Bedside angiography of distal perfusion catheter for veno-arterial extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912110070
Author(s):  
Aakash Shah ◽  
Danielle Arons ◽  
Chetan Pasrija ◽  
Zachary N Kon ◽  
Mehrdad Ghoreishi
Keyword(s):  
Lower Extremity ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Analysis ◽  
Saphenous Vein ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Distal Perfusion ◽  
Va Ecmo

Background: The aim of this study was to evaluate the ipsilateral lower extremity (ILE) outcomes of patients who underwent bedside angiography via the distal perfusion catheter while on femoral veno-arterial extracorporeal membrane oxygenation (VA ECMO). Methods: This is a retrospective analysis of all patients placed on VA ECMO at a single center from January 2017 to December 2019 who underwent bedside angiography via the distal perfusion catheter. Results: Twenty-four patients underwent bedside angiography via the distal perfusion catheter after being placed on VA ECMO. A vasodilator was directly administered in three patients for suspected spasm. One patient had distal thrombus and underwent thrombectomy and fasciotomy. One patient had a dislodged catheter and underwent thrombectomy, fasciotomy, and replacement of the catheter. One patient had severe ILE ischemia, however was not intervened upon due to critical acuity. Finally, one patient had inadvertent placement in the saphenous vein and had a new catheter placed in the SFA. No patients underwent amputation. Ultimately, 21 patients (87.5%) had no ILE compromise at the end their ECMO course. Survival to decannulation was 66.7% ( n = 16). Conclusions: Bedside angiography of the distal perfusion catheter is feasible and can be a useful adjunct in informing the need for further intervention to the ILE. Classifications: extracorporeal membrane oxygenation, ischemia

scholarly journals Double Distal Perfusion Catheters for Severe Limb Ischemia on the IABP Side in Patients Who Received Femoro-Femoral VA-ECMO With IABP

2021 ◽  
Vol 8 ◽  
Author(s):  
Meng Xin ◽  
Liangshan Wang ◽  
Xiaqiu Tian ◽  
Dengbang Hou ◽  
Hong Wang ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Near Infrared ◽  
Limb Ischemia ◽  
Symptomatic Treatment ◽  
Acute Limb Ischemia ◽  
Membrane Oxygenation ◽  
Number Of Patients ◽  
Distal Perfusion ◽  
Va Ecmo ◽  
Postcardiotomy Cardiogenic Shock

Background: Limited research is available on the pattern of double distal perfusion catheters in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) with an intra-aortic balloon pump(IABP). Here, we compared the outcomes of a double distal perfusion catheter and conventional treatment in patients who received VA-ECMO with IABP and had severe lower limb ischemia on the IABP side.Methods: We reviewed the data of 15 adult patients with postcardiotomy cardiogenic shock who received VA-ECMO via femoral cannulation combined with an IABP in the contralateral artery that was complicated with severe acute limb ischemia (ALI) on the same side as the IABP between January 2004 and December 2016. Patients underwent symptomatic treatment (conventional group, n = 9) and double distal perfusion catheterization treatment (DDPC group, n = 6). ALI was monitored using near-infrared spectroscopy placed on both calves after double distal perfusion catheters. The outcomes were compared.Results: All 6 patients who underwent double distal perfusion catheters were successfully decannulated without the development of osteofascial compartment syndrome, amputation, or bleeding and infection of the double distal perfusion catheters. The number of patients who weaned from extracorporeal membrane oxygenation successfully in the DDPC and conventional groups was 6 (100%) and 3 (33%, p = 0.028), respectively. The in-hospital mortality rates were 17% and 89% for the DDPC and conventional groups, respectively (p = 0.011).Conclusions: DDPC can be considered a strategy for severe limb ischemia on the IABP side in patients who received femoro-femoral VA-ECMO with IABP.

Venoarterial Extracorporeal Membrane Oxygenation via Direct Axillary Artery Cannulation

2021 ◽  
pp. 155698452110126
Author(s):  
Aakash Shah ◽  
Ronson J. Madathil ◽  
Bartley P. Griffith ◽  
David J. Kaczorowski
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Axillary Artery ◽  
Effective Means ◽  
Severe Pulmonary Hypertension ◽  
Artery Cannulation ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Femoral Vessels ◽  
Distal Perfusion ◽  
Va Ecmo

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an effective means of support for patients awaiting cardiac or cardiopulmonary transplantation. Typically, peripheral cannulation via the femoral vessels is preferred. However, an alternative is use of the axillary or subclavian artery, which is typically performed via a graft. Here we present the case of a patient who required VA-ECMO for cardiogenic shock with severe pulmonary hypertension as a bridge to heart-lung transplantation. Initially cannulated via the femoral artery, he was converted to a direct axillary cannulation strategy with a distal perfusion catheter and successfully bridged to transplantation. This technique avoids the use of an interposition graft and mitigates problems associated with it.

