VA-ECMO in Landouzy Sepsis or Tubercular Septic Shock

Abstract Background While recommended by international societal guidelines in the paediatric population, the use of venoarterial extracorporeal membrane oxygenation (VA ECMO) as mechanical circulatory support for refractory septic shock in adults is controversial. We aimed to characterise the outcomes of adults with septic shock requiring VA ECMO, and identify factors associated with survival. Methods We searched Pubmed, Embase, Scopus and Cochrane databases from inception until 1st June 2021, and included all relevant publications reporting on > 5 adult patients requiring VA ECMO for septic shock. Study quality and certainty in evidence were assessed using the appropriate Joanna Briggs Institute checklist, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, respectively. The primary outcome was survival to hospital discharge, and secondary outcomes included intensive care unit length of stay, duration of ECMO support, complications while on ECMO, and sources of sepsis. Random-effects meta-analysis (DerSimonian and Laird) were conducted. Data synthesis We included 14 observational studies with 468 patients in the meta-analysis. Pooled survival was 36.4% (95% confidence interval [CI]: 23.6%–50.1%). Survival among patients with left ventricular ejection fraction (LVEF) < 20% (62.0%, 95%-CI: 51.6%–72.0%) was significantly higher than those with LVEF > 35% (32.1%, 95%-CI: 8.69%–60.7%, p = 0.05). Survival reported in studies from Asia (19.5%, 95%-CI: 13.0%–26.8%) was notably lower than those from Europe (61.0%, 95%-CI: 48.4%–73.0%) and North America (45.5%, 95%-CI: 16.7%–75.8%). GRADE assessment indicated high certainty of evidence for pooled survival. Conclusions When treated with VA ECMO, the majority of patients with septic shock and severe sepsis-induced myocardial depression survive. However, VA ECMO has poor outcomes in adults with septic shock without severe left ventricular depression. VA ECMO may be a viable treatment option in carefully selected adult patients with refractory septic shock.

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Downward Dog: A Case of VA-ECMO for Septic Shock Causing LV Failure Due to Capnocytophaga

10.1164/ajrccm-conference.2020.201.1_meetingabstracts.a5203 ◽

2020 ◽

Author(s):

E. Rojas ◽

B. Hackett ◽

A. Roohollahi ◽

S. Ali ◽

P.J. McCarthy ◽

...

Keyword(s):

Septic Shock ◽

Va Ecmo

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Sequential Extracorporeal Therapy Collaborative Device and Timely Support for Endotoxic, Septic, and Cardiac Shock: A Case Report

Blood Purification ◽

10.1159/000505146 ◽

2019 ◽

Vol 49 (4) ◽

pp. 502-508 ◽

Cited By ~ 3

Author(s):

Silvia De Rosa ◽

Sara Samoni ◽

Claudio Ronco

Keyword(s):

Septic Shock ◽

Myocardial Dysfunction ◽

Endotoxic Shock ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Septic Cardiomyopathy ◽

Ventricular Ejection Fraction ◽

Circulatory Insufficiency ◽

Extracorporeal Therapy ◽

Va Ecmo

We report a 49-year-old man, without prior medical history, consulted in the emergency department with a 5 day history of cough, fever, and dysuria. He was admitted to the intensive care unit due to septic shock. Critical care management was initiated, including mechanical ventilation and vasopressors. Endotoxic shock was suspected (endotoxin activity assay [EAA] 0.75), and 2 treatments with Polymyxin B hemoperfusion (Toraymyxin®, Toray Medical Co., Ltd., Tokyo, Japan) were performed in 48 h, alternate with high-volume hemofiltration sessions. Initial blood cultures were positive for Neisseria meningitidis (serogroup B), and a lumbar puncture was deferred because of the coagulopathy and a bleeding risk. The circulatory efficiency significantly improved after the second procedure of hemoperfusion, and the treatment resulted in a marked decrease in the serum endotoxin level (EAA <0.4). However, after 48 h, tachycardia did not improve, left ventricular ejection fraction was 20%, and circulatory insufficiency progressed. Therefore, considering the involvement of septic cardiomyopathy and cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated for circulation assistance on day 3 from admission. Continuous cytokine hemoadsorption (Cytosorb®, Cytosorbent Corporation, Monmouth Junction, NJ, USA) was incorporated into a VA-ECMO circuit for 48 h without a considerable improvement. For this reason, a 72-h continuous veno-venous hemodialysis session was started in which a high cutoff filter was used. Tachycardia and myocardial dysfunction improved by day 6, and VA-ECMO was withdrawn on the tenth day. Subsequently, nutrition management and rehabilitation were performed, and the patient was transferred to the department of respiratory medicine on day 80, he was discharged from our hospital on day 113. Sequential extracorporeal therapy may be beneficial when concomitant with circulatory assistance in uncontrollable cases of septic shock using catecholamines and blockers.

