Surging Role of Extracorporeal Membrane Oxygenation in Refractory ARDS Due COVID-19 and In-depth Review of Existing Applications

Introduction: Extra Corporeal Membrane Oxygenation (ECMO) is a device applied to maintain cardiopulmonary support in patients in whom there is a failure of the cardiopulmonary function to maintain perfusion to vital organs. Previously, ECMO was used in pulmonary embolism, cardiogenic shock, myocarditis, and heart failure cases. Its use in refractory acute respiratory distress syndrome (ARDS) in coronavirus disease 2019 (COVID-19) has increased, but the data regarding its safety, efficacy, and mortality benefit remains unclear. The focus of our review is to further expand on these areas and outline the indication, techniques, and complications associated with its use. Methods: We did an extensive search of various databases such as PubMed, Cochrane, ScienceDirect, and Jama Network and studied 41 papers, including free full articles such as systematic reviews, meta-analyses, and clinical trials published within the past five years. Results: Implementation of ECMO is advantageous when the PaO2/FiO2 is in the range of 100 to 150 mmHg. For COVID-19 patients, the most appropriate approach is to drain from a femoral venous cannula and thread it to the inferior vena cava just 1-2cm below the cavoatrial junction. It was seen that the most common complication of ECMO use is coagulopathy. Limb ischemia had a variable incidence from 10 to 70% and is more common in venous-arterial ECMO. Conclusion: ECMO is lifesaving in a highly selected group of patients to prolong survival, reduce complications and provide a good prognosis in terms of mortality. To prevent circuit thrombosis, anticoagulation is key, and understanding feasible intra-atrial communication sites, such as a patent foramen ovale or atrial septal defects, is beneficial to mitigate the risk of stroke and cutting down consequences of thromboembolism.

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Inferior vena cava thrombosis during extracorporeal membrane oxygenation: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-03057-0 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

YouLian Chen ◽

HuaiSheng Chen ◽

XueYan Liu ◽

ChengYing Hong ◽

HuaDong Zhang

Keyword(s):

Inferior Vena Cava ◽

Extracorporeal Membrane Oxygenation ◽

Anticoagulant Therapy ◽

Inferior Vena ◽

Rare Complication ◽

Vena Cava ◽

Membrane Oxygenation ◽

Cardiopulmonary Support ◽

Ivc Thrombosis ◽

Ecmo Therapy

Abstract Background Extracorporeal membrane oxygenation (ECMO) is an effective cardiopulmonary support therapy, which can provide temporary cardiopulmonary support for critically ill patients whose condition cannot be reversed by conventional therapy. However, there are many complications in the use of ECMO, such as bleeding, thrombosis, and so on. Among them, inferior vena cava (IVC) thrombosis which can cause pulmonary embolism is a rare complication, which may be life-threatening. Case presentation A 75-year-old female patient (Han Chinese ethnicity) with acute heart failure due to acute myocardial infarction in our department was retrospectively analyzed. After regular treatment was unsuccessful, she was treated with venoarterial ECMO (VA-ECMO). After her condition improved, she was withdrawn from ECMO and experienced a complication of IVC thrombosis. Enoxaparin was given immediately for 1 mg/kg every 12 hours hypodermic injection. The thrombus disappeared after anticoagulant therapy. She was discharged on the 60th day. Her level of consciousness returned to normal without residual central nervous system-related complications. Conclusions IVC thrombosis is one of the possible serious complications in the process of ECMO therapy. Prevention of thrombosis and optimization of the anticoagulant regimen are the main preventive measures. Anticoagulant therapy is still the main treatment of IVC thrombosis in the process of ECMO therapy. Other interventional strategies need to accumulate clinical experience.

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Role of Inferior Vena Cava Filter Retrieval in Patients on Chronic Anticoagulation Therapy

Current Treatment Options in Cardiovascular Medicine ◽

10.1007/s11936-020-00891-1 ◽

2021 ◽

Vol 23 (2) ◽

Author(s):

Savannah Fletcher ◽

Adam Plotnik ◽

Ravi N. Srinivasa ◽

Jeffrey Forris Beecham Chick ◽

John M. Moriarty

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena Cava Filter ◽

Inferior Vena ◽

Treatment Options ◽

Anticoagulation Therapy ◽

Vena Cava ◽

Vena Cava Filter ◽

Venous Thromboembolic

Abstract Purpose of review Describe the role of inferior vena cava filter (IVCF) retrieval in patients on chronic anticoagulation given the overlap of these treatment options in the management of patients with venous thromboembolic disease. Recent findings Despite the increase in IVCF retrievals since the Food and Drug Administration safety communications in 2010 and 2014, retrieval rates remain low. Previous studies have shown that longer filter dwell times are associated with greater risk for filter complications and more difficulty with filter retrievals. Recent findings suggest that complications are more frequent in the first 30 days after placement. Summary The decision to retrieve an optional IVCF is individualized and requires diligent follow-up with consistent re-evaluation of the need for the indwelling IVCF, particularly in those on long-term anticoagulation therapy.

