scholarly journals Extracorporeal Cardiopulmonary Resuscitation in Adults. Interim Guideline Consensus Statement From the Extracorporeal Life Support Organization

ASAIO Journal ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alexander (Sacha) C. Richardson ◽  
Joseph E. Tonna ◽  
Vinodh Nanjayya ◽  
Paul Nixon ◽  
Darryl C. Abrams ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Consensus Statement ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Extracorporeal Life Support Organization ◽  
Interim Guideline ◽  
Support Organization

Abstract 10907: Association of Intentional Cooling, Achieved Temperature, and Hypothermia Duration with Survival in Patients Treated with Extracorporeal Cardiopulmonary Resuscitation-An Exploratory Analysis of ELSO Registry

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Takahiro Nakashima ◽  
Soshiro Ogata ◽  
Teruo Noguchi ◽  
Kunihiro Nishimura ◽  
Nana Sefa ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Hospital Mortality ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Exploratory Analysis ◽  
Temperature Management ◽  
Hospital Death ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Support Organization ◽  
Significant Difference

Background: The efficacy of targeted temperature management remains unclear for patients treated with extracorporeal cardiopulmonary resuscitation (ECPR) due to refractory cardiac arrest. Methods: We analyzed the Extracorporeal Life Support Organization registry between 2010 and 2019. Patients 18-79 years old who received ECPR and had a reported temperature were included. First, we compared outcomes between patients who completed intentional cooling (IC) and those who did not complete intentional cooling (NIC). Among those who completed IC, we compared the outcomes between i) actual observed temperature <34°C, 34 - 36°C, and ≥36°C, and ii) hypothermia duration below 36°C for <12 hours, 12 - 48 hours, and >48 hours. The primary outcome was in-hospital death within 90 days. Cox proportional hazard models were conducted with adjustment for covariates. Results: Among a total of 8,060 patients who received ECPR, 911 patients who had a record of actual temperature were identified. After multivariable adjustment, there was no significant difference in in-hospital mortality between patients treated with IC and NIC (Hazard ratio [HR] 1.13 [95% CI 0.93 - 1.39], p=0.2252). However, among patients treated with IC, recorded temperature at 34 - 36°C had a significantly lower adjusted HR for in-hospital mortality compared with ≥36°C (HR 0.73 [0.56 - 0.97], p=0.0274). Maintaining a temperature <36°C for 12 - 48 hours had a significantly lower adjusted HR for in-hospital mortality compared with <36°C for <12 hours (HR 0.70 [0.53 - 0.91], p=0.0080). Conclusion: In this exploratory analysis, IC was not associated with lower in-hospital mortality in patients treated with ECPR. However, among those treated with IC, achieving a target temperature of 34 - 36°C and maintaining it for 12 - 48 hours were associated with lower in-hospital mortality.

Impact of ventricular assistance devices on patients submitted to heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Perez-Ortega ◽  
J Prats ◽  
E Querol
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiopulmonary Resuscitation ◽  
Heart Transplant ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Terminal Heart Failure ◽  
One Year ◽  
Ventricular Assistance

