scholarly journals Extra-corporeal membrane oxygenation and emergency C-section for a pregnant COVID-19 positive patient

Perfusion ◽  
2021 ◽  
pp. 026765912110497
Author(s):  
Alejandro Quintero ◽  
Eric E Vinck ◽  
Luz E Pérez ◽  
José J Escobar ◽  
Juan C Rendón ◽  
...  
Keyword(s):  
Fetal Monitoring ◽  
Fetal Distress ◽  
Ecmo Support ◽  
Positive Patient ◽  
Extra Corporeal Membrane Oxygenation ◽  
Lung Maturation ◽  
Membrane Oxygenation ◽  
Emergency Cesarean ◽  
Mother And Child ◽  
Ecmo Therapy

Introduction: Data on extra-corporeal membrane oxygenation (ECMO) therapy for pregnant patients with Coronavirus 2019 (COVID-19) infection are limited. Here we report a case of an emergency cesarean section performed while the COVID-19 positive mother was on ECMO support. Case report: A 36-year-old COVID-19 positive patient at 26 weeks gestational age presented with respiratory failure requiring extra-corporeal membrane oxygenation therapy. Nine days later fetal distress demanded an emergency C-section. After 5 weeks on ECMO, the patient was weaned off. Both mother and child were discharged. Discussion: The decision to perform an urgent C-section is one that requires meticulous thought from the attending team. Pulmonary maturation is key as pregnancy may need to be terminated at any time during ECMO. Conclusion: Data on ECMO support for pregnant patients with COVID-19 infection are scarce. Best results can be achieved ensuring adequate anticoagulation, meticulous choice of cannulas, continued fetal monitoring, early lung maturation, and precision timing of delivery.

scholarly journals Delaying Decannulation After Extracorporeal Membrane Oxygenation Is Safe and Advantageous

2019 ◽  
Vol 10 (1) ◽  
pp. 98-100 ◽  
Author(s):  
Jess L. Thompson ◽  
Elaine Griffeth ◽  
Nicholas Rappa ◽  
Colette Calame ◽  
Robert W. Letton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Adverse Outcomes ◽  
Ecmo Support ◽  
Time Interval ◽  
Single Patient ◽  
Children's Hospital ◽  
Membrane Oxygenation ◽  
The Mean ◽  
Systemic Anticoagulation ◽  
Ecmo Therapy

Removal of extracorporeal membrane oxygenation (ECMO) cannulae and discontinuing systemic anticoagulation typically occurs soon after separation from ECMO. We have found, however, that delaying decannulation after terminating ECMO therapy does not predispose to adverse outcomes and may be advantageous. Between January 2014 and June 2016, 36 postcardiotomy patients at the Children’s Hospital of Oklahoma required ECMO. In this cohort of 36 patients, there was a need for 42 ECMO runs. Of the 42 ECMO runs, 29 (69%) survived to decannulation. Of those ECMO runs that survived to decannulation, 18 (62%) were cannulated centrally and 11 (38%) were cannulated via the neck. For the runs where the patient survived to decannulation, the mean number of days on ECMO support was 4 ± 2 days. There was an average time interval of 21 ± 14 hours from ECMO termination to decannulation. A single patient failed being separated from ECMO support and required reinstitution of ECMO 18 hours after separation (but did not require recannulation).

Severe influenza a cases requiring extra-corporeal membrane oxygenation (ECMO) therapy, 2018–2019

2020 ◽  
Vol 80 (4) ◽  
pp. 469-496
Author(s):  
Matthew Charlton ◽  
Christopher Dunn ◽  
Susan Dashey ◽  
Florence Y. Lai ◽  
Julian W. Tang
Keyword(s):  
Influenza A ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Severe Influenza ◽  
Ecmo Therapy

scholarly journals Outcomes of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome in COVID-19 Patients: A Propensity-Matched Analysis

2021 ◽  
Vol 10 (12) ◽  
pp. 2547
Author(s):  
Teresa Autschbach ◽  
Nima Hatam ◽  
Koray Durak ◽  
Oliver Grottke ◽  
Michael Dreher ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Ecmo Support ◽  
Survival Prediction ◽  
Historical Cohort ◽  
Membrane Oxygenation ◽  
Ecmo Therapy

It remains unclear to what extent the outcomes and complications of extracorporeal membrane oxygenation (ECMO) therapy in COVID-19 patients with acute respiratory distress syndrome (ARDS) differ from non-COVID-19 ARDS patients. In an observational, propensity-matched study, outcomes after ECMO support were compared between 19 COVID-19 patients suffering from ARDS (COVID group) and 34 matched non-COVID-19 ARDS patients (NCOVID group) from our historical cohort. A 1:2 propensity matching was performed based on respiratory ECMO survival prediction (RESP) score, age, gender, bilirubin, and creatinine levels. Patients’ characteristics, laboratory parameters, adverse events, and 90-day survival were analyzed. Patients’ characteristics in COVID and NCOVID groups were similar. Before ECMO initiation, fibrinogen levels were significantly higher in the COVID group (median: 493 vs. 364 mg/dL, p < 0.001). Median ECMO support duration was similar (16 vs. 13 days, p = 0.714, respectively). During ECMO therapy, patients in the COVID group developed significantly more thromboembolic events (TEE) than did those in the NCOVID group (42% vs. 12%, p = 0.031), which were mainly pulmonary artery embolism (PAE) (26% vs. 0%, p = 0.008). The rate of major bleeding events (42% vs. 62%, p = 0.263) was similar. Fibrinogen decreased significantly more in the COVID group than in the NCOVID group (p < 0.001), whereas D-dimer increased in the COVID group (p = 0.011). Additionally, 90-day mortality did not differ (47% vs. 74%; p = 0.064) between COVID and NCOVID groups. Compared with that in non-COVID-19 ARDS patients, ECMO support in COVID-19 patients was associated with comparable in-hospital mortality and similar bleeding rates but a higher incidence of TEE, especially PAE. In contrast, coagulation parameters differed between COVID and NCOVID patients.