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Prognostic role of bland thrombus in patients treated with resection of renal cell carcinoma with inferior vena cava tumor thrombus

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2021.02.005 ◽

2021 ◽

Author(s):

Hanfeng Wang ◽

Xintao Li ◽

Qingbo Huang ◽

Andrej Panic ◽

Donglai Shen ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Prognostic Role

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Reassessment of the Role of Inferior-Vena-Cava Ligation in Venous Thromboembolism

New England Journal of Medicine ◽

10.1056/nejm196512022732305 ◽

1965 ◽

Vol 273 (23) ◽

pp. 1250-1253 ◽

Cited By ~ 44

Author(s):

Donald C. Nabseth ◽

John M. Moran

Keyword(s):

Venous Thromboembolism ◽

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava

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Role of right heart receptors in the control of renin, vasopressin, and cortisol secretion in dogs

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1992.263.5.r1071 ◽

1992 ◽

Vol 263 (5) ◽

pp. R1071-R1077 ◽

Cited By ~ 3

Author(s):

D. H. Carr ◽

D. B. Jennings ◽

T. N. Thrasher ◽

L. C. Keil ◽

D. J. Ramsay

Keyword(s):

Inferior Vena ◽

Vena Cava ◽

Plasma Renin ◽

Atrial Pressure ◽

Right Atrial ◽

Right Heart ◽

Hormonal Responses ◽

The Right ◽

Maximal Reduction

We have reported that increased left heart pressure inhibits increases in plasma renin activity (PRA), arginine vasopressin (AVP), and cortisol during arterial hypotension. The goal of this study was to determine whether increases in right heart pressure also inhibited hormonal responses to hypotension. Seven dogs were chronically instrumented with inflatable cuffs around the ascending aorta (AA), the pulmonary artery (PA), and the thoracic inferior vena cava (IVC), as well as with catheters in both atria, the abdominal aorta, and vena cava. The IVC, the PA, and the AA cuffs were inflated on different days to cause step reductions in mean arterial pressure (MAP) of 5, 10, 20, and 30% below control MAP. Graded constriction of the AA caused large increases in left atrial pressure and plasma atrial natriuretic peptide (ANP), but had no effect on plasma AVP or cortisol and caused only a small increase in PRA at the maximal reduction of MAP. Constriction of the IVC reduced both atrial pressures and plasma ANP, but stimulated increases in PRA, AVP, and cortisol. Constriction of the PA increased right atrial pressure and plasma ANP and caused increases in plasma AVP and cortisol that were similar to responses during IVC constriction, but the PRA response was only half (P < 0.05). These results indicate that increasing pressure on the right side of the heart can attenuate the PRA response to hypotension, and suggest that the inhibition is mediated by the rise in plasma ANP.

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Simple validation for the hepatic venous cannula implanted chronically in conscious rats

Journal of Applied Physiology ◽

10.1152/jappl.1991.71.1.359 ◽

1991 ◽

Vol 71 (1) ◽

pp. 359-364 ◽

Cited By ~ 7

Author(s):

M. T. Huang

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Superior Vena ◽

Tritiated Water ◽

Vena Cava ◽

Systemic Circulation ◽

Tracer Injection ◽

Conscious Rats ◽

Tygon Tubing ◽

Venous Cannula

A method for the detection of vena caval contamination in blood taken from hepatic venous cannulas in conscious rats was described. The procedures included 1) bolus injection of tritiated water (50 microCi) through a cannula into the abdominal inferior vena cava and 2) continuous blood sampling (less than 0.2 ml) from the hepatic venous cannula for 2 min into a 180-cm piece of Tygon tubing, starting concurrently with tracer injection. The washout of tritium was determined from samples in 15-cm sections of Tygon tubing. Because circulation from the inferior vena cava to the hepatic vein is interceded by the systemic circulation, the washout of tritium from a valid hepatic venous cannula should resemble the pattern determined elsewhere in the systemic circulation. In the current study, the reference systemic washout was determined in the superior vena cava of a group of rats similarly injected with tritiated water in the inferior vena cava. The maximum of tritium washout derived from a valid hepatic venous cannula should fall in the range encompassed by one standard deviation of the mean of the maximum of the reference (1,400 to 1,930 cpm/sample). The maximum of the washout pattern derived from the invalid cannula, which lay adjacent to the site of injection, was expected to exceed this range. On the basis of these criteria, hepatic blood flow (HBF) was determined by sulfbromophthalein (BSP) extraction in groups of rats with valid and invalid cannulas. HBF in rats with valid hepatic venous cannulas was 2.58 +/- 0.15 in the conscious state and 2.76 +/- 0.26 ml.min-1.g wet wt-1 in the ketamine-anesthetized state.(ABSTRACT TRUNCATED AT 250 WORDS)

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