AMONG EQUIVALENT DRG RISK-ADJUSTED PATIENTS

Background: The role of venovenous extracorporeal membrane oxygenation (VV ECMO) in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) still remains unclear. Our aim was to investigate the clinical course and outcome of those patients and to identify factors associated with the need for prolonged ECMO therapy. Methods: A retrospective single-center study on patients with VV ECMO for COVID-19-associated ARDS was performed. Baseline characteristics, ventilatory and ECMO parameters, and laboratory and virological results were evaluated over time. Six months follow-up was assessed. Results: Eleven of 16 patients (68.8%) survived to 6 months follow-up with four patients requiring short-term (<28 days) and seven requiring prolonged (⩾28 days) ECMO support. Lung compliance before ECMO was higher in the prolonged than in the short-term group (28.1 (28.8–32.1) ml/cmH2O vs 18.7 (17.7–25.0) ml/cmH2O, p = 0.030). Mechanical ventilation before ECMO was longer (19 (16–23) days vs 5 (5–9) days, p = 0.002) and SOFA score was higher (12.0 (10.5–17.0) vs 10.0 (9.0–10.0), p = 0.002) in non-survivors compared to survivors. Low viral load during the first days on ECMO tended to indicate worse outcomes. Seroconversion against SARS-CoV-2 occurred in all patients, but did not affect outcome. Conclusions: VV ECMO support for COVID-19-induced ARDS is justified if initiated early and at an experienced ECMO center. Prolonged ECMO therapy might be required in those patients. Although no relevant predictive factors for the duration of ECMO support were found, the decision to stop therapy should not be made dependent of the length of ECMO treatment.

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The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

The International Journal of Artificial Organs ◽

10.1177/03913988211016007 ◽

2021 ◽

pp. 039139882110160

Author(s):

Kelsey L Browder ◽

Ayesha Ather ◽

Komal A Pandya

Keyword(s):

Cohort Study ◽

Extracorporeal Membrane Oxygenation ◽

Cumulative Dose ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Primary Outcome ◽

Ecmo Support ◽

Single Center ◽

Membrane Oxygenation ◽

Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

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Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽

10.1177/02676591211012840 ◽

2021 ◽

pp. 026765912110128

Author(s):

Ismael A Salas De Armas ◽

Bindu Akkanti ◽

Pratik B Doshi ◽

Manish Patel ◽

Sachin Kumar ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Injury Severity ◽

Invasive Mechanical Ventilation ◽

Ecmo Support ◽

Trauma Patients ◽

Membrane Oxygenation ◽

Trauma Service ◽

Proper Patient Selection ◽

Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

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Heparin-free adventitia pulmonary oxygenation in the treatment of trauma complicated with severe pulmonary infection: a case report

Perfusion ◽

10.1177/0267659120984087 ◽

2021 ◽

pp. 026765912098408

Author(s):

Gu Qiao ◽

Xiao-Kang Zeng ◽

Xiang-Ying Yang ◽

Meng-Yuan Diao ◽

Ying Zhu ◽

...

Keyword(s):

Case Report ◽

Pulmonary Infection ◽

Cervical Spinal Cord ◽

Femoral Vein ◽

Severe Bleeding ◽

Bleeding Tendency ◽

Cord Injury ◽

Internal Jugular Vein Catheterization ◽

Vv Ecmo ◽

Vein Catheterization

The application of Venovenous (VV) extracorporeal membrane oxygenation (ECMO) in trauma and patients with severe bleeding tendency has been controversial. However, VV ECMO without anticoagulation contributes to reducing the risk of bleeding during ECMO maintenance. VV ECMO serves critical roles in therapy of patients with severe pulmonary infection and failure in conventional therapy. The common peripheral catheterization approach for VV ECMO is femoral vein-internal jugular vein catheterization, and bilateral femoral vein catheterization can also achieve the purpose of respiratory support for patients with limited cervical catheterization. In this case report, we described a patient with post-traumatic cervical spinal cord injury and severe pulmonary infection who was successfully treated with heparin-free intravenous ECMO.