Simple technique of distal leg perfusion during heart transplant in patients with preoperative veno-arterial extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110647
Author(s):  
Suguru Ohira ◽  
Stephen Pan ◽  
Avi Levine ◽  
Chhaya Aggarwal-Gupta ◽  
Gregg M Lanier ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplant ◽  
Simple Technique ◽  
Ecmo Support ◽  
Smooth Transition ◽  
Minimal Risk ◽  
Membrane Oxygenation ◽  
Distal Perfusion ◽  
Va Ecmo ◽  
Leg Ischemia

Direct heart transplant from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support is challenging. Continuation of postoperative VA-ECMO support may be required in the setting of primary graft dysfunction or severe vasoplegia. We describe a simple technique to perfuse the ipsilateral leg of an arterial ECMO cannula during heart transplant while the ECMO circuit is turned off but maintaining the arterial cannula and distal perfusion catheter in place. This technique minimizes the number of intraoperative procedures with a minimal risk of leg ischemia, and provides a smooth transition to postoperative VA-ECMO support if necessary.

scholarly journals Oseltamivir Improved Thrombocytopenia During Veno-Arterial Extracorporeal Membrane Oxygenation in Adults With Refractory Cardiac Failure: A Single-Center Retrospective Real-World Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuan Li ◽  
Lin Wang ◽  
Jianning Zhang ◽  
Hui Han ◽  
Han Liu ◽  
...  
Keyword(s):  
Platelet Count ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiac Failure ◽  
Real World ◽  
Severe Thrombocytopenia ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Significant Difference ◽  
Va Ecmo ◽  
Cox Analysis

Background: Severe thrombocytopenia is a common complication of extracorporeal membrane oxygenation (ECMO). Oseltamivir can be used to treat infection-associated thrombocytopenia.Objective: To evaluate the effect of oseltamivir on attenuating severe thrombocytopenia during ECMO.Methods: This was a single-center real-world study in critically ill patients supported with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients suspected or confirmed with influenza received oseltamivir according to the Chinese guidelines. Thrombocytopenia and survival were compared between the oseltamivir-treated and untreated group. The factors associated with survival were analyzed by multivariable Cox analysis.Results: A total of 82 patients were included. All patients developed thrombocytopenia after initiating VA-ECMO. Twenty-three patients received oseltamivir (O+ group), and 59 did not use oseltamivir (O− group). During the first 8 days after VA-ECMO initiation, the platelet count in the O+ group was higher than that in the O− group (all P < 0.05). The patients in the O+ group had a higher median nadir platelet count (77,000/μl, 6,000–169,000/μl) compared with the O− group (49,000/μl, 2,000–168,000/μl; P = 0.04). A nadir platelet count of <50,000/μl was seen in 26% of the patients in the O+ group, compared with 53% in the O− group (P = 0.031). No significant difference in survival from cardiac failure was seen between the O+ and O− group (48 vs. 56%, P = 0.508). The Sequential Organ Failure Assessment (SOFA) score on initiation of VA-ECMO were independently associated with survival (OR = 1.12, 95% confidence interval (95% CI): 1.02–1.22, P = 0.015).Conclusions: Oseltamivir could ameliorate VA-ECMO-related thrombocytopenia. These findings suggested the prophylactic potential of oseltamivir on severe thrombocytopenia associated with the initiation of VA-ECMO.

scholarly journals Oseltamivir improved thrombocytopenia during veno-arterial extracorporeal membrane oxygenation in adults with refractory cardiac failure: A single-center retrospective real-world study

2021 ◽  
Author(s):  
Yuan Li ◽  
Lin Wang ◽  
Jianning Zhang ◽  
Hui Han ◽  
Han Liu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real World ◽  
Severe Thrombocytopenia ◽  
Single Center ◽  
Platelet Counts ◽  
Membrane Oxygenation ◽  
Failure Assessment ◽  
Va Ecmo ◽  
Cox Analysis ◽  
Platelet Count Nadir