Safety Profile of Argatroban vs Heparin for Anticoagulation in Patients Requiring Extra Corporeal Membrane Oxygenation (ECMO) Therapy

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 193A
Author(s):  
Killol Patel ◽  
Pankhoori Saraf ◽  
David Shiu ◽  
Chaitali Patel ◽  
Nadeem Ali ◽  
...  
Keyword(s):  
Safety Profile ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Ecmo Therapy

Extracorporeal membrane oxygenation for pneumonitis after a Glenn palliation

Perfusion ◽  
2002 ◽  
Vol 17 (6) ◽  
pp. 457-458 ◽  
Author(s):  
James C Nielsen ◽  
Howard S Seiden ◽  
Khanh Nguyen ◽  
Susan A Vlahakis ◽  
Chitra Ravishankar
Keyword(s):  
Respiratory Syncytial Virus ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Insufficiency ◽  
Single Ventricle ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Cavopulmonary Anastomosis ◽  
Syncytial Virus ◽  
Bidirectional Cavopulmonary Anastomosis ◽  
Ecmo Therapy

A five-month old male with a single ventricle palliated with a bidirectional cavopulmonary anastomosis developed severe respiratory insufficiency from respiratory syncytial virus (RSV) pneumonitis. He was successfully rescued with extra-corporeal membrane oxygenation (ECMO) therapy and recovered with minimal morbidity.

scholarly journals Cerebrovascular accidents in patients supported with veno-arterial extra-corporeal membrane oxygenation- is duration of support important?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Hussain ◽  
N Zero ◽  
T Al-Saadi ◽  
M Asghar ◽  
N Glowacki ◽  
...  
Keyword(s):  
Ecmo Support ◽  
P Value ◽  
Extra Corporeal Membrane Oxygenation ◽  
Cerebrovascular Accidents ◽  
Membrane Oxygenation ◽  
Funding Sources ◽  
Signed Rank ◽  
Increased Risk ◽  
Va Ecmo ◽  
Control Study

Abstract Purpose of study Veno-Arterial Extra-corporeal Membrane Oxygenation (VA-ECMO) is indicated for refractory cardiac and/or respiratory failure. Adverse events remain considerable despite best practices. We specifically aimed to understand risk factors associated with cerebrovascular accidents (CVA) in patients who underwent VA-ECMO support. Methods We retrospectively assessed all VA-ECMO patients from 2007 to 2019 at our institution. We identified those who experienced a CVA while supported by VA-ECMO. Patients with the primary event (CVA) were matched to controls (no CVA) based on age and sex. Comparisons were made between groups using McNemar's, Mantel-Haenszel, and Wilcoxon Signed-Rank tests where appropriate. Results Of the 278 VA-ECMO patients in the registry, 32 patients who experienced a CVA were identified; 24 (8.6%) ischemic and 8 (2.9%) hemorrhagic. Median age was 59.5 years (inter-quartile range: 49–65 years) and 75% of patients were males. Hypertension, diabetes, CAD and CHF were common co-morbidities (Table 1). Cardiogenic shock was the most common indication for VA-ECMO support in both cohorts, 75% in cases and 71.9% in controls. Cannulation strategies were identified as central or peripheral. There was a significant association of duration of VA-ECMO support with incidence of CVA, with a p-value of 0.03. Regression analysis showed a trend of increased risk of CVA by 4% for each additional day on VA-ECMO, however, this was not statistically significant (Odds ratio: 1.04; confidence interval 1.00–1.08). Most common outcome was death followed by decannulation to recovery and bridge to LVAD. Conclusion Ischemic and hemorrhagic CVAs are not uncommon during VA-ECMO support. Our case control study shows an association of duration of VA-ECMO support with incidence of CVA. This underscores the importance of timely assessment and weaning or bridging of VA-ECMO patients to their next management step. FUNDunding Acknowledgement Type of funding sources: None.

Pharmacokinetics of Total and Unbound Cefazolin during Veno-Arterial Extracorporeal Membrane Oxygenation: A Case Report

Chemotherapy ◽  
2019 ◽  
Vol 64 (3) ◽  
pp. 115-118
Author(s):  
Jayesh A. Dhanani ◽  
Jeffrey Lipman ◽  
Jason Pincus ◽  
Shane Townsend ◽  
Amelia Livermore ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Impaired Renal Function ◽  
Massive Pulmonary Embolism ◽  
Antibiotic Administration ◽  
Extra Corporeal Membrane Oxygenation ◽  
Blood Samples ◽  
Membrane Oxygenation ◽  
Drug Concentrations ◽  
Ecmo Therapy ◽  
Refractory Cardiac Arrest

Extra-corporeal membrane oxygenation (ECMO) therapy could affect effective drug concentrations via adsorption onto the oxygenator or associated circuit. We describe a case of a 25-year-old female who required a veno-arterial ECMO therapy for refractory cardiac arrest due to massive pulmonary embolism. She had mild renal dysfunction as a result of the cardiac arrest. A total of 2 g of intravenous cefazolin 8-hourly was administered. Pre- and post-oxygenator blood samples were collected at 0, 1, 4, and 8 h post antibiotic administration. Samples were analyzed for total and unbound cefazolin concentrations. Protein binding was ∼60%. Clearance was reduced due to impaired renal function. The pharmacokinetics of cefazolin appear to not be affected by ECMO therapy and dosing adjustment may not be required.

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