scholarly journals Early Tracheostomy for ARDS Patients Supported by Venovenous Extracorporeal Membrane Oxygenation Is Associated With A Decreased Incidence of Ventilator-Associated Pneumonia, Duration of Extracorporeal Membrane Oxygenation and Mechanical Ventilation: Experience From A Single-Center Retrospective Cohort.

2021 ◽  
Author(s):  
Zeyu Zhang ◽  
Sichao Gu ◽  
Xu Huang ◽  
Jingen Xia ◽  
Fang Lin ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Cohort ◽  
Ecmo Support ◽  
Ventilator Associated Pneumonia ◽  
Icu Mortality ◽  
Early Tracheostomy ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation

Abstract Background: Venovenous extracorporeal membrane oxygenation (ECMO) has become the ultimate supporting technique for the rescue of severe acute respiratory distress syndrome (ARDS) patients. Although tracheostomy during ECMO has proven to be beneficial, the proper time point for performing the tracheostomy remains unclear. The purpose of our study was to demonstrate whether early tracheostomy (ET; within 7 days of ECMO initiation) outweighs delayed tracheostomy (DT; 8 days of more after ECMO initiation).Methods: A retrospective cohort study was established. All ARDS patients who underwent tracheostomy during V-V ECMO support in the intensive care unit (ICU) of a tertiary hospital from December 2013 to November 2020 were reviewed.Results: Of the 187 ARDS patients who received V-V ECMO support, 30 (16%) underwent tracheostomy—18 (60%) during ECMO support and the other 12 after ECMO decannulation. Among the 18 patients who underwent tracheostomy while receiving ECMO, 11 (61.1%) received ET, and 7 received DT. No significant difference was found between the ET and DT groups in terms of demographic data, medical history, disease severity (estimated based on the RESP, PRESERVE, APACHE Ⅱ, SOFA and Murray scores), ARDS risk factors or mechanical ventilation duration before ECMO. The ET group showed a decreased incidence of ventilator-associated pneumonia (VAP) during ECMO support (45.5% vs. 100%; P= 0.038) and shortened durations of ECMO (9.0 vs. 27.0 days; P= 0.011) and mechanical ventilation (16.0 vs. 56.0 days; P= 0.027). ET did not significantly alter the all-cause ICU mortality rate (54.5% vs. 28.6%; P= 0.367), all-cause hospital mortality rate (which was the same as the ICU mortality rate), length of ICU stay (336 vs. 627 hours; P= 0.085), or length of hospital stay (26 vs. 37 days; P= 0.285). Local bleeding at the tracheostomy wound did not differ between the two groups (27.3% vs. 42.9%, P= 0.627) .Conclusion: Compared with delayed tracheostomy, ET performed within 7 days of ECMO cannulation for severe ARDS patients could decrease the VAP incidence during ECMO support and shorten the durations of ECMO and mechanical ventilation; However, it may not improve the outcome. Prospective and multicenter studies are needed for further research.

scholarly journals Venovenous extracorporeal membrane oxygenation versus conventional mechanical ventilation to treat refractory hypoxemia in patients with acute respiratory distress syndrome: a retrospective cohort study

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093570
Author(s):  
Surat Tongyoo ◽  
Chairat Permpikul ◽  
Siwalai Sucher ◽  
Preecha Thomrongpairoj ◽  
Akekarin Poompichet ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Cohort Study ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Retrospective Cohort ◽  
Distress Syndrome ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Objective To compare the treatment outcome of venovenous extracorporeal membrane oxygenation (VV-ECMO) versus mechanical ventilation in hypoxemic patients with acute respiratory distress syndrome (ARDS) at a referral center that started offering VV-EMCO support in 2010. Methods This retrospective cohort study enrolled adults with severe ARDS (PaO2/FiO2 ratio of <100 with FiO2 of ≥90 or Murray score of ≥3) who were admitted to the intensive care unit of Siriraj Hospital (Bangkok, Thailand) from January 2010 to December 2018. All patients were treated using a low tidal volume (TV) and optimal positive end-expiratory pressure. The primary outcome was hospital mortality. Results Sixty-four patients (ECMO, n = 30; mechanical ventilation, n = 34) were recruited. There was no significant difference in the baseline PaO2/FiO2 ratio (67.2 ± 25.7 vs. 76.6 ± 16.0), FiO2 (97 ± 9 vs. 94 ± 8), or Murray score (3.4 ± 0.5 vs. 3.3 ± 0.5) between the ECMO and mechanical ventilation groups. The hospital mortality rate was also not significantly different between the two groups (ECMO, 20/30 [66.7%] vs. mechanical ventilation, 24/34 [70.6%]). Patients who underwent ECMO were ventilated with a significantly lower TV than patients who underwent mechanical ventilation (3.8 ± 1.8 vs. 6.6 ± 1.4 mL, respectively). Conclusion Although VV-ECMO promoted lower-TV ventilation, it did not improve the in-hospital mortality rate. Trial registration: www.clinicaltrials.gov (NCT 04031794).

