scholarly journals Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases

2020 ◽  
Author(s):  
Yen-Yu Chen ◽  
Yin-Chia Chen ◽  
Chia-Chen Wu ◽  
Hsu-Ting Yen ◽  
Kwan-Ru Huang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Course ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Hospital Death ◽  
Close Monitoring ◽  
Membrane Oxygenation ◽  
Acute Pe

Abstract Background: Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE.Methods: Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated.Results: Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 hours after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in 10 patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). Conclusions: ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.

scholarly journals Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yen-Yu Chen ◽  
Yin-Chia Chen ◽  
Chia-Chen Wu ◽  
Hsu-Ting Yen ◽  
Kwan-Ru Huang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Course ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Hospital Death ◽  
Close Monitoring ◽  
Membrane Oxygenation ◽  
Acute Pe

Abstract Background Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE. Methods Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated. Results Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 h after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in ten patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). Conclusions ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.

scholarly journals Clinical course and outcome of patients with acute pulmonary embolism rescued by veno-arterial extracorporeal membrane oxygenation: a retrospective review of 21 cases

2020 ◽  
Author(s):  
Yen Yu Chen ◽  
Chia-Chen Wu ◽  
Hsu-Ting Yen ◽  
Kwan-Ru Huang ◽  
Jiunn-Jye Sheu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Clinical Course ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Hospital Death ◽  
Close Monitoring ◽  
Membrane Oxygenation ◽  
Acute Pe

Abstract Background Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly being utilized in patients with massive pulmonary embolism (PE). However, the efficacy and the safety remain uncertain. This study aimed to investigate clinical courses and outcomes in ECMO-treated patients with acute PE. Methods Twenty-one patients with acute PE rescued by ECMO from January 2012 to December 2019 were retrospectively analysed. Clinical features, laboratory biomarkers, and imaging findings of these patients were reviewed, and the relationship with immediate outcome and clinical course was investigated. Results Sixteen patients (76.2%) experienced refractory circulatory collapse requiring cardiopulmonary resuscitation (CPR) or ECMO support within 2 hours after the onset of cardiogenic shock, and none could receive definitive reperfusion therapy before ECMO initiation. Before or during ECMO support, more than 90% of patients had imaging signs of right ventricular (RV) dysfunction. In normotension patients, the computed tomography (CT) value was a valuable predictor of rapid disease progression compared with cardiac troponin I level. Ultimately, in-hospital death occurred in 10 patients (47.6%) and 90% of them died of prolonged CPR-related brain death. Cardiac arrest was a significant predictor of poor prognosis (p = 0.001). Conclusions ECMO appears to be a safe and effective circulatory support in patients with massive PE. Close monitoring in intensive care unit is recommended in patients with RV dysfunction and aggressive use of ECMO may reduce the risk of sudden cardiac arrest and improve clinical outcome.

scholarly journals The use of veno-venous extracorporeal membrane oxygenation following thrombolysis for massive pulmonary embolism

2017 ◽  
Vol 18 (4) ◽  
pp. 342-347 ◽  
Author(s):  
Alister Seaton ◽  
Luke E Hodgson ◽  
Ben Creagh-Brown ◽  
Adrian Pakavakis ◽  
Duncan LA Wyncoll ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Massive Pulmonary Embolism ◽  
Spontaneous Circulation ◽  
Short Term ◽  
Excellent Outcome ◽  
Cardiorespiratory Failure ◽  
Membrane Oxygenation ◽  
Retrieval Team

A 59-year-old man was diagnosed with a massive pulmonary embolism. Despite thrombolysis there were two episodes of cardiac arrest and following recovery of spontaneous circulation profound cardiorespiratory failure ensued. An extracorporeal membrane oxygenation retrieval team initiated veno-venous extracorporeal membrane oxygenation on site to facilitate transfer to the extracorporeal membrane oxygenation centre. An excellent outcome is reported in the short term. This represents one of the few published cases of veno-venous extracorporeal membrane oxygenation for a massive pulmonary embolism following thrombolysis.

Continuation of Extracorporeal Membrane Oxygenation Support After Multiple Failed Lung Transplantations

ICU Director ◽  
2012 ◽  
Vol 3 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Richard B. Silverman
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Clinical Course ◽  
Circulatory Support ◽  
Initial Attempt ◽  
Membrane Oxygenation ◽  
The Family ◽  
Postoperative Time ◽  
Lung Transplants ◽  
Extended Course

This report describes the clinical course of a patient who in sequence had 2 failed orthotopic lung transplants. After each transplant, she required extended periods of circulatory support via extracorporeal membrane oxygenation (ECMO). The patient was never able to be weaned from ECMO. In the end she developed extensive multisystem organ failure and expired 45 days after the initial attempt at transplantation after spending the entire postoperative time on ECMO. The family, ethical, and sociopolitical issues raised by the extended course of care for this patient are discussed.