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The Futility Dilemma: Successful VV ECMO in a Young Male With No Recruitable Lung

CHEST Journal ◽

10.1016/j.chest.2017.08.447 ◽

2017 ◽

Vol 152 (4) ◽

pp. A421

Author(s):

Noor Salam ◽

Andy Iriza ◽

Andres Zirlinger

Keyword(s):

Young Male ◽

Vv Ecmo

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Outcomes of severe systemic rheumatic disease patients requiring extracorporeal membrane oxygenation

Annals of Intensive Care ◽

10.1186/s13613-021-00819-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Pierre Bay ◽

Guillaume Lebreton ◽

Alexis Mathian ◽

Pierre Demondion ◽

Cyrielle Desnos ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Critically Ill ◽

Left Ventricular ◽

Arterial Lactate ◽

Saps Ii ◽

Membrane Oxygenation ◽

Saps Ii Score ◽

Va Ecmo ◽

Vv Ecmo

Abstract Background Systemic rheumatic diseases (SRDs) are a group of inflammatory disorders that can require intensive care unit (ICU) admission because of multiorgan involvement with end-organ failure(s). Critically ill SRD patients requiring extracorporeal membrane oxygenation (ECMO) were studied to gain insight into their characteristics and outcomes. Methods This French monocenter, retrospective study included all SRD patients requiring venovenous (VV)- or venoarterial (VA)-ECMO admitted to a 26-bed ECMO-dedicated ICU from January 2006 to February 2020. The primary endpoint was in-hospital mortality. Results Ninety patients (male/female ratio: 0.5; mean age at admission: 41.6 ± 15.2 years) admitted to the ICU received VA/VV-ECMO, respectively, for an SRD-related flare (n = 69, n = 38/31) or infection (n = 21, n = 10/11). SRD was diagnosed in-ICU for 31 (34.4%) patients. In-ICU and in-hospital mortality rates were 48.9 and 51.1%, respectively. Nine patients were bridged to cardiac (n = 5) or lung transplantation (n = 4), or left ventricular assist device (n = 2). The Cox multivariable model retained the following independent predictors of in-hospital mortality: in-ICU SRD diagnosis, day-0 Simplified Acute Physiology Score (SAPS) II score ≥ 70 and arterial lactate ≥ 7.5 mmol/L for VA-ECMO–treated patients; diagnosis other than vasculitis, day-0 SAPS II score ≥ 70, ventilator-associated pneumonia and arterial lactate ≥ 7.5 mmol/L for VV-ECMO–treated patients. Conclusions ECMO support is a relevant rescue technique for critically ill SRD patients, with 49% survival at hospital discharge. Vasculitis was independently associated with favorable outcomes of VV-ECMO–treated patients. Further studies are needed to specify the role of ECMO for SRD patients.

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Pre-emptive veno-venous ECMO in advanced tracheal malignancy prior to tracheal stenting

BMJ Case Reports ◽

10.1136/bcr-2021-243596 ◽

2021 ◽

Vol 14 (8) ◽

pp. e243596

Author(s):

Mohammad Salman Siddiqi ◽

Adil H Al Kindi ◽

Ahmed Fahmy Mandisha ◽

Rashid Al Sukaiti

Keyword(s):

Carbon Dioxide ◽

Extracorporeal Membrane Oxygenation ◽

Airway Obstruction ◽

Jugular Vein ◽

Femoral Vein ◽

Ventilatory Support ◽

Successful Management ◽

Flexible Bronchoscope ◽

Carbon Dioxide Levels ◽

Vv Ecmo

Extracorporeal membrane oxygenation (ECMO) is helpful in providing ventilatory support when other conventional methods of ventilation fail. We report a case of successful management of advanced tracheal malignancy with impeding airway obstruction where veno-venous ECMO (VV-ECMO) was instituted prior to performing critical endotracheal procedure. After securing the VV-ECMO through right jugular vein and left femoral vein under local anaesthesia, the tracheal stent placement was conducted under flexible bronchoscope and fluoroscope control. Oxygenation and carbon dioxide levels were maintained by the ECMO. VV-ECMO is a useful adjunct in the management of subglottic difficult airway obstruction due to complex tracheal pathology where conventional ventilation may not be possible or adequate.

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