Abstract 12990: The Association of Modifiable Mechanical Ventilation Settings, Blood Gas Changes and Survival After Extracorporeal Cardiopulmonary Resuscitation

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Joseph Tonna ◽  
Craig Selzman ◽  
Jason Bartos ◽  
Zhining Ou ◽  
Yeonjung Jo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Cohort Analysis ◽  
Peak Inspiratory Pressure ◽  
Estimating Equation ◽  
Future Research ◽  
Case Mix ◽  
Blood Gas ◽  
Extracorporeal Cardiopulmonary Resuscitation

Introduction: Gas exchange during ECMO can occur independent of the lungs through ECMO, enabling a wider range of ventilator settings and blood gas values. Yet it is not known if potentially modifiable mechanical ventilation parameters or blood gas values are associated with survival for patients who receive ECPR. Hypothesis: To determine associations between ventilation parameters, blood gas values, and survival. Methods: Cohort analysis among 7,488 ECPR patients ≥18yrs of age from the Extracorporeal Life Support Organization (ELSO) Registry from 2008 - 2019. We examined the association between mechanical ventilation parameters on-ECMO with case-mix adjusted hospital survival. We used generalized estimating equation logistic regression, accounting for center level variation. Results: Case-mix adjusted patient-level mechanical ventilation parameters and blood gas values on-ECMO varied across individual hospitals, including arterial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), and changes in these values from pre-ECMO to on-ECMO. Increasing absolute on-ECMO PaO2 (OR 0.88 [95% CI 0.86, 0.9]; p<0.001), and relative increases in PaO2 from pre- to on-ECMO (OR 0.91 [0.89,0.93]; p<0.001) were both associated with decreased survival. Relative increases in pre- to on-ECMO PaCO2 (OR 1.31 [1.14, 1.1.54]; p<0.001) were associated with improved survival. Decreasing peak inspiratory pressure (OR 0.77, per 5 centimeters of water (cmH2O) [0.72, 0.81]; p<0.001) and fraction of inspired oxygen (OR 0.94, per 5% [0.92, 0.96]; p<0.001) were both associated with improved survival. Conclusions: Mechanical ventilation parameters of ECPR patients varies across hospitals. Potentially modifiable parameters and blood gas values are associated with survival and should be the focus of future research.

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

Rest ventilator management in children on veno-venous extracorporeal membrane oxygenation

2021 ◽  
pp. 039139882199938
Author(s):  
Matthew L Friedman ◽  
Samer Abu-Sultaneh ◽  
James E Slaven ◽  
Christopher W Mastropietro
Keyword(s):  
Mechanical Ventilation ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Arterial Oxygen Saturation ◽  
Peak Inspiratory Pressure ◽  
Conventional Mechanical Ventilation ◽  
Arterial Oxygen ◽  
Multivariable Logistic Regression Analysis ◽  
Membrane Oxygenation ◽  
Ventilator Management

Background: We aimed to use the Extracorporeal Life Support Organization registry to describe the current practice of rest mechanical ventilation setting in children receiving veno-venous extracorporeal membrane oxygenation (V-V ECMO) and to determine if relationships exist between ventilator settings and mortality. Methods: Data for patients 14 days to 18 years old who received V-V ECMO from 2012-2016 were reviewed. Mechanical ventilation data available includes mode and settings at 24 h after ECMO cannulation. Multivariable logistic regression analysis was performed to determine if rest settings were associated with mortality. Results: We reviewed 1161 subjects, of which 1022 (88%) received conventional mechanical ventilation on ECMO. Rest settings, expressed as medians (25th%, 75th%), are as follows: rate 12 breaths/minute (10, 17); peak inspiratory pressure (PIP) 22 cmH2O (20,27); positive end expiratory pressure (PEEP) 10 cmH2O (8, 10); and fraction of inspired oxygen (FiO2) 0.4 (0.37, 0.60). Survival to discharge was 68%. Higher ventilator FiO2 (odds ratio:1.13 per 0.1 increase, 95% confidence interval:1.04, 1.23), independent of arterial oxygen saturation, was associated with mortality. Conclusions: Current rest ventilator management for children receiving V-V ECMO primarily relies on conventional mechanical ventilation with moderate amounts of PIP, PEEP, and FiO2. Further study on the relationship between FiO2 and mortality should be pursued.