The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

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.

scholarly journals Clinical outcomes of patients receiving prolonged extracorporeal membrane oxygenation for respiratory support

2019 ◽  
Vol 13 ◽  
pp. 175346661984894 ◽  
Author(s):  
Soo Jin Na ◽  
Jae-Seung Jung ◽  
Sang-Bum Hong ◽  
Woo Hyun Cho ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Acute Respiratory Failure ◽  
Ecmo Support ◽  
Respiratory Support ◽  
Short Term ◽  
Membrane Oxygenation

Background: There are limited data regarding prolonged extracorporeal membrane oxygenation (ECMO) support, despite increase in ECMO use and duration in patients with respiratory failure. The objective of this study was to investigate the outcomes of severe acute respiratory failure patients supported with prolonged ECMO for more than 28 days. Methods: Between January 2012 and December 2015, all consecutive adult patients with severe acute respiratory failure who underwent ECMO for respiratory support at 16 tertiary or university-affiliated hospitals in South Korea were enrolled retrospectively. The patients were divided into two groups: short-term group defined as ECMO for ⩽28 days and long-term group defined as ECMO for more than 28 days. In-hospital and 6-month mortalities were compared between the two groups. Results: A total of 487 patients received ECMO support for acute respiratory failure during the study period, and the median support duration was 8 days (4–20 days). Of these patients, 411 (84.4%) received ECMO support for ⩽28 days (short-term group), and 76 (15.6%) received support for more than 28 days (long-term group). The proportion of acute exacerbation of interstitial lung disease as a cause of respiratory failure was higher in the long-term group than in the short-term group (22.4% versus 7.5%, p < 0.001), and the duration of mechanical ventilation before ECMO was longer (4 days versus 1 day, p < 0.001). The hospital mortality rate (60.8% versus 69.7%, p = 0.141) and the 6-month mortality rate (66.2% versus 74.0%, p = 0.196) were not different between the two groups. ECMO support longer than 28 days was not associated with hospital mortality in univariable and multivariable analyses. Conclusions: Short- and long-term survival rates among patients receiving ECMO support for more than 28 days for severe acute respiratory failure were not worse than those among patients receiving ECMO for 28 days or less.

Approach to Sedation and Analgesia in COVID-19 Patients on Venovenous Extracorporeal Membrane Oxygenation

2021 ◽  
pp. 106002802110107
Author(s):  
Diane Dreucean ◽  
Jesse E. Harris ◽  
Prakruthi Voore ◽  
Kevin R. Donahue
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Patient Population ◽  
Data Extraction ◽  
Ecmo Support ◽  
Pharmacokinetic Studies ◽  
Safety And Efficacy ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Sedation And Analgesia ◽  
Vv Ecmo

Objective: To describe clinically pertinent challenges of managing sedation in COVID-19 patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) and describe considerations for enhanced safety and efficacy of pharmacological agents used. Data Sources: A PubMed search was performed using the following search terms: ECMO, ARDS, sedation, COVID-19, coronavirus, opioids, analgesia, fentanyl, hydromorphone, morphine, oxycodone, methadone, ketamine, propofol, dexmedetomidine, clonidine, benzodiazepines, midazolam, lorazepam, and diazepam. Study Selection and Data Extraction: Relevant clinical and pharmacokinetic studies were considered. All studies included were published between January 1988 and March 2021. Data Synthesis: Patients with acute respiratory distress syndrome secondary to COVID-19 may progress to requiring VV-ECMO support. Agents frequently used for sedation and analgesia in these patients have been shown to have significant adsorption to ECMO circuitry, leading to possible diminished clinical efficacy. Use of hydromorphone-based analgesia has been associated with improved clinical outcomes in patients on VV-ECMO. However, safety and efficacy regarding use of other agents in this patient population remains an area of further research. Relevance to Patient Care and Clinical Practice: This review addresses clinical challenges associated with sedation management in COVID-19 patients requiring VV-ECMO support and provides potential strategies to overcome these challenges. Conclusions: Historically, sedation and analgesia management in patients requiring ECMO support have posed a challenge for bedside clinicians given the unique physiological and pharmacokinetic changes in this patient population. A multimodal strategy to managing analgesia and sedation should be used, and the use of enteral agents may play a role in reducing parenteral agent requirements.

