Bronchotracheal Stenting Management by Rigid Bronchoscopy under Extracorporeal Membrane Oxygenation (ECMO) Support: 10 Years of Experience in a Tertiary Center

Purpose. Airway stenting offers good palliation and improves the quality of life in patients with inoperable bronchotracheal stenosis. However, in some cases, the management of stenting can be life-threatening. Hence, a strategy for maintaining oxygenation and hemodynamic stability should be anticipated to avoid critical situations. Herein, we report the use of extracorporeal membrane oxygenation (ECMO) in bronchotracheal stenting management to secure oxygenation and facilitate interventions. Methods. We retrospectively reviewed all patients who underwent rigid bronchoscopy under ECMO support for the management of bronchotracheal stenting at CHU UCL Namur hospital (Belgium), between January 2009 and December 2019. Results. We included 14 bronchoscopy cases performed on 11 patients (3 patients underwent 2 bronchoscopies) in this study; 12 were performed on males and 2 on females. The median age was 54 years. There were 11 benign and 3 malignant etiologies for the central airway obstruction/stenosis. Eight cases were supported by venovenous ECMO and six by venoarterial ECMO. The median ECMO time was 267 minutes. The weaning of ECMO support was successful in all cases. In most cases, the procedures were performed effectively and safely. Only two local complications caused by the cannulation of ECMO were reported, and anticoagulation was adapted to avoid bleeding at the operating site and clot formation in the system. Conclusion. Elective ECMO support was helpful and safe for the high-risk management of bronchotracheal stenting with rigid bronchoscopy and was not associated with any additional significant complications.

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Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients

Clinical Critical Care ◽

10.54205/ccc.v29i.252413 ◽

2021 ◽

Author(s):

Surat Tongyoo ◽

Suneerat Kongsayreepong

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Janus Kinase ◽

Systemic Steroid ◽

Heparin Infusion ◽

Membrane Oxygenation ◽

Rescue Treatment ◽

Threatening Condition ◽

Life Threatening ◽

The Individual

During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.

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Central Airway Obstruction due to Mediastinal Malignant Lymphoma Requiring Venovenous-Extracorporeal Membrane Oxygenation

Case Reports in Acute Medicine ◽

10.1159/000501649 ◽

2019 ◽

Vol 2 (2) ◽

pp. 42-47 ◽

Cited By ~ 1

Author(s):

Yoshihiro Ueda ◽

Ichiro Hirayama ◽

Ryohei Horie ◽

Kent Doi ◽

Naoto Morimura

Keyword(s):

Intensive Care ◽

Extracorporeal Membrane Oxygenation ◽

Airway Obstruction ◽

Malignant Lymphoma ◽

Hematological Malignancy ◽

Central Airway Obstruction ◽

Membrane Oxygenation ◽

Life Threatening ◽

Central Airway ◽

Ecmo Therapy

Extracorporeal membrane oxygenation (ECMO) therapy might be controversial when patients with advanced malignant disease develop heart or lung failure refractory to conventional management. Especially as for the hematological malignancy patients, the induction of ECMO therapy must be considered carefully, since it is often associated with bleeding complications or infectious diseases. Here, we report a case of life-threatening airway obstruction requiring ECMO. The trachea of the patient was narrowed by an anterior mediastinal tumor too highly to ventilate both lungs, so she had to be connected to venovenous-ECMO (VV-ECMO) before pathological examination and radical treatment were planned. During the intensive care with ECMO, she was diagnosed with malignant lymphoma and the chemotherapy was started. The chemotherapy brought such an immediate result that the trachea regained its patency and ECMO was disconnected 9 days after the initiation of the chemotherapy. Then, the patient was able to leave the intensive care unit with no sequelae. Central airway obstruction is a life-threatening situation, in which prompt decisions are essential. On the other hand, if the airway is impaired by hematological malignancy, it might be generally challenging to consider ECMO as a bridge until the chemotherapy takes an effect. The prognosis of hematological malignancy differs according to its subtype or stage, so it may be reasonable to take ECMO therapy into consideration for some population.

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Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

10.21203/rs.2.11328/v2 ◽

2019 ◽

Author(s):

Jing Xiong ◽

Li Zhang ◽

Lei Bao

Keyword(s):

Systematic Review ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Meta Analysis ◽