Abstract Background The introduction of veno-arterial extracorporeal life support (v-a ECLS) widens the spectrum of patients that can be included in the heart transplant program, some examples are extended myocardial infarction, fulminant myocarditis or advanced cardiac insufficiency. In addition to this, the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) extends even more the range of patients that can be benefitted of this therapy as a bridge to transplant. Purpose Our objective is to describe the incidence of v-a ECLS in those patients submitted to a heart transplant and to establish whether or not this technique increases the risk of mortality in this population. Methods Retrospective and descriptive statistical analysis of 82 consecutive patients submitted to heart transplant between 2015 and 2019 in a High Technology University Hospital. Demographic and clinical data, extracorporeal life support, extracorporeal cardiopulmonary resuscitation and assistance device type, together with survival at 30 days and one year were collected. Results 82 patients were transplanted during the study period distributed as follows: 47 (51.69%) were elective and 35 (48.1%) emergent being 25 (30.12%) of grade 1A and 10 (12.19%) of grade 1B. 52% had prior intra-aortic balloon contrapulsation. Patients transplanted under ECLS were 80% men and average age of 53 (SD 15) years old. The most prevalent diagnosis was acute myocardial infarction Killip IV (32%), followed by terminal heart failure (28%). 32% of the patients were under peripheral ECMO, 36% under left ventricular assistance, 20% under biventricular assist device, and 12% required ECPR. 72% of devices were implanted in the operating room and 16% in the ICU. The one-year survival of the sample was 88%. 2 patients died after transplantation (8%) during the first month, and 1 patient died within the first year. All three patients had terminal heart failure and the VAD implant was inserted electively Conclusions ECLS prior to cardiac transplantation allow selected patients to arrive alive to the transplant. The choice among devices is related to the diagnosis and expected duration of the therapy but we have not found in our series effects on subsequent mortality. Survival at one year in the subjects analysed is greater than the national registry of the last 10 years, although the tendency is to improve every year. This new scenario implies an increment of the complexity in the management of these patients and requires an special effort in terms of staff ratio and training. In our centre, the implementation of ECLS resulted in an increment of our staff and formative sessions. Funding Acknowledgement Type of funding source: None

scholarly journals ECMO em Recém-nascidos com Hérnia Diafragmática Congénita: A Experiência de um Centro de Referência de ECMO em Portugal

2020 ◽  
Vol 33 (12) ◽  
pp. 819
Author(s):  
Mariana Miranda ◽  
Francisco Abecasis ◽  
Sofia Almeida ◽  
Erica Torres ◽  
Leonor Boto ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Ventilatory Support ◽  
Pediatric Intensive Care ◽  
Cycle Duration ◽  
Extracorporeal Life Support Organization ◽  
Support Organization ◽  
Technological Advances

Introduction: The use of extracorporeal membrane oxygenation (ECMO) is considered by many authors as one of the most important technological advances in the care of newborns with congenital diaphragmatic hernia. The main objective of this study was to report the experience of a Portuguese ECMO center in the treatment of congenital diaphragmatic hernia.Material and Methods: Descriptive retrospective study of newborns with congenital diaphragmatic hernia requiring ECMO support in a Pediatric Intensive Care Unit from January 2012 to December 2019. Data collection using the Extracorporeal Life Support Organization registration and unit data base.Results: Fourteen newborns were included, all with left congenital diaphragmatic hernia, in a total of 15 venoarterial ECMO cycles. The median gestational age was 38 weeks and the median birth weight was 2.950 kg. Surgical repair was performed before entry into ECMO in six, during in seven and after in one newborn. The average age at placement was 3.3 days and the median cycle duration was 16 days. Prior to ECMO, all newborns had severe hypoxemia and acidosis despite optimized ventilatory support, with nitric oxide and inotropic therapy. After 24 hours on ECMO, there was correction of acidosis, improvement of oxygenation and hemodynamic stability. All cycles presented mechanical complications, the most frequent being the presence of clots in the circuit. The most frequent physiological complications were hemorrhagic and embolic (three newborns suffered an ischemic stroke during the cycle). Five newborns (35.7%) died, all associated with complications (two strokes, two massive bleedings and one accidental decannulation). Chronic lung disease, poor weight gain and psychomotor developmental delay were the most frequent long-term morbidities.Discussion: Despite technological advances in respiratory care and improved safety of the ECMO technique, the management of these newborns is complex and there are still several open questions, including the appropriate selection of patients, the best approach and time for surgical correction, and the treatment of pulmonary hypertension in the presence of persistent fetal shunts.Conclusion: Survival rate was higher than reported in 2017 Extracorporeal Life Support Organization report (64% versus 50%). Mechanical and hemorrhagic complications were very frequent.

Extracorporeal Life Support Organization Registry International Report 2016

ASAIO Journal ◽  
2017 ◽  
Vol 63 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Ravi R. Thiagarajan ◽  
Ryan P. Barbaro ◽  
Peter T. Rycus ◽  
D. Michael Mcmullan ◽  
Steven A. Conrad ◽  
...  
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Extracorporeal Life Support Organization ◽  
Support Organization ◽  
International Report
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