Evaluating the effectiveness of resuscitation with extracorporeal membrane oxygenation in a model of acute hypoxic cardiac arrest in pigs (experimental study)

2014 ◽  
Vol 5 (4) ◽  
pp. 20-26
Author(s):  
Gennadiy Grigoryevich Khubulava ◽  
Aleksey Borisovich Naumov ◽  
Sergey Pavlovich Marchenko ◽  
Vitaliy Vladimirovich Suvorov ◽  
Igor Igorevich Averkin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Extracorporeal Membrane Oxygenation ◽  
Circulatory Support ◽  
Cardiac Massage ◽  
Membrane Oxygenation ◽  
Neurologic Outcomes ◽  
Intergroup Comparison ◽  
Life Threatening ◽  
Switching Method

Cardiopulmonary resuscitation (CPR) with closed-chest cardiac massage was developed to maintain circulation and ventilation until life-threatening problems could be corrected or reversed. Studies on the effect of CPR have shown that about 80-95 % cases of resuscitation are fatal or severe neurological consequences and survival to discharge after CPR ranged from 6 to 22 % [2, 4, 8, 11]. Furthermore, the chances of survival decline rapidly if the resuscitation period more than 10 minute. At the same time, we know that successful neurologic outcomes are inversely associated with the time of brain hypoperfusion. Because of the low survival rate after prolonged CPR, more aggressive methods have been suggested to increase success. With the advancement of techniques, extracorporeal mechanical support has been applied in conjunction with CPR, with variable results [5, 12]. To assess the efficacy of resuscitation with extracorporeal membrane oxygenation was modeled the acute hypoxic cardiac arrest in pigs. Results of the study in the two groups demonstrate efficient switching method supporting circulatory support (ECMO) in the minutes of CPR. In the provision of an extended set of measures of cardiopulmonary resuscitation in the modeling of hypoxic cardiac arrest in animals in the group with ECMO received great survival to the end of the experiment, less expressed manifestations of acute heart failure. Intergroup comparison given the prerequisites for the development of protocols with the use of ECMO CPR, which would reduce the number of complications and death in patients undergoing cardiac surgery.

Extracorporeal Membrane Oxygenation in Postcardiotomy Pediatric Patients—15 Years of Experience Outside Europe and North America

2017 ◽  
Vol 67 (01) ◽  
pp. 028-036 ◽  
Author(s):  
Mohamed Ismail ◽  
Tamer Hamouda ◽  
Rafik Shaikh ◽  
Alaa Mahmoud ◽  
Mohammad Shihata ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cardiac Surgery ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Univariate Analysis ◽  
Ecmo Support ◽  
Hospital Death ◽  
Congenital Cardiac Surgery ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Support

Background The increasing complexity of congenital cardiac surgery has resulted in the increased use of extracorporeal membrane oxygenation (ECMO) support for children who cannot be weaned from cardiopulmonary bypass. The purpose of this research was to assess the mortality and morbidity in children requiring ECMO support after the repair of congenital heart defects (CHDs). Methods The hospital records of all patients with CHD who required ECMO after a cardiac surgical procedure between January 2001 and December 2016 were retrospectively reviewed. Various outcomes were reported and tested for any association with hospital death. Results A total of 113 children required ECMO for cardiopulmonary support after congenital cardiac surgery; 88 (77.9%) were placed on ECMO in the operating room. Median age of the patients was 3 months (range, 4 days–15 years) and median weight was 3.5 kg (range, 2.2–42.5). Forty-two (37.2%) survived to hospital discharge. In children with single-ventricle physiology, survival to discharge was 37.3% (19/51 patients) and for biventricular physiology, it was 37.1% (23/62 patients). Univariate analysis revealed number of days on ECMO support, renal failure, and stroke as risk factors for hospital mortality, while age and cross-clamp time were found to be statistically nonsignificant. Conclusion Satisfactory results can be achieved in pediatric patients by using ECMO support for postoperative cardiac and pulmonary failure refractory to medical management. Prolonged ECMO support, renal failure, and stroke are risk of mortality.

scholarly journals Massive aspiration syndrome: a possible indication for “emergent” veno-venous extracorporeal membrane oxygenation?: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Emiliano Gamberini ◽  
Venerino Poletti ◽  
Emanuele Russo ◽  
Alessandro Circelli ◽  
Marco Benni ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
White Male ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Lung Protective Ventilation ◽  
Emergency Setting ◽  
Membrane Oxygenation ◽  
Va Ecmo ◽  
Vv Ecmo

Abstract Background Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is usually performed in cases of severe respiratory failure in which conventional and advanced mechanical ventilation strategies are ineffective in achieving true lung-protective ventilation, thus triggering ventilatory-induced lung injury. If circulatory failure coexists, veno-arterial ECMO (VA-ECMO) may be preferred over VV-ECMO because of its potential for circulatory support. In VA-ECMO, the respiratory contribution is less effective and the complication rate is higher than in the VV configuration. Case presentation The authors present a case in which VV-ECMO was performed in an emergency setting to treat a 68-year-old White male patient who experienced acute respiratory failure after massive aspiration. Despite intubation and intensive care unit admission, multiple organ failure occurred suddenly, thus prompting referral to a level-1 trauma center with an ECMO facility. The patient’s condition slowly improved with VV-ECMO support along with standard treatment for hemodynamic impairment. VV-ECMO was discontinued on day 8. The patient was extubated on day 14 and discharged home fully recovered 34 days after the event. Conclusions Attention was focused on the decision to initiate VV-ECMO support even in the presence of severe hemodynamic derangement, although VA-ECMO could have provided better hemodynamic support but less effective respiratory support.

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