Abstract Background Severe thrombocytopenia is a common complication of extracorporeal membrane oxygenation (ECMO). Oseltamivir can be used to treat infection-associated thrombocytopenia. Objective To evaluate the effect of oseltamivir on attenuating severe thrombocytopenia during ECMO. Methods This was a single-center real-world study in critically ill patients supported with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients suspected or confirmed with influenza received oseltamivir according to the Chinese guidelines. Thrombocytopenia and survival were compared between the oseltamivir-treated and -untreated groups. The factors associated with survival were analyzed by multivariable Cox analysis. Results A total of 82 patients were included. All patients developed thrombocytopenia after initiating VA-ECMO. Twenty-three patients received oseltamivir (O+ group), and 59 did not (O− group). During the first 8 days of VA-ECMO initiation, the platelet counts in the O+ group were higher than in the O− group (all P < 0.05). The patients in the O+ group had higher median platelet counts at the nadir (77,000/µL, 6,000-169,000/µL), compared with the O− group (49,000/µL, 2,000-168,000/µL; P = 0.04). A platelet count nadir < 50,000/µL was seen in 26% of the patients in the O+ group, compared with 53% in the O− group (P = 0.031). No significant differences in survival to discharge were seen between the O+ and O− groups (48% vs. 56%, P = 0.508). Only the Sequential Organ Failure Assessment (SOFA) scores at the time of VA-ECMO initiation were independently associated with survival (OR = 1.12, 95% confidence interval (95% CI): 1.02–1.22, P = 0.015). Conclusions Oseltamivir could ameliorate VA-ECMO-related thrombocytopenia. These findings suggest the prophylactical potential of oseltamivir on severe thrombocytopenia associated with the initiation of VA-ECMO.

scholarly journals Oseltamivir improved thrombocytopenia during veno-arterial extracorporeal membrane oxygenation in adults with refractory cardiac failure: A single-center retrospective real-world study

2021 ◽  
Author(s):  
Yuan Li ◽  
Lin Wang ◽  
Jianning Zhang ◽  
Hui Han ◽  
Han Liu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Real World ◽  
Severe Thrombocytopenia ◽  
Single Center ◽  
Platelet Counts ◽  
Membrane Oxygenation ◽  
Failure Assessment ◽  
Va Ecmo ◽  
Cox Analysis ◽  
Platelet Count Nadir

Abstract Background Severe thrombocytopenia is a common complication of extracorporeal membrane oxygenation (ECMO). Oseltamivir can be used to treat infection-associated thrombocytopenia. Objective To evaluate the effect of oseltamivir on attenuating severe thrombocytopenia during ECMO. Methods This was a single-center real-world study in critically ill patients supported with venous-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients suspected or confirmed with influenza received oseltamivir according to the Chinese guidelines. Thrombocytopenia and survival were compared between the oseltamivir-treated and -untreated groups. The factors associated with survival were analyzed by multivariable Cox analysis. Results A total of 82 patients were included. All patients developed thrombocytopenia after initiating VA-ECMO. Twenty-three patients received oseltamivir (O+ group), and 59 did not (O− group). During the first 8 days of VA-ECMO initiation, the platelet counts in the O+ group were higher than in the O− group (all P < 0.05). The patients in the O+ group had higher median platelet counts at the nadir (77,000/µL, 6,000-169,000/µL), compared with the O− group (49,000/µL, 2,000-168,000/µL; P = 0.04). A platelet count nadir < 50,000/µL was seen in 26% of the patients in the O+ group, compared with 53% in the O− group (P = 0.031). No significant differences in survival to discharge were seen between the O+ and O− groups (48% vs. 56%, P = 0.508). Only the Sequential Organ Failure Assessment (SOFA) scores at the time of VA-ECMO initiation were independently associated with survival (OR = 1.12, 95% confidence interval (95% CI): 1.02–1.22, P = 0.015). Conclusions Oseltamivir could ameliorate VA-ECMO-related thrombocytopenia. These findings suggest the prophylactical potential of oseltamivir on severe thrombocytopenia associated with the initiation of VA-ECMO.

Single-Center Outcome of Pediatric Extracorporeal Membrane Oxygenation

2013 ◽  
Vol 61 (S 02) ◽  
Author(s):  
A Rüffer ◽  
F Münch ◽  
A Purbojo ◽  
O Toka ◽  
M Glöckler ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Single Center ◽  
Membrane Oxygenation
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