Elective Extracorporeal Membrane Oxygenation: An Improved Perioperative Technique in the Treatment of Tracheal Obstruction

The surgical management of children with tracheal stenosis and obstruction is complicated by the perioperative needs of pressure ventilation and indwelling endotracheal tubes. These factors predispose to surgical failure and anastomotic breakdown, restenosis, and pneumomediastinum. The use of extracorporeal membrane oxygenation (ecmo) to manage ventilation during tracheal repair allows better visualization at the surgical site and obviates the need for indwelling endotracheal tubes and high-pressure ventilation. Six children were treated with elective ecmo at a tertiary care hospital. All 6 underwent successful surgical repair, and 4 of the 6 were ultimately extubated. There were no significant complications at the surgical site. There was 1 death from postoperative complications, and 2 patients required tracheotomy. One tracheotomy was performed for upper airway obstruction secondary to retrognathia, and this patient was subsequently decannulated. Medical complications were confined to 2 patients and included sepsis, hyperbilirubinemia, seizure disorder, renal failure, intracranial hemorrhage, and hydrocephalus. Elective ecmo provides a reliable perioperative technique for airway management of children with tracheal stenosis or obstruction. This technique offers the advantage of improved visibility at the operative site and eliminates the need for high-pressure ventilation, thereby likely reducing the risk of perioperative morbidity.

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Evaluation of Endothelial Biomarkers on the Prognosis of Patients on Extracorporeal Membrane Oxygenation

10.21203/rs.2.43/v2 ◽

2019 ◽

Author(s):

Tsung-Yu Tsai ◽

Kun-Hua Tu ◽

Feng-Chun Tsai ◽

Yu-Yun Nan ◽

Pei-Chun Fan ◽

...

Keyword(s):

Mortality Rate ◽

Extracorporeal Membrane Oxygenation ◽

Characteristic Curve ◽

Tertiary Care ◽

Laboratory Data ◽

Endothelial Activation ◽

Organ Damage ◽

Care Hospital ◽

Serum Samples ◽

Membrane Oxygenation

Abstract Background Extracorporeal membrane oxygenation (ECMO) is often used in critical patients with severe myocardial failure. However, patients on ECMO often have high mortality rate and poor prognosis. Recent studies suggest that endothelial activation with subsequent vascular barrier breakdown is a critical pathogenic mechanism in organ damage and related to the outcome in critical illness. This study aimed to determine whether the endothelial biomarkers could serve as prognostic factors for the outcome of patients on ECMO. Methods This prospective study enrolled total 23 critically ill patients on veno-arterial ECMO in the intensive care units of a tertiary care hospital between March 2014 and February 2015. Serum samples were tested for thrombomodulin, angiopoietin (Ang)-1, Ang-2, and vascular endothelial growth factor (VEGF). Demographic, clinical, and laboratory data were also collected. Results The overall mortality rate was 56.5%. The combination of Ang-2 at the time of ECMO support (day 0) and VEGF at day 2 had modest prognostic ability of discriminating mortality (area under receiver operating characteristic curve [AUROC], 0.854; 95% confidence interval: 0.645-0.965). Conclusions In this study, we found that the combination of Ang-2 at day 0 and VEGF at day 2 was a modest model for mortality discrimination in this group of patients.

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Rates of nosocomial infection associated with interhospital transfer of patients receiving extracorporeal membrane oxygenation

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.251 ◽

2021 ◽

pp. 1-6

Author(s):

Joseph E. Marcus ◽

Valerie G. Sams ◽

James K. Aden ◽

Andriy Batchinsky ◽

Michal J. Sobieszczyk ◽

...

