scholarly journals Characteristics of Venous-Venous Extracorporeal Membrane Oxygenation Related Bloodstream Infections

2021 ◽  
Author(s):  
Joseph Wang ◽  
Cason Christensen ◽  
Aleem Siddique ◽  
HelenMari Merritt Genore ◽  
Kelly Cawcutt
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Right Ventricular ◽  
Operating Room ◽  
Infection Rate ◽  
Bloodstream Infections ◽  
Infectious Complications ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Membrane Oxygenation ◽  
Vv Ecmo

Infectious complications have been shown to increase the morbidity of venous-venous extracorporeal membrane oxygenation (VV-ECMO) population, including the use of right ventricular assist devices. We aimed to evaluate our VV-ECMO population for ECMO related bloodstream infections (E-BSI) and characteristics that affect risk and overall outcomes. We report a low infection rate of 2.7%. We postulate our low BSI rate may be due to our use of perioperative antimicrobials as well as a majority of our cannulations occurring in the operating room. Further investigation into trends, risks, and outcomes related to E-BSI is needed.

Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective

2021 ◽  
pp. 108925322199854
Author(s):  
Dash F. T. Newington ◽  
Fabrizio De Rita ◽  
Alan McCheyne ◽  
Claire Louise Barker
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Extracorporeal Membrane Oxygenation ◽  
Congenital Heart ◽  
Anesthetic Management ◽  
Inotropic Support ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Membrane Oxygenation ◽  
Delayed Sternal Closure

Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.

Inflow cannula obstruction in Berlin Heart Excor and novel extracorporeal membrane oxygenation cannulation for rescue

2020 ◽  
Vol 43 (9) ◽  
pp. 625-628
Author(s):  
Shriprasad R Deshpande ◽  
Manan Desai ◽  
Pranava Sinha ◽  
Joshua Kanter ◽  
Can Yerebakan
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Ventricular Assist Devices ◽  
Thromboembolic Complications ◽  
Bridge To Transplantation ◽  
Ventricular Assist ◽  
Assist Devices ◽  
Membrane Oxygenation ◽  
Acute Decompensation ◽  
Life Threatening ◽  
Inflow Cannula

Utilization of Berlin Excor as a pediatric bridge to transplantation device continues to increase. Thromboembolic complications continue to be an important morbidity related to ventricular assist devices. Obstructions to the device cannulae are rare but potentially life-threatening complications of ventricular assist devices, but inflow cannula obstruction is hitherto unreported. We present a case of a 4-year-old supported with Berlin BiVAD who demonstrated acute decompensation related to thrombus within the left atrial cannula. We describe the diagnosis, intervention, as well as novel rescue using existing cannulae for extracorporeal membrane oxygenation support.

scholarly journals Update on Weaning from Veno-Arterial Extracorporeal Membrane Oxygenation

2020 ◽  
Vol 9 (4) ◽  
pp. 992 ◽  
Author(s):  
Enzo Lüsebrink ◽  
Christopher Stremmel ◽  
Konstantin Stark ◽  
Dominik Joskowiak ◽  
Thomas Czermak ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Membrane Oxygenation ◽  
Hemodynamic Compromise ◽  
Successful Weaning ◽  
Bridge To Decision ◽  
Va Ecmo

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides temporary cardiac and respiratory support and has emerged as an established salvage intervention for patients with hemodynamic compromise or shock. It is thereby used as a bridge to recovery, bridge to permanent ventricular assist devices, bridge to transplantation, or bridge to decision. However, weaning from VA-ECMO differs between centers, and information about standardized weaning protocols are rare. Given the high mortality of patients undergoing VA-ECMO treatment, it is all the more important to answer the many questions still remaining unresolved in this field Standardized algorithms are recommended to optimize the weaning process and determine whether the VA-ECMO can be safely removed. Successful weaning as a multifactorial process requires sufficient recovery of myocardial and end-organ function. The patient should be considered hemodynamically stable, although left ventricular function often remains impaired during and after weaning. Echocardiographic and invasive hemodynamic monitoring seem to be indispensable when evaluating biventricular recovery and in determining whether the VA-ECMO can be weaned successfully or not, whereas cardiac biomarkers may not be useful in stratifying those who will recover. This review summarizes the strategies of weaning of VA-ECMO and discusses predictors of successful and poor weaning outcome.

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