Retrieval of Adult Patients on Extracorporeal Membrane Oxygenation by an Intensive Care Physician Model

2017 ◽  
Vol 42 (3) ◽  
pp. 254-262 ◽  
Author(s):  
Aidan J. C. Burrell ◽  
David V. Pilcher ◽  
Vincent A. Pellegrino ◽  
Stephen A. Bernard
Keyword(s):  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Care Physician ◽  
Adult Patients ◽  
Intensive Care Physician ◽  
Membrane Oxygenation

scholarly journals Simplified frontal EEG in adults under veno-arterial extracorporeal membrane oxygenation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Cyril Touchard ◽  
◽  
Jérôme Cartailler ◽  
Geoffroy Vellieux ◽  
Etienne de Montmollin ◽  
...  
Keyword(s):  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Exploratory Analysis ◽  
Adult Patients ◽  
Rank Test ◽  
Membrane Oxygenation ◽  
Frontal Electrode ◽  
Eeg Recordings ◽  
Poor Outcomes ◽  
Va Ecmo

Abstract Background EEG-based prognostication studies in intensive care units often rely on a standard 21-electrode montage (stdEEG) requiring substantial human, technical, and financial resources. We here evaluate whether a simplified 4-frontal electrode montage (4-frontEEG) can detect EEG patterns associated with poor outcomes in adult patients under veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Methods We conducted a reanalysis of EEG data from a prospective cohort on 118 adult patients under VA-ECMO, in whom EEG was performed on admission to intensive care. EEG patterns of interest included background rhythm, discontinuity, reactivity, and the Synek’s score. They were all reassessed by an intensivist on a 4-frontEEG montage, whose analysis was then compared to an expert’s interpretation made on stdEEG recordings. The main outcome measure was the degree of correlation between 4-frontEEG and stdEEG montages to identify EEG patterns of interest. The performance of the Synek scores calculated on 4-frontEEG and stdEEG montage to predict outcomes (i.e., 28-day mortality and 90-day Rankin score $${\ge {4}}$$ ≥ 4 ) was investigated in a secondary exploratory analysis. Results The detection of EEG patterns using 4-frontEEG was statistically similar to that of stdEEG for background rhythm (Spearman rank test, ρ = 0.66, p < 0.001), discontinuity (Cohen’s kappa, $$\kappa$$ κ  = 0.955), reactivity ($$\kappa$$ κ  = 0.739) and the Synek’s score (ρ = 0.794, p < 0.001). Using the Synek classification, we found similar performances between 4-frontEEG and stdEEG montages in predicting 28-day mortality (AUC 4-frontEEG 0.71, AUC stdEEG 0.68) and for 90-day poor neurologic outcome (AUC 4-frontEEG 0.71, AUC stdEEG 0.66). An exploratory analysis confirmed that the Synek scores determined by 4 or 21 electrodes were independently associated with 28-day mortality and poor 90-day functional outcome. Conclusion In adult patients under VA-ECMO, a simplified 4-frontal electrode EEG montage interpreted by an intensivist, detected common EEG patterns associated with poor outcomes, with a performance similar to that of a standard EEG montage interpreted by expert neurophysiologists. This simplified montage could be implemented as part of a multimodal evaluation for bedside prognostication.

Organ Donor Issues for the Intensive Care Physician

1998 ◽  
Vol 13 (6) ◽  
pp. 269-279 ◽  
Author(s):  
Francis L. Delmonico ◽  
Jeffrey C. Reese ◽  
Keyword(s):  
Intensive Care ◽  
Organ Donor ◽  
Care Physician ◽  
Intensive Care Physician

Outcomes of adult patients supported by extracorporeal membrane oxygenation (ECMO) following cardiopulmonary arrest. The Mayo Clinic experience

2021 ◽  
Author(s):  
Pramod K Guru ◽  
Troy G Seelhammer ◽  
Tarun D Singh ◽  
Devang K Sanghavi ◽  
Sanjay Chaudhary ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Mayo Clinic ◽  
Cardiopulmonary Arrest ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Clinic Experience

scholarly journals Monitoring of adult patient on venoarterial extracorporeal membrane oxygenation in intensive care medicine

