Bleomycin-induced lung injury treated with venovenous extracorporeal membrane oxygenation (ECMO) and ultra-protective ventilator settings

2020 ◽  
Vol 13 (11) ◽  
pp. e236474
Author(s):  
Mazen Faris Odish ◽  
William Cameron McGuire ◽  
Patricia Thistlethwaite ◽  
Laura E Crotty Alexander
Keyword(s):  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Case Reports ◽  
Rapid Onset ◽  
High Dose ◽  
Drug Induced ◽  
Membrane Oxygenation ◽  
Hypoxic Respiratory Failure ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Bleomycin treats malignancies, such as germ cell tumours and Hodgkin lymphoma. While efficacious, it can cause severe drug-induced lung injury. We present a 42-year-old patient with stage IIB seminoma treated with radical orchiectomy followed by adjuvant chemotherapy with bleomycin, etoposide and cisplatin. His postbleomycin course was complicated by the rapid onset of hypoxic respiratory failure, progressing to acute respiratory distress syndrome and requiring venovenous extracorporeal membrane oxygenation (VV-ECMO) support. Although the patient was treated with high dose systemic steroids and ultra-protective ventilator strategies to minimise ventilator-induced lung injury while on VV-ECMO, his lung injury failed to improve. Care was withdrawn 29 days later. Lung autopsy revealed diffuse organising pneumonia. We found six case reports (including this one) of bleomycin-induced lung injury requiring VV-ECMO with a cumulative survival of 33% (2/6). While VV-ECMO may be used to bridge patients to recovery or lung transplant, the mortality is high.

scholarly journals Severe Noncardiogenic Pulmonary Edema Secondary to Massive Verapamil Overdose and Treatment with Venovenous Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
An Ho ◽  
Abigail Go ◽  
Christopher Barrios ◽  
Anthony Scalzo
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pulmonary Edema ◽  
Cardiovascular Complications ◽  
High Dose ◽  
Verapamil Overdose ◽  
Membrane Oxygenation ◽  
First Case ◽  
Hypoxic Respiratory Failure ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Calcium channel blocker (CCB) poisoning frequently presents with cardiovascular complications such as cardiogenic shock and arrhythmia. We present a case of massive verapamil overdose causing refractory noncardiogenic pulmonary edema successfully treated with extracorporeal membrane oxygenation. To our knowledge, this is the first case with these features reported in literature. A 27-year-old female patient presented with an overdose of 18,000 mg of verapamil. Her clinical condition deteriorated to severe hypoxic respiratory failure despite being treated with calcium, high-dose insulin, and full invasive ventilation support. She eventually required venovenous extracorporeal membrane oxygenation (VV-ECMO) for three days with full recovery. Large ingestion of verapamil could lead to noncardiogenic pulmonary edema. VV-ECMO might play an important role to support the treatment in severe cases with refractory hypoxia.

scholarly journals Use of Extracorporeal Membrane Oxygenation in Pneumocystis Pneumonia of an Infant with AIDS

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Grégoire Cane ◽  
Arnaud De Boislambert ◽  
Charlotte Sgro ◽  
Pierre Lavedan ◽  
Hélène Foulgoc ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Rapid Onset ◽  
Pneumocystis Pneumonia ◽  
Pulmonary Complications ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome ◽  
Inflammatory Syndrome ◽  
Vv Ecmo

Pneumocystis pneumonia is a common complication of cellular immunosuppression and may trigger severe pulmonary complications. Rapid onset of acquired immunodeficiency syndrome is possible in infants infected with human immunodeficiency virus (HIV). We report here the case of a 13-week-old girl who was previously healthy presenting with altered immunity and refractory acute respiratory distress syndrome (ARDS) initially attributed to bacterial pneumonia. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was initiated because her condition was poor. An HIV infection was later fortuitously diagnosed after accidental exposure of a nurse to the child’s urine. The mother had congenitally transmitted HIV to the child after late (undetected) infection during pregnancy. The lung lesions were finally attributed to Pneumocystis pneumonia. We prescribed combined antiretroviral, antibiotic, and steroid therapy aimed at preventing immune reconstitution inflammatory syndrome. VV-ECMO weaning progressed over 30 days to the time of decannulation, rapidly followed by extubation and hospital discharge. The case highlights the fact that rare curable causes of refractory pediatric ARDS should always be investigated early. VV-ECMO should not be excluded as an ARDS treatment for immunocompromised children.

scholarly journals Comparing The Efficacy of Sevoflurane To Propofol For Inflammatory Response During Venovenous Extracorporeal Membrane Oxygenation