Keyword(s):

Nosocomial Infection ◽

Extracorporeal Membrane Oxygenation ◽

Univariate Analysis ◽

Tertiary Care ◽

Subsequent Development ◽

High Risk Population ◽

Care Hospital ◽

Membrane Oxygenation ◽

Interhospital Transfer ◽

Increased Risk

Abstract Objectives: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently require interhospital transfer to a center that has ECMO capabilities. Patients receiving ECMO were evaluated to determine whether interhospital transfer was a risk factor for subsequent development of a nosocomial infection. Design: Retrospective cohort study. Setting: A 425-bed academic tertiary-care hospital. Patients: All adult patients who received ECMO for >48 hours between May 2012 and May 2020. Methods: The rate of nosocomial infections for patients receiving ECMO was compared between patients who were cannulated at the ECMO center and patients who were cannulated at a hospital without ECMO capabilities and transported to the ECMO center for further care. Additionally, time to infection, organisms responsible for infection, and site of infection were compared. Results: In total, 123 patients were included in analysis. For the primary outcome of nosocomial infection, there was no difference in number of infections per 1,000 ECMO days (25.4 vs 29.4; P = .03) by univariate analysis. By Cox proportional hazard analysis, transport was not significantly associated with increased infections (hazard ratio, 1.7; 95% confidence interval, 0.8–4.2; P = .20). Conclusion: In this study, we did not identify an increased risk of nosocomial infection during subsequent hospitalization. Further studies are needed to identify sources of nosocomial infection in this high-risk population.

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Evaluation of Heparin Anti–Factor Xa Levels Following Antithrombin Supplementation in Pediatric Patients Supported With Extracorporeal Membrane Oxygenation

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-25.8.717 ◽

2020 ◽

Vol 25 (8) ◽

pp. 717-722

Author(s):

Sharon E. Gordon ◽

Travis S. Heath ◽

Ali B.V. McMichael ◽

Christoph P. Hornik ◽

Caroline P. Ozment

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Pediatric Patients ◽

Life Support ◽

Extracorporeal Life Support ◽

Tertiary Care ◽

Factor Xa ◽

Care Hospital ◽

Membrane Oxygenation ◽

Support Organization ◽

Clinical Benefits

OBJECTIVE Thrombotic events are potential complications in patients receiving extracorporeal membrane oxygenation (ECMO) necessitating the use of systemic anticoagulation with heparin. Heparin works by potentiating the effects of antithrombin (AT), which may be deficient in critically ill patients and can be replaced. The clinical benefits and risks of AT replacement in children on ECMO remain incompletely understood. METHODS This single-center, retrospective study reviewed 28 neonatal and pediatric patients supported on ECMO at a tertiary care hospital between April 1, 2013, and October 31, 2014, who received at least 1 dose of AT during their ECMO course. The primary outcome of the study was the change in anti–factor Xa levels after pooled human AT supplementation. Secondary outcomes included the percentage of anti–factor Xa levels within the therapeutic range surrounding AT administration; survival to decannulation; 30 days after cannulation and discharge; time to first circuit change; and incidence of bleeding and thrombotic events. RESULTS A total of 78 doses of AT were administered during the study period. The mean increase in anti–factor Xa level following AT administration in patients without a ≥10% concurrent change in heparin was 0.075 ± 0.13 international units/mL. A greater percentage of anti–factor Xa levels were therapeutic for the 48 hours following AT administration (64.2% vs 38.6%). Survival and adverse events were similar to Extracorporeal Life Support Organization averages, with the exception of a higher incidence of intracranial hemorrhage. CONCLUSIONS Patients experienced a small but significant increase in anti–factor Xa level and a greater percentage of therapeutic anti–factor Xa levels following AT supplementation.

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Evaluation of Endothelial Biomarkers on the Prognosis of Patients on Extracorporeal Membrane Oxygenation

10.21203/rs.2.43/v1 ◽

2018 ◽

Author(s):