scholarly journals Extracorporeal Membrane Oxygenation for SARS-CoV-2 Acute Respiratory Distress Syndrome: A Retrospective Study From Hubei, China

2021 ◽  
Vol 7 ◽  
Author(s):  
Xiaobo Yang ◽  
Ming Hu ◽  
Yuan Yu ◽  
Xijing Zhang ◽  
Minghao Fang ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Median Duration ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Arterial Blood ◽  
Before And After

Background: The data on long-term outcomes of patients infected by SARS-CoV-2 and treated with extracorporeal membrane oxygenation (ECMO) in China are merely available.Methods: A retrospective study included 73 patients infected by SARS-CoV-2 and treated with ECMO in 21 intensive care units in Hubei, China. Data on demographic information, clinical features, laboratory tests, ECMO durations, complications, and living status were collected.Results: The 73 ECMO-treated patients had a median age of 62 (range 33–78) years and 42 (63.6%) were males. Before ECMO initiation, patients had severe respiratory failure on mechanical ventilation with a median PO2/FiO2 of 71.9 [interquartile range (IQR), 58.6–87.0] mmHg and a median PCO2 of 62 [IQR, 43–84] mmHg on arterial blood analyses. The median duration from symptom onset to invasive mechanical ventilation, and to ECMO initiation was19 [IQR, 15–25] days, and 23 [IQR, 19–31] days. Before and after ECMO initiation, the proportions of patients receiving prone position ventilation were 58.9 and 69.9%, respectively. The median duration of ECMO support was 18.5 [IQR 12–30] days. During the treatments with ECMO, major hemorrhages occurred in 31 (42.5%) patients, and oxygenators were replaced in 21 (28.8%) patients. Since ECMO initiation, the 30-day mortality and 60-day mortality were 63.0 and 80.8%, respectively.Conclusions: In Hubei, China, the ECMO-treated patients infected by SARS-CoV-2 were of a broad age range and with severe hypoxemia. The durations of ECMO support, accompanied with increased complications, were relatively long. The long-term mortality in these patients was considerably high.

Early tracheostomy after initiation of venovenous extracorporeal membrane oxygenation is associated with decreased duration of extracorporeal membrane oxygenation support

Perfusion ◽  
2020 ◽  
Vol 35 (6) ◽  
pp. 509-514
Author(s):  
Laura DiChiacchio ◽  
Francesca M Boulos ◽  
Francis Brigante ◽  
Maxwell Raithel ◽  
Aakash Shah ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Extracorporeal Membrane Oxygenation ◽  
Unit Length ◽  
Intensive Care Unit Discharge ◽  
Hospital Costs ◽  
Early Tracheostomy ◽  
Membrane Oxygenation ◽  
Secondary Endpoints ◽  
Venovenous Extracorporeal Membrane Oxygenation

Timing of tracheostomy placement for patients with respiratory failure requiring venovenous extracorporeal membrane oxygenation support is variable and continues to depend on surgeon preference. We retrospectively reviewed all consecutive adult patients supported with peripheral venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome at a single institution with the hypothesis that early tracheostomy (within 7 days of extracorporeal membrane oxygenation initiation) decreases the duration of extracorporeal membrane oxygenation support. The primary endpoint was duration of extracorporeal membrane oxygenation support. Secondary endpoints included mortality, overall and intensive care unit length of stay, duration of mechanical ventilation, and time from extracorporeal membrane oxygenation initiation to liberation from ventilator, intensive care unit discharge, and hospital discharge. Overall and extracorporeal membrane oxygenation–associated hospital costs were compared. A total of 50 patients were identified for inclusion (early n = 21; late n = 29). Baseline characteristics including indices of disease severity were similar between groups. Duration of extracorporeal membrane oxygenation support was significantly shorter in the early tracheostomy group (12 vs. 21 days; p = 0.005). Median extracorporeal membrane oxygenation–related costs were significantly decreased in the early tracheostomy group ($3,624 vs. $5,603, p = 0.03). Early tracheostomy placement is associated with decreased time on extracorporeal membrane oxygenation support and reduced extracorporeal membrane oxygenation–related costs in this cohort. Validation in a prospective cohort or a clinical trial is indicated.

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