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P0220 / #481: SURVIVING STAPHYLOCOCCUS AUREUS REFRACTORY SEPTIC SHOCK IN VA-ECMO: CASE REPORT

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000739224.67830.34 ◽

2021 ◽

Vol 22 (Supplement 1 3S) ◽

pp. 132-133

Author(s):

C.D. Hernandez Rosales ◽

A. Rodriguez Sanchez ◽

J. Rodriguez Coronado ◽

R. Gomez Gutierrez ◽

B. Cardenas Del Castillo

Keyword(s):

Staphylococcus Aureus ◽

Septic Shock ◽

Case Report ◽

Refractory Septic Shock ◽

Va Ecmo

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Risk factors for refractory septic shock treated with VA ECMO

Annals of Translational Medicine ◽

10.21037/atm.2019.08.07 ◽

2019 ◽

Vol 7 (18) ◽

pp. 476-476

Author(s):

Lei Han ◽

Yan Zhang ◽

Yonghui Zhang ◽

Wei Wu ◽

Ping He

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Refractory Septic Shock ◽

Va Ecmo

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Dual veno-arterial extra-corporeal membrane oxygenation support in a patient with refractory hyperdynamic septic shock: a case report

Perfusion ◽

10.1177/0267659121998962 ◽

2021 ◽

pp. 026765912199896

Author(s):

Michal Porizka ◽

Jan Rulisek ◽

Marek Flaksa ◽

Michal Otahal ◽

Michal Lips ◽

...

Keyword(s):

Septic Shock ◽

Cardiac Output ◽

Multiorgan Failure ◽

Haemodynamic Instability ◽

Total Blood ◽

Membrane Oxygenation ◽

Distributive Shock ◽

Va Ecmo ◽

Total Blood Flow ◽

Hyperdynamic Septic Shock

The hypodynamic septic shock appears to be a promising indication to veno-arterial membrane oxygenation (VA-ECMO) support of a patient with insufficient cardiac output. With cardiac recovery most of those patients progress into a hyperdynamic septic shock with cardiac output, which may not match critically low systemic vascular resistance to maintain perfusion pressures. Such refractory distributive shock represents a challenging indication to VA-ECMO. We report a rare case of a 27-year old patient who developed severe refractory hypodynamic septic shock due to the bilateral staphylococcal pneumonia and had to be initially rescued by femoro-femoral VA-ECMO. Despite extensive measures, he remained in intractable hypotension and profound tissue hypoperfusion with imminent multiorgan failure. The commencement of a second jugulo-axillary VA ECMO secured a total blood flow of 14.3 L/min, which restored perfusion pressure and successfully bridged patient over the period of critical haemodynamic instability and ultimately may have facilitated recovery.

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Central venoarterial extracorporeal life support in pediatric refractory septic shock: a single center experience

Perfusion ◽

10.1177/02676591211001782 ◽

2021 ◽

pp. 026765912110017

Author(s):

Amanda Ruth ◽

Adam M Vogel ◽

Iki Adachi ◽

Lara S Shekerdemian ◽

Patricia Bastero ◽

...

Keyword(s):

Septic Shock ◽

Pediatric Patients ◽

Life Support ◽

Extracorporeal Life Support ◽

Case Series ◽

Maximum Flow ◽

Retrospective Case ◽

Refractory Septic Shock ◽

Va Ecmo ◽

Central Cannulation

Objective: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is recognized as a potential support therapy for pediatric patients with refractory septic shock (RSS). This review aims to report our experience with central VA cannulation in pediatric patients with RSS, and to compare this with peripheral VA ECMO cannulations for this condition at our institution. Design: Retrospective case series. Setting: Pediatric and cardiac intensive care units in an academic pediatric hospital. Patients: All patients 0–18 years old meeting criteria of RSS placed on VA ECMO between January 2011 and December 2018. Interventions: None. Measurements: Demographics, relevant clinical variables, ECMO run details, and outcomes were collected. Results: Between 2011 and 2018, 14 children were placed on VA ECMO for RSS. Nine were cannulated centrally, with the rest placed on peripheral VA ECMO. Overall survival to hospital discharge was 57.1% (8/14), with 66.7% of the central cannulation cohort surviving versus 40% in the peripheral cannulation (p = 0.34). Median ECMO duration was 147.1 hours (IQR: 91.9–178.6 hours), with survivors having a median length of 147.1 (IQR: 138.5–185.7) versus non survivors 114.7 hours (IQR: 63.7–163.5), p = 0.48. Overall median ICU length of stay (LOS) was 19 days (IQR: 10.5–42.2). The median % maximum flow achieved on VA ECMO was higher in the central cannulation group at 179.6% (IQR: 154.4–188.1) versus the peripheral with 133.5% (98.1–149.1), p = 0.01. Functional status scale (FSS) was used to capture morbidity. All survivors had a mean increase in their FSS from baseline. In the centrally cannulated group, 50% (4/8) received mediastinal exploration, but none developed mediastinitis. In terms of blood product utilization, the central cannulation received more platelets compared to the peripherally cannulated group (median 15.6 vs 3.3 mL/kg/day, p = 0.03). Conclusion: A central approach to VA ECMO cannulation is feasible and has potential for good patient outcomes in selected patients.

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Role of VA ECMO in septic shock: Does it work?

