Feasibility of inter-hospital transportation using extra-corporeal membrane oxygenation (ECMO) support of patients affected by severe swine-flu(H1N1)-related ARDS

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.

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

Perfusion ◽

10.1177/02676591211049769 ◽

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.

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Veno-venous extra-corporeal membrane oxygenation implantation in a patient with left ventricular assist device

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332359 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

D Saeed ◽

A Albert ◽

H Kamiya ◽

B Maxhera ◽

P Ortmann ◽

...

Keyword(s):

Left Ventricular Assist Device ◽

Ventricular Assist Device ◽

Left Ventricular ◽

Extra Corporeal Membrane Oxygenation ◽

Assist Device ◽

Ventricular Assist ◽

Membrane Oxygenation ◽

Left Ventricular Assist

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Pharmacokinetics of Antibiotics During Extracorporeal Membrane Oxygenation (ECMO) Support

Case Medical Research ◽

10.31525/ct1-nct03922451 ◽

2019 ◽

Author(s):

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Ecmo Support ◽

Membrane Oxygenation

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The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

The International Journal of Artificial Organs ◽

10.1177/03913988211016007 ◽

2021 ◽

pp. 039139882110160

Author(s):

Kelsey L Browder ◽

Ayesha Ather ◽

Komal A Pandya

Keyword(s):

Cohort Study ◽

Extracorporeal Membrane Oxygenation ◽

Cumulative Dose ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Primary Outcome ◽

Ecmo Support ◽

Single Center ◽

Membrane Oxygenation ◽

Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

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Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽

10.1177/02676591211012840 ◽

2021 ◽

pp. 026765912110128

Author(s):

Ismael A Salas De Armas ◽

Bindu Akkanti ◽

Pratik B Doshi ◽

Manish Patel ◽

Sachin Kumar ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Injury Severity ◽

Invasive Mechanical Ventilation ◽

Ecmo Support ◽

Trauma Patients ◽

Membrane Oxygenation ◽

Trauma Service ◽

Proper Patient Selection ◽

Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

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