scholarly journals Use of Venovenous Extracorporeal Membrane Oxygenation in Critically-Ill Patients With COVID-19

2020 ◽  
Vol 7 ◽  
Author(s):  
Mathieu Jozwiak ◽  
Jean-Daniel Chiche ◽  
Julien Charpentier ◽  
Zakaria Ait Hamou ◽  
Paul Jaubert ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Case Series ◽  
Oxygenation Index ◽  
Neuromuscular Blocking ◽  
Predicted Body Weight ◽  
Membrane Oxygenation ◽  
Respiratory Parameters ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Venovenous Ecmo ◽  
Main Complication

Acute respiratory distress syndrome (ARDS) related to Coronavirus disease (COVID-19) is associated with high mortality. It has been suggested that venovenous extracorporeal membrane oxygenation (ECMO) was suitable in this indication, albeit the effects of ECMO