2019 ◽  
Vol 11 (S6) ◽  
pp. S946-S956 ◽  
Author(s):  
Julia Merkle ◽  
Farid Azizov ◽  
Javid Fatullayev ◽  
Carolyn Weber ◽  
Johanna Maier ◽  
...  
Keyword(s):  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Adult Patient ◽  
Intensive Care Medicine ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation

scholarly journals MP275ADEQUATE FLUID BALANCE AFFECTS OUTCOME OF ADULT PATIENTS UNDERGOING EXTRACORPOREAL MEMBRANE OXYGENATION TREATMENT

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii528-iii528
Author(s):  
Shin-Wook Kang ◽  
Misol Lee ◽  
Jung Tak Park
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Fluid Balance ◽  
Adult Patients ◽  
Membrane Oxygenation

scholarly journals Predictors of brain infarction in adult patients on extracorporeal membrane oxygenation: an observational cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Riccardo Iacobelli ◽  
Alexander Fletcher-Sandersjöö ◽  
Caroline Lindblad ◽  
Boris Keselman ◽  
Eric Peter Thelin ◽  
...  
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Brain Infarction ◽  
Multivariable Analysis ◽  
Group Analysis ◽  
Observational Cohort Study ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Observational Cohort ◽  
Va Ecmo

AbstractNon-hemorrhagic brain infarction (BI) is a recognized complication in adults treated with extracorporeal membrane oxygenation (ECMO) and associated with increased mortality. However, predictors of BI in these patients are poorly understood. The aim of this study was to identify predictors of BI in ECMO-treated adult patients. We conducted an observational cohort study of all adult patients treated with venovenous or venoarterial (VA) ECMO at our center between 2010 and 2018. The primary endpoint was a computed tomography (CT) verified BI. Logistic regression models were employed to identify BI predictors. In total, 275 patients were included, of whom 41 (15%) developed a BI. Pre-ECMO Simplified Acute Physiology Score III, pre-ECMO cardiac arrest, VA ECMO and conversion between ECMO modes were identified as predictors of BI. In the multivariable analysis, VA ECMO demonstrated independent risk association. VA ECMO also remained the independent BI predictor in a sub-group analysis excluding patients who did not undergo a head CT scan during ECMO treatment. The incidence of BI in adult ECMO patients may be higher than previously believed and is independently associated with VA ECMO mode. Larger prospective trials are warranted to validate these findings and ascertain their clinical significance.

Risk factors of acute renal injury and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation: utility of MELD-XI score

Perfusion ◽  
2021 ◽  
pp. 026765912110066
Author(s):  
Xiaochen Ding ◽  
Haixiu Xie ◽  
Feng Yang ◽  
Liangshan Wang ◽  
Xiaotong Hou
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Sofa Score ◽  
Adult Patients ◽  
Left Ventricular Ejection ◽  
Survival Group ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
Postcardiotomy Cardiogenic Shock

Background: The suitability of model for end-stage liver disease excluding international normalized ratio (MELD-XI) score to predict the incidence of acute kidney injury (AKI) and in-hospital mortality in adult patients with postcardiotomy cardiogenic shock (PCS) requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) remains uncertain. This study was performed to explore whether the MELD-XI score has the association with the incidence of AKI and in-hospital mortality in these patients. Methods: Adult patients with PCS requiring VA ECMO from January 2012 to December 2017 were enrolled and first classified into AKI group ( n = 151) versus no-AKI group ( n = 132), then classified into survival group ( n = 143) versus no-survival group ( n = 140). Multivariate logistic regressions were performed to identify factors independently associated with AKI and mortality. Baseline data were defined as the first measurement available. Results: Of 283 patients, the incidence of AKI was 53.36%. The in-hospital mortality rates were 63.58% and 33.33% in patients with and without AKI (p < 0.0001). Baseline MELD-XI score, baseline serum total bilirubin (T-Bil), baseline blood urea nitrogen (BUN), baseline left ventricular ejection fraction (LVEF), sequential organ failure assessment (SOFA) score, and lactate level at ECMO initiation were shown to be associated with the AKI. Vasoactive-inotropic score (VIS) and SOFA score at ECMO initiation as well as renal failure requiring renal replacement therapy (RRT) were shown to be associated with in-hospital mortality. Conclusions: The baseline MELD-XI score, baseline BUN, baseline T-Bil, baseline LVEF, SOFA score and lactate at the initiation of ECMO were associated with AKI. AKI, SOFA score, and VIS at the initiation of ECMO were associated with in-hospital mortality, whereas MELD-XI score was not found to be associated with in-hospital mortality. A specific MELD-XI score as a threshold, as well as its sensitivity and specificity, needs to be confirmed in further studies.

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