EXTRACORPOREAL LIFE SUPPORT FOR STATUS ASTHMATICUS

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 261-261
Author(s):  
Thomas Bell
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Status Asthmaticus ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Alternative Therapy ◽  
Treatment Resistant ◽  
Venovenous Bypass ◽  
Primary Indication ◽  
Additional Therapy

Purpose of the Study. This report presents the experience with one case of status asthmaticus who failed to respond to mechanical ventilation and was successfully managed with extracorporeal life support (ECLS) using venovenous bypass. The purpose is to inform the practitioner of an additional therapy, potentially of benefit, in management of asthma complicated by treatment-resistant respiratory failure. Methods. Low volume venovenous bypass with extracorporeal life support resolved severe respiratory failure in a 23-year-old female asthmatic over a 22-hour period after failure of 5 hours of mechanical ventilation. Bypass was initiated remotely by an ECLS team using a portable ECLS circuit before the 180-mile transport to the "nearby" center. Details of the technique are presented. Conclusion and Reviewer's Comments. This may be the first instance where asthma was the primary indication for ECLS; other asthmatics have been so treated, but for other complicating conditions like pneumonia and adult respiratory distress syndrome. This report provides a further alternative therapy, even in somewhat remote areas, for asthma-caused respiratory failure.

scholarly journals Decompressive laparotomy for abdominal compartment syndrome in patient on extracorporeal life support: A first survival case among adults with literature review

2017 ◽  
Vol 25 (3) ◽  
pp. 166-168
Author(s):  
Won Ho Chang
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Life Support ◽  
Perfusion Pressure ◽  
Extracorporeal Life Support ◽  
Bladder Pressure ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Decompressive Laparotomy ◽  
Abdominal Compartment ◽  
Survival Case

Here, we report a case of successful treatment for a patient with abdominal compartment syndrome who was on venoarterial extracorporeal life support. A 33-year-old man visited the emergency room with cardiac arrest. Extracorporeal cardiopulmonary resuscitation was performed, and massive volume infusion was needed to maintain adequate perfusion pressure. After 6 h, his abdomen was distended, and venous drain was decreased. His bladder pressure was more than 25 mm Hg. Abdominal compartment syndrome was suspected, and prompt decompressive laparotomy was performed to restore venous drain, resulting in stabilization hemodynamically. The patient made a full recovery. He was discharged after implantation of internal cardiac defibrillator.

scholarly journals Extracorporeal Life Support and New Therapeutic Strategies for Cardiac Arrest Caused by Acute Myocardial Infarction - a Critical Approach for a Critical Condition

2016 ◽  
Vol 2 (4) ◽  
pp. 164-174 ◽  
Author(s):  
Theodora Benedek ◽  
Monica Marton Popovici ◽  
Dietmar Glogar
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Systems Of Care ◽  
Extracorporeal Life Support ◽  
Coronary Revascularization ◽  
Critical Approach ◽  
Extracorporeal Cardiopulmonary Resuscitation

Abstract This review summarizes the most recent developments in providing advanced supportive measures for cardiopulmonary resuscitation, and the results obtained using these new therapies in patients with cardiac arrest caused by acute myocardial infarction (AMI). Also detailed are new approaches such as extracorporeal cardiopulmonary resuscitation (ECPR), intra-arrest percutaneous coronary intervention, or the regional models for systems of care aiming to reduce the critical times from cardiac arrest to initiation of ECPR and coronary revascularization.

Mechanical ventilation during extracorporeal life support (ECLS): a systematic review

2015 ◽  
Vol 41 (6) ◽  
pp. 994-1003 ◽  
Author(s):  
Jonathan D. Marhong ◽  
Laveena Munshi ◽  
Michael Detsky ◽  
Teagan Telesnicki ◽  
Eddy Fan
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Life Support ◽  
Extracorporeal Life Support

Neonatal Kawasaki syndrome presenting as out of hospital cardiac arrest rescued by extracorporeal cardiopulmonary resuscitation

Perfusion ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 86-88
Author(s):  
Marguerite Tyson ◽  
Ala Mustafa ◽  
Prem Venugopal ◽  
Ben Whitehead ◽  
Ben Anderson ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Kawasaki Disease ◽  
Cardiopulmonary Resuscitation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pediatric Intensive Care ◽  
Kawasaki Syndrome ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Diagnostic Uncertainty ◽  
Local Emergency Department

A 7-week-old girl presented in severe shock to a local emergency department. During transfer to the quaternary pediatric hospital, the child had a cardiac arrest and cardiopulmonary resuscitation was commenced en route. Upon arrival to the pediatric intensive care unit, extracorporeal life support was initiated via trans-sternal cannulation. Chest CT performed after extracorporeal life support cannulation, demonstrated widespread aneurysms and a diagnosis of Kawasaki disease was made. Immunomodulatory therapy with immunoglobulin and glucocorticoid medication was commenced and the child was separated from extracorporeal life support after 48 hours. Our case highlights both an unusual presentation of Kawasaki disease and the role extracorporeal cardiopulmonary resuscitation can play in the treatment of this disease. It describes the youngest reported patient in the literature with Kawasaki disease rescued by extracorporeal cardiopulmonary resuscitation and highlights how extracorporeal life support therapy can facilitate appropriate investigations to resolve diagnostic uncertainty and treat the underlying condition.

Sign in / Sign up

Export Citation Format

Share Document