Qatar Medical Journal ◽

10.5339/qmj.2017.swacelso.24 ◽

2017 ◽

Vol 2017 (1) ◽

pp. 24 ◽

Cited By ~ 2

Author(s):

Alain Combes

Keyword(s):

Septic Shock ◽

Va Ecmo

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Venoarterial Extracorporeal Membrane Oxygenation as Mechanical Circulatory Support in Adult Septic Shock: A Systematic Review and Meta-Analysis with Individual Participant Data Meta-Regression Analysis.

10.21203/rs.3.rs-507866/v1 ◽

2021 ◽

Author(s):

Ryan Ruiyang Ling ◽

Kollengode Ramanathan ◽

Wynne Hsing Poon ◽

Chuen Seng Tan ◽

Nicolas Brechot ◽

...

Keyword(s):

Septic Shock ◽

Extracorporeal Membrane Oxygenation ◽

Mechanical Circulatory Support ◽

Meta Analysis ◽

Left Ventricular ◽

Adult Patients ◽

Circulatory Support ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Refractory Septic Shock ◽

Va Ecmo

Abstract Background: While recommended by international societal guidelines in the paediatric population, the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as mechanical circulatory support for refractory septic shock in adults is controversial. We aimed to characterise the outcomes of adults with septic shock requiring VA-ECMO, and identify factors associated with survival.Methods: We searched Pubmed, Embase, Scopus and Cochrane databases from inception until 1st April 2021, and included all relevant publications reporting on >5 adult patients requiring VA-ECMO for septic shock. Study quality and certainty in evidence were assessed using the appropriate Joanna Briggs Institute checklist, and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach respectively. The primary outcome was survival to hospital discharge, and secondary outcomes included intensive care unit length of stay, duration of ECMO support, complications while on ECMO, and sources of sepsis. Random-effects meta-analysis (DerSimonian and Laird) were conducted. Data synthesis: We included 14 observational studies with 468 patients in the meta-analysis. Pooled survival was 36.4% (95% confidence interval [CI] :23.6%-50.1%). Survival among patients with left ventricular ejection fraction (LVEF) <20% (62.0%, 95%CI: 51.6%-72.0%) was significantly higher than those with LVEF>35% (32.1%, 95%CI: 8.69%-60.7%, p=0.05). Survival reported in studies from Asia (19.5%, 95%CI: 13.0%-26.8%) was notably lower than those from Europe (61.0%, 95%CI: 48.4%-73.0%) and North America (45.5%, 95%CI: 16.7%-75.8%). Extracorporeal cardiopulmonary resuscitation was associated with reduced chances of survival (Risk ratio: 0.403, 95%CI: 0.197-0.826, p=0.01). GRADE assessment indicated high certainty of evidence for pooled survival.Conclusions: When treated with VA-ECMO, the majority of patients with septic shock and severe sepsis-induced myocardial depression survive. However, VA ECMO has poor outcomes in adults with septic shock but without severe left ventricular depression. VA-ECMO may be a viable treatment option in carefully selected adult patients with refractory septic shock.

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Continuous cytokine haemoadsorption incorporated into a venoarterial ECMO circuit for the management of postcardiotomy cardiogenic and septic shock – a case report

Perfusion ◽

10.1177/0267659118777442 ◽

2018 ◽

Vol 33 (7) ◽

pp. 593-596 ◽

Cited By ~ 3

Author(s):

Endre Nemeth ◽

Szabolcs Szigeti ◽

Tamas Varga ◽

Laszlo Daroczi ◽

Zoltan Barati ◽

...

Keyword(s):

Septic Shock ◽

Cardiac Surgery ◽

Case Report ◽

Postoperative Mortality ◽

High Volume ◽

Ecmo Circuit ◽

Successful Weaning ◽

Inflammatory Processes ◽

Va Ecmo ◽

Postcardiotomy Cardiogenic Shock

Introduction: The acute surgical treatment of infective endocarditis (IE) carries a high risk of postoperative mortality. Most complications are linked to uncontrolled sepsis and inflammatory processes. Cytokine haemoadsorption is an extracorporeal technique which has benefits reported in haemodynamic stability and inflammatory response. Case Report: A 46-year-old male patient underwent emergency cardiac surgery due to progressive IE. Postcardiotomy cardiogenic shock associated with cardiac surgery required the implantation of venoarterial (VA)-ECMO. Three days later, the patient developed secondary septic shock. The novel application of continuous CytoSorbTM treatment installed in the VA-ECMO circuit is demonstrated in this case during the management of simultaneous shocks. Advanced intensive care led to an improvement in the patient’s condition, which facilitated successful weaning from mechanical ventilation. However, the patient died from a new onset fulminant septic shock two months after his initial cardiac surgery. Discussion: VA-ECMO is suitable for installation of the CytoSorbTM cartridge. This modality could be an option for high-volume, continuous cytokine haemoadsorption when VA-ECMO is employed without renal replacement therapy. Conclusion: This specific application of CytoSorbTM was safe, feasible and contributed to the optimal management of simultaneous shocks.

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