Cochrane Library ◽

Membrane Oxygenation ◽

Venovenous Ecmo ◽

Complications And Mortality ◽

Overall Mortality

Abstract Background: Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. To systematically evaluate the complications and mortality of venovenous ECMO in the treatment of neonatal respiratory failure, we performed a systematic review and meta-analysis of all the related studies. Methods: PubMed, Embase, and Cochrane Library were searched. The retrieval period was from the establishment of the database to February 2019. Two investigators independently screened articles according to the inclusion and exclusion criteria. The quality of article was assessed by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by Stata 15.0 software. Results: Four observational studies were included, with a total of 347 newborns. The overall mortality at hospital charge was 12% (5% - 18%) with a heterogeneity of I2 = 73.8% (p = 0.01). Two studies reported mortality during ECMO and after decannulation, with 10% (0.8% -19.2%) and 6.1% (2.6% - 9.6%) respectively. The most common complications associated with venovenous ECMO were: pneumothorax (20.6%), hypertension (20.4%), cannula dysfunction (20.2%), seizure (14.9%), renal failure requiring hemofiltration (14.7%), infectious complications (10.3%), thrombi (7.4%), intracranial hemorrhage or infarction (6.6%), hemolysis (5.3%), cannula site bleeding (4.4%), gastrointestinal bleeding (3.7%), oxygenator failure (2.8%), other bleeding events (2.8%), brain death (1.9%), and myocardial stun (0.9%). Conclusion: The overall mortality at discharge of venovenous ECMO in the treatment of neonatal respiratory failure was 12%. Although complications are frequent, the survival rate during hospitalization is still high. Further larger samples and higher quality of randomized controlled trials (RCT) are needed to clarify the efficacy and safety of this technique in the treatment of neonatal respiratory failure.

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Complications and mortality of venovenous extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure: a systematic review and meta-analysis

10.21203/rs.2.11328/v1 ◽

2019 ◽

Author(s):

Jing Xiong ◽

Li Zhang ◽

Lei Bao

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Meta Analysis ◽

Cochrane Library ◽

Bleeding Events ◽

Membrane Oxygenation ◽

Venovenous Ecmo ◽

Complications And Mortality ◽

Overall Mortality

Abstract Background Extracorporeal membrane oxygenation (ECMO) has been increasingly used for severe neonatal respiratory failure refractory to conventional treatments. To systematically evaluate the complications and mortality of venovenous ECMO in the treatment of neonatal respiratory failure. Methods PubMed, Embase, and Cochrane Library were searched. The retrieval period was from the establishment of the database to February 2019. Two investigators independently screened articles according to the inclusion and exclusion criteria. The quality of article was assessed by the Newcastle-Ottawa scale (NOS). The meta-analysis was performed by Stata 15.0 software. Results Four observational studies were included, with a total of 347 newborns. The overall mortality at hospital charge was 12% (5% - 18%) with a heterogeneity of I2 = 73.8% (p = 0.01). Two studies reported mortality during ECMO and after decannulation, with 10% (0.8% -19.2%) and 6.1% (2.6% - 9.6%) respectively. The most common complications associated with venovenous ECMO were: pneumothorax (20.6%), hypertension (20.4%), cannula dysfunction (20.2%), seizure (14.9%), renal failure requiring hemofiltration (14.7%), infectious complications (10.3%), thrombi (7.4%), intracranial hemorrhage or infarction (6.6%), hemolysis (5.3%), cannula site bleeding (4.4%), gastrointestinal bleeding (3.7%), oxygenator failure (2.8%), other bleeding events (2.8%), brain death (1.9%), and myocardial stun (0.9%). Conclusion The overall mortality at discharge of venovenous ECMO in the treatment of neonatal respiratory failure was 12%. Although complications are frequent, the survival rate during hospitalization is still high. Further larger samples, and higher quality of randomized controlled trials (RCT) are needed to clarify the efficacy and safety of this technique in the treatment of neonatal respiratory failure.

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Extracorporeal membrane oxygenation for COVID-19: a systematic review and meta-analysis

Critical Care ◽

10.1186/s13054-021-03634-1 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Kollengode Ramanathan ◽

Kiran Shekar ◽

Ryan Ruiyang Ling ◽

Ryan P. Barbaro ◽

Suei Nee Wong ◽

...

Keyword(s):

Systematic Review ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Observational Studies ◽

Clinical Decision Making ◽

Meta Analysis ◽

Ecmo Support ◽

Membrane Oxygenation ◽

Meta Regression ◽

Venovenous Ecmo

Abstract Background There are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research. Methods We searched MEDLINE, Embase, Cochrane and Scopus databases from 1 December 2019 to 10 January 2021 for observational studies or randomised clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and meta-regression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO. Results We included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI 32.3–42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI 30.7–40.7%, high certainty). Meta-regression found that age and ECMO duration were associated with increased mortality. Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI 13.4–18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI 50.5–82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common. Conclusion The majority of patients received venovenous ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1% during the first year of the pandemic, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS. PROSPERO CRD42020192627.

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Extracorporeal Membrane Oxygenation for COVID-19: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-381055/v1 ◽

2021 ◽

Author(s):

Kollengode Ramanathan ◽

Kiran Shekar ◽

Ryan Ruiyang Ling ◽

Ryan Barbaro ◽

Suei Nee Wong ◽

...

