scholarly journals Outcomes in Trauma Patients Undergoing Venovenous Extracorporeal Membrane Oxygenation for Adult Respiratory Distress Syndrome

2021 ◽  
Author(s):  
Seon Hee Kim ◽  
Up Huh ◽  
Seunghwan Song ◽  
Min Su Kim ◽  
Il Jae Wang ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Adult Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Trauma Patients ◽  
Factors Affecting ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Abstract Background: Use of venovenous extracorporeal membrane oxygenation (VV ECMO) remains controversial in trauma patients with adult respiratory distress syndrome (ARDS). Here, we aimed to investigate its therapeutic benefits and the factors affecting patient outcomes.Methods: From 2017–2019, 21/1938 trauma patients (median age: 47 years; 20 men) at a level I trauma center received VV ECMO for post-traumatic ARDS. Demographic, injury-specific, ECMO, and outcome data were prospectively collected and retrospectively reviewed to analyze the factors affecting hospital mortality and ECMO results.Results: Nineteen patients (90.5%) were successfully weaned off ECMO; 16 patients (76.2%) survived to discharge. In the univariate analysis, there was a significant difference in survival between the groups with a Trauma and Injury Severity Score (TRISS) ≥0.5 and TRISS <0.5 (p=0.05). The area under the receiver operating characteristic curve (AUC) of both TRISS and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction (RESP) scores in death was 0.78. In those who failed ECMO weaning, the AUCs of TRISS and RESP scores were 0.90 and 0.80, respectively.Conclusions: In patients with ARDS caused by severe trauma and supported by VV ECMO, survival is associated with TRISS; TRISS and RESP scores may be predictive of mortality and failure of ECMO weaning.

Sedation and analgesia requirements during venovenous extracorporeal membrane oxygenation in acute respiratory distress syndrome patients

Perfusion ◽  
2021 ◽  
pp. 026765912110521
Author(s):  
Xingshu Ren ◽  
Yuhang Ai ◽  
Lina Zhang ◽  
Chunguang Zhao ◽  
Li Li ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Linear Correlation ◽  
Distress Syndrome ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Sedation And Analgesia ◽  
Vv Ecmo

Introduction: The purpose of this study is to describe sedation and analgesia management, and identify the factors associated with increased demand for medication in acute respiratory distress syndrome (ARDS) patients receiving venovenous extracorporeal membrane oxygenation (VV-ECMO). Methods: This retrospective, single-center study included consecutive adult ARDS patients who received VV-ECMO for at least 24 hours from January 2018 to December 2020 in a comprehensive intensive care unit. The electronic medical records were retrospectively reviewed to collect data. Results: Forty-two adult patients meeting the inclusion criteria were included in the study. Midazolam, sufentanil, and remifentanil were main sedatives and analgesics used in the patient population. The morphine equivalents, representative of the demand for opioids, was 512.9 (IQR, 294.5, 798.2) mg/day. The midazolam equivalents, representative of benzodiazepine requirement, was 279.6 (IQR, 208.8, 384.5) mg/day. The levels of serum creatinine, total bilirubin, lactic acid, SOFA score, and APACHE Ⅱ score at cannulation were found to be associated with opiate or benzodiazepine requirements. Multiple linear regression analysis revealed a linear correlation between midazolam equivalents and morphine equivalents (p < 0.001). In addition, there was a negative linear correlation between Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score and midazolam equivalents (p = 0.024). Conclusions: The sedation and analgesia requirements of ARDS patients receiving VV-ECMO often increase simultaneously. More large-scale studies are needed to confirm the risk factors for increased sedation and analgesia needs in patients supported on VV-ECMO.

scholarly journals Case Report of Patients with Acute Respiratory Distress Syndrome Caused by COVID-19: Successfully Treated by Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 570
Author(s):  
Mi Hwa Park ◽  
Ah Jin Kim ◽  
Man-Jong Lee ◽  
Young Sam Kim ◽  
Jung Soo Kim
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Peak Inspiratory Pressure ◽  
Protective Ventilation ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Coronavirus disease (COVID-19) started in Wuhan (China) at the end of 2019, and then increased rapidly. In patients with severe acute respiratory distress syndrome (ARDS) caused by COVID-19, venovenous extracorporeal membrane oxygenation (VV-ECMO) is considered a rescue therapy that provides adequate gas exchange. The way in which mechanical ventilation is applied during VV-ECMO is not clear, however it is associated with prognosis. Currently, the mortality rate of COVID-19 patients that receive VV-ECMO stands at approximately 50%. Here, we report three patients that successfully recovered from COVID-19-induced ARDS after VV-ECMO and implementation of an ultra-protective ventilation. This ventilation strategy involved maintaining a peak inspiratory pressure of ≤20 cmH2O and a positive end-expiratory pressure (PEEP) of ≤ 10 cmH2O, which are lower values than have been previously reported. Thus, we suggest that this ultra-protective ventilation be considered during VV-ECMO as it minimizes the ventilator-induced lung injury.

scholarly journals Early initiation of venovenous extracorporeal membrane oxygenation in a mechanically ventilated patient with severe acute respiratory distress syndrome

2018 ◽  
pp. bcr-2018-226223 ◽  
Author(s):  
Nisha Krishnakant Raiker ◽  
Hector Cajigas
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Early Initiation ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

A 49-year-old man presented to the emergency department with acute-onset dyspnoea and hypoxaemia 1 day following nasal surgery for obstructive sleep apnoea. A chest X-ray showed diffuse bilateral pulmonary infiltrates. Supplemental 100% fractional inspired oxygen (FiO2) via non-rebreather mask was delivered with resulting arterial oxygen tension:FiO2 ratio of 67. Transthoracic echocardiogram demonstrated normal heart function. A clinical diagnosis of severe acute respiratory distress syndrome (ARDS) was promptly made. Based on patient preference to avoid intubation and following a multidisciplinary approach, we decided to initiate venovenous extracorporeal membrane oxygenation (VV-ECMO) as an alternative strategy to mechanical ventilation. Though he ultimately required brief mechanical ventilation during ECMO cannulation, the patient spent a total of 5 days on VV-ECMO and a total of 8 days in the intensive care unit. Six days after discharge, his pulmonary function test demonstrated no significant abnormalities. We present a rare case of early initiation of VV-ECMO in a patient with severe ARDS that served as a bridge to recovery.

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