2021 ◽  
Author(s):  
Rongzhi Zhang ◽  
Jian Huang ◽  
Jianbao Yang ◽  
Xingdong Cheng ◽  
Kerong Zhai ◽  
...  
Keyword(s):  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Enzyme Linked Immunosorbent Assay ◽  
Blood Gas ◽  
Membrane Oxygenation ◽  
Arterial Blood ◽  
Sd Rats ◽  
Significant Difference ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Abstract Background: Acute respiratory distress syndrome (ARDS), a clinical syndrome resulting from intrapulmonary and/or extrapulmonary causes, is characterized by refractory hypoxemia. Currently, venovenous extracorporeal membrane oxygenation (VV ECMO) is considered as a reasonable alternative to salvage ARDS, but it requires sedation of the patient. Several studies suggest that anesthetics, such as sevoflurane and propofol, have lung protective and immunomodulatory functions. The aim of this study was to explore the effects of sevoflurane and propofol on ARDS in VV ECMO rat models.Methods: To establish the ARDS model, male Sprague-Dawley (SD) rats were injected with 100mg/kg oleic acid (OA). Twenty-four SD rats were randomly divided into two groups: sevoflurane group (Sevo group) and propofol group (Pro group). The basic vital signs of rats in each group were continuously monitored using a life monitor, and arterial blood gas tests were performed at the following three time points: T0 (baseline), T1 (the time to ARDS), and T2 (after weaning from ECMO for 1 h). Bicinchoninic acid assay (BCA) method was used to determine protein concentration in bronchial alveolar lavage fluid (BALF), whereas hemotaxylin and eosin (HE) staining was used to evaluate the lung pathological scores in each group. In addition, inflammatory factors (IL-1b, TNF-a, and MPO) in BALF, serum, and lung were determined using enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC).Results: With regard to the blood gas index, the Sevo group exhibited a better effect in improving the oxygenation function than the Pro group (P<0.05). However, there was no significant difference in mean arterial pressure (MAP) between the two groups (P>0.05). After VV ECMO assistance, the degree of lung injury and inflammatory changes in the Sevo group were significantly reduced compared to the Pro group.Conclusion: This study shows that sedation with sevoflurane during VV ECMO assisted ARDS in rats improved lung injury and inflammation, and was better than propofol in improving the oxygenation function.

scholarly journals Neurologically Devastating Intraparenchymal Hemorrhage in COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Case Series

Neurosurgery ◽  
2020 ◽  
Vol 87 (2) ◽  
pp. E147-E151 ◽  
Author(s):  
Sabrina M Heman-Ackah ◽  
YouRong Sophie Su ◽  
Michael Spadola ◽  
Dmitriy Petrov ◽  
H Isaac Chen ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Intracranial Hemorrhage ◽  
Case Reports ◽  
Case Series ◽  
Therapeutic Modality ◽  
Membrane Oxygenation ◽  
Resource Setting ◽  
Therapeutic Algorithms ◽  
Successful Recovery ◽  
Vv Ecmo

Abstract BACKGROUND AND IMPORTANCE Extracorporeal membrane oxygenation (ECMO) represents a life-saving therapy in cases of refractory hypoxia and has been utilized in patients suffering from the most severe forms of coronavirus disease 2019 (COVID-19). A strikingly high mortality rate of 94% was described in early reports of patients with COVID-19 transitioned to ECMO. Later case reports and series demonstrating successful recovery from COVID-19 after ECMO have revived interest in this therapeutic modality, including the recent approval of ECMO for COVID-19 patients by the Food and Drug Administration (FDA). Here, we present the first reports of devastating intracranial hemorrhage as a complication of veno-venous (VV) ECMO in two COVID-19 patients. CLINICAL PRESENTATION We performed a retrospective analysis of 2 cases of devastating intracranial hemorrhage in patients on VV-ECMO for the treatment of COVID-19. Collected data included clinical history, laboratory results, treatment, and review of all available imaging. Both patients demonstrated activated partial thromboplastin times (aPTT) within an appropriate therapeutic range. No risk factors that clearly predicted likelihood of this complication were identified. CONCLUSION Understanding the complications of ECMO in this cohort and developing therapeutic algorithms to aid in optimal patient selection will be critical in the limited resource setting experienced as a result of global pandemic. We propose the use of head computed tomography (CT) to identify devastating neurological complications as early as possible, aiding in the resource allocation of ECMO machines to the most appropriately selected patients.

Comparison of atrio-femoral and femoro-atrial venovenous extracorporeal membrane oxygenation in adult

Perfusion ◽  
2020 ◽  
pp. 026765912096902
Author(s):  
Steven Kin-ho Ling
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Case Control Study ◽  
Case Control ◽  
Single Centre ◽  
Retrospective Case ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Control Study ◽  
Ecmo Flow ◽  
Vv Ecmo