Keyword(s):

Systematic Review ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Observational Studies ◽

Randomized Clinical Trials ◽

Clinical Decision Making ◽

Meta Analysis ◽

Ecmo Support ◽

Membrane Oxygenation ◽

Venovenous Ecmo

Abstract Background: There are several reports of extracorporeal membrane oxygenation (ECMO) use in patients with coronavirus disease 2019 (COVID-19) who develop severe acute respiratory distress syndrome (ARDS). We conducted a systematic review and meta-analysis to guide clinical decision-making and future research.Methods: We searched MEDLINE, Embase, Cochrane, and Scopus databases from 1st December 2019 to 10th January 2021 for observational studies or randomized clinical trials examining ECMO in adults with COVID-19 ARDS. We performed random-effects meta-analyses and metaregression, assessed risk of bias using the Joanna Briggs Institute checklist and rated the certainty of evidence using the GRADE approach. Survival outcomes were presented as pooled proportions while continuous outcomes were presented as pooled means, both with corresponding 95% confidence intervals [CIs]. The primary outcome was in-hospital mortality. Secondary outcomes were duration of ECMO therapy and mechanical ventilation, weaning rate from ECMO and complications during ECMO.Results: We included twenty-two observational studies with 1896 patients in the meta-analysis. Venovenous ECMO was the predominant mode used (98.6%). The pooled in-hospital mortality in COVID-19 patients (22 studies, 1896 patients) supported with ECMO was 37.1% (95% CI: 32.3%-42.0%, high certainty). Pooled mortality in the venovenous ECMO group was 35.7% (95% CI: 30.7%-40.7%, high certainty). Duration of ECMO support (18 studies, 1844 patients) was 15.1 days (95% CI: 13.4-18.7). Weaning from ECMO (17 studies, 1412 patients) was accomplished in 67.6% (95% CI:50.5%-82.7%) of patients. There were a total of 1583 ECMO complications reported (18 studies, 1721 patients) and renal complications were the most common.Conclusion: Majority of patients received ECMO support for COVID-19-related ARDS. In-hospital mortality in patients receiving ECMO support for COVID-19 was 37.1%, similar to those with non-COVID-19-related ARDS. Increasing age was a risk factor for death. Venovenous ECMO appears to be an effective intervention in selected patients with COVID-19-related ARDS.PROSPERO CRD42020192627

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Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01675-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Albert Youngwoo Jang ◽

Young Jun Oh ◽

Seok In Lee ◽

Oh Kyung Lim ◽

Soon Yong Suh

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Extracorporeal Membrane Oxygenation ◽

Femoral Neuropathy ◽

Vein Thrombosis ◽

Membrane Oxygenation ◽

Life Threatening ◽

Deep Vein ◽

Ecmo Therapy

Abstract Background Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one’s quality of life. Case presentation A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling. Conclusion The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.

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Emergency rigid bronchoscopy and immunotherapy: successful combination in dramatic respiratory debut of pulmonary adenocarcinoma

Tumori Journal ◽

10.1177/03008916211022834 ◽

2021 ◽

pp. 030089162110228

Author(s):

Carmine Guarino ◽

Cristiano Cesaro ◽

Giuseppe La Cerra ◽

Raffaella Lucci ◽

Flavio Cesaro ◽

...

Keyword(s):

Respiratory Symptoms ◽

Rigid Bronchoscopy ◽

Therapeutic Success ◽

Emergency Scenario ◽

Joint Application ◽

Threatening Condition ◽

Life Threatening ◽

Central Airway ◽

Targeted Immunotherapy

Malignant central airway obstruction is a life-threatening condition that often causes respiratory failure. In many cases, treatment of tumor in rigid bronchoscopy must be performed urgently, soothing respiratory symptoms and improving patient quality of life, in many cases reducing time to and allowing application of oncologic therapies. Immuno-oncologic therapies target the immune system selectively and are therefore much less toxic than standard chemotherapies, sometimes leading to outstanding results in advanced cancers for which there were no effective treatments until a few years ago. This report shows the effect of the joint application of rigid bronchoscopy and targeted immunotherapy in an emergency scenario, resulting in an unexpected extraordinary therapeutic success.

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Experience with Extracorporeal Membrane Oxygenation in Children More than One Month Old

Anaesthesia and Intensive Care ◽

10.1177/0310057x9202000305 ◽

1992 ◽

Vol 20 (3) ◽

pp. 308-310 ◽

Cited By ~ 5

Author(s):

W. Butt ◽

T. Karl ◽

A. Horton ◽

F. Shann ◽

R. Mullaly

Keyword(s):

Quality Of Life ◽

Extracorporeal Membrane Oxygenation ◽

Cardiac Failure ◽

Cardiorespiratory Failure ◽

Children's Hospital ◽

Membrane Oxygenation ◽

Acceptable Quality ◽

Children’S Hospital ◽

Life Threatening

Extracorporeal membrane oxygenation (ECMO) has been used at the Royal Children's Hospital, Melbourne, in the treatment of children with life-threatening respiratory or cardiac failure since May 1988. The main indications for its use are, first, the disease is thought to be reversible, second, the child will survive with an acceptable quality of life and, third, the child has an 80% chance of dying without ECMO. Seven of eighteen children receiving ECMO have survived to leave hospital, and all are functionally normal: these results are similar to international results. It would appear that ECMO is a useful therapy for some children with otherwise fatal cardiorespiratory failure.

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