Tsung-Yu Tsai ◽

Kun-Hua Tu ◽

Feng-Chun Tsai ◽

Yu-Yun Nan ◽

Pei-Chun Fan ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cell Injury ◽

Characteristic Curve ◽

Tertiary Care ◽

Laboratory Data ◽

Vascular Endothelial Cell ◽

Vascular Endothelial ◽

Care Hospital ◽

Serum Samples ◽

Membrane Oxygenation

Abstract Background: Extracorporeal membrane oxygenation (ECMO) is often used in critical patients with severe myocardial failure. However, acute kidney injury (AKI) commonly occurs in patients on ECMO and usually brings about poor outcome. Recent studies suggest that renal vascular endothelial cell injury participates in the extent and maintenance of AKI. This study aimed to determine whether the endothelial biomarkers could serve as prognostic factors for the outcome of patients on ECMO. Methods: This prospective study enrolled total 23 critically ill patients on veno-arterial ECMO in the intensive care units of a tertiary care hospital between March 2014 and February 2015. Serum samples were tested for thrombomodulin, angiopoietin (Ang)-1, Ang-2, and vascular endothelial growth factor (VEGF). Demographic, clinical, and laboratory data were also collected. Results: The overall mortality rate was 56.5%. The combination of Ang-2 at the time of ECMO support (day 0) and VEGF at day 2 had modest prognostic ability of discriminating mortality (area under receiver operating characteristic curve [AUROC], 0.854; 95% confidence interval: 0.645-0.965). Conclusions: In this study, we found that the combination of Ang-2 at day 0 and VEGF at day 2 was a modest model for mortality discrimination in this group of patients.

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Extra-corporeal membrane oxygenation and outcomes in massive pulmonary embolism: Two eras at an urban tertiary care hospital

Vascular Medicine ◽

10.1177/1358863x17739697 ◽

2017 ◽

Vol 23 (1) ◽

pp. 60-64 ◽

Cited By ~ 13

Author(s):

David L Ain ◽

Mazen Albaghdadi ◽

Jay Giri ◽

Farhad Abtahian ◽

Michael R Jaff ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Clinical Laboratory ◽

Tertiary Care ◽

Disease Process ◽

Circulatory Support ◽

Care Hospital ◽

Imaging Data ◽

Extra Corporeal Membrane Oxygenation ◽

Membrane Oxygenation

Mortality associated with high-risk pulmonary embolism (PE) remains high. Extra-corporeal membrane oxygenation (ECMO) allows for acute hemodynamic stabilization and potentially for administration of other disease process altering therapies. We sought to compare two eras: pre-ECMO and post-ECMO in relation to high-risk PE treatment and mortality. A single-center retrospective chart review was conducted of high-risk PE patients. High-risk PE was defined as acute PE and cardiac arrest or shock. A total of 60 patients were identified, 31 in the pre-ECMO era and 29 in the post-ECMO era. Mean age was 56.1±21.1 years and 51.7% were women. More patients in the post-ECMO era were identified with computed tomography (82.8% vs 51.6%, p=0.011) and more patients in the post-ECMO era had right ventricular dysfunction on echocardiography (96.4% vs 78.3%, p=0.045). No other differences were noted in baseline characteristics or clinical, laboratory and imaging data between the two groups. In total, ECMO was used in 13 (44.8%) patients in the post-ECMO era. There was greater utilization of catheter-directed therapies in the post-ECMO era compared to the pre-ECMO era ( n = 7 (24.1%) vs n = 1 (3.2%), p=0.024). Thirty-day survival increased from 17.2% in patients who presented in the pre-ECMO era to 41.4% in the post-ECMO era ( p=0.043). While more work is necessary to better identify those PE patients who stand to benefit from mechanical circulatory support, our findings have important implications for the management of such patients.

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The Use of Extracorporeal Membrane Oxygenation in the Bronchoscopic Management of Critical Upper Airway Obstruction

Journal of Bronchology & Interventional Pulmonology ◽

10.1097/lbr.0000000000000347 ◽

2017 ◽

Vol 24 (1) ◽

pp. e12-e14 ◽

Cited By ~ 7

Author(s):

Bhupinder Natt ◽

James Knepler ◽

Toshinobu Kazui ◽

Jarrod M. Mosier

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Airway Obstruction ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Membrane Oxygenation

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Otolaryngology Service Usage in Children With Cleft Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665617752210 ◽

2018 ◽

Vol 55 (5) ◽

pp. 743-746 ◽

Cited By ~ 1

Author(s):

Kenneth R. Whittemore ◽

Jenna M. Dargie ◽

Briana K. Dornan ◽

Brian Boudreau

Keyword(s):

Cleft Palate ◽

Cleft Lip And Palate ◽

Tertiary Care ◽

Case Series ◽

Upper Airway ◽

Care Hospital ◽

Tympanostomy Tube ◽

Increased Risk ◽

Tympanostomy Tubes ◽

Clinic Visits

Objectives: To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Design: Retrospective case series. Setting: Specialty clinic at a pediatric tertiary care hospital. Patients: Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Main Outcome Measures: Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). Results: In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Conclusions: Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.

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