Introduction: Different cannulation approaches existed for veno-venous extracorporeal membrane oxygenation (VV ECMO). We aimed to compare the atrio-femoral (AF) and femoro-atrial (FA) configuration in terms of their flow efficiency and influence on patient outcome. Method: This was a single-centre, retrospective case control study. Adult patients admitted to the Intensive Care Unit and required VV ECMO service at Tuen Mun Hospital, Hong Kong, from June 2015 to January 2020 were included. Data were collected from our ECMO database for comparison. Results: Between June 2015 and January 2020, eight patients received AF configuration and 19 patients received FA configuration. The maximum achieved flow in the AF group was significantly higher than that in the FA group (4.08 ± 0.57 L/min vs. 3.52 ± 0.58 L/min, p = 0.03). The fluid balance in first 3 days of ECMO was significantly lower in the AF group compared to that in the FA group (1.16 ± 2.71 L vs. 3.46 ± 1.97 L, p = 0.02). As well, the chance for successful awake ECMO was statistically higher in the AF group (p = 0.048). Conclusion: Atrio-femoral configuration in VV ECMO was associated with a higher maximum achieved ECMO flow, less fluid gain in first 3 days of ECMO and more successful awake ECMO.

Does Earlier Cannulation With Veno-Venous Extracorporeal Membrane Oxygenation in Adult Patients With Acute Respiratory Distress Syndrome Decrease Duration of Artificial Mechanical Ventilation?

2020 ◽  
Vol 13 (2) ◽  
pp. 148-155
Author(s):  
Christine Hartner ◽  
Jacqueline Ochsenreither ◽  
Kenneth Miller ◽  
Michael Weiss
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
Vv Ecmo

BackgroundAcute respiratory distress syndrome (ARDS) is characterized by an acute, diffuse, inflammatory lung injury, leading to increased alveolar capillary permeability, increased lung weight, and loss of aerated lung tissue (Fan, Brodie, & Slutsky, 2018). Primary treatment for ARDS is artificial mechanical ventilation (AMV) (Wu, Huang, Wu, Wang, & Lin, 2016). Given recent advances in technology, the use of veno-venous extracorporeal membrane oxygenation (VV-ECMO) to treat severe ARDS is growing rapidly (Combes et al., 2014).ObjectiveThis 49-month quantitative, retrospective inpatient EMR chart review compared if cannulation with VV-ECMO up to and including 48 hours of admission and diagnosis in adult patients 30 to 65 years of age diagnosed with ARDS, decreased duration on AMV, as compared to participants who were cannulated after 48 hours of admission and diagnosis with ARDS.MethodsA total of 110 participants were identified as receiving VV-ECMO during the study timeframe. Of the 58 participants who met all inclusion criteria, 39 participants were cannulated for VV-ECMO within 48 hours of admission and diagnosis with ARDS, and 19 participants were cannulated with VV-ECMO after 48 hours of admission and diagnosis with ARDS.ResultsData collected identified no statistically significant (p < 0.579) difference in length of days on AMV between participant groups.ConclusionsFurther studies are needed to determine if earlier initiation of VV-ECMO in adult patients with ARDS decrease time on AMV.Implications for NursingAlthough the results related to length of time on AMV did not produce statistical significance, the decreased duration of AMV in the participants who were cannulated within 48 hours (21 days vs. 27 days) may support several benefits associated with this participant population including increased knowledge of healthcare providers, decreased lung injury, earlier discharge which decreases hospital and patient cost, ability for patients to communicate sooner, decreased risk of pulmonary infection, decreased length of stay, decreased cost, and improved patient and family satisfaction.

A descriptive evaluation of causes of death in venovenous extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912110359
Author(s):  
Sagar B Dave ◽  
Kristopher B Deatrick ◽  
Samuel M Galvagno ◽  
Michael A Mazzeffi ◽  
David J Kaczorowski ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Cause Of Death ◽  
Lung Transplant ◽  
Acute Hemorrhage ◽  
Ventilator Support ◽  
Common Cause ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Veno-venous extracorporeal membrane oxygenation (VV ECMO) has become an important support modality for patients with acute respiratory failure refractory to optimal medical therapy, such as low tidal volume mechanical ventilator support, early paralytic infusion, and early prone positioning. The objective of this cohort study was to investigate the causes and timing of in-hospital mortality in patients on VV ECMO. All patients, excluding trauma and bridge to lung transplant, admitted 8/2014–6/2019 to a specialty ICU for VV ECMO were reviewed. Two hundred twenty-five patients were included. In-hospital mortality was 24.4% ( n = 55). Most non-survivors (46/55, 84%) died prior to lung recovery and decannulation from VV ECMO. Most common cause of death (COD) for patients who died on VV ECMO was removal of life sustaining therapy (LST) in setting of multisystem organ failure (MSOF) ( n = 24). Nine patients died a median of 9 days [6, 11] after decannulation. Most common COD in these patients was palliative withdrawal of LST due to poor prognosis ( n = 3). Non-survivors were older and had worse predictive mortality scores than survivors. We found that death in patients supported with VV ECMO in our study most often occurs prior to decannulation and lung recovery. This study demonstrated that the most common cause of death in patients supported with VV ECMO was removal of LST due MSOF. Acute hemorrhage (systemic or intracranial) was not found to be a common cause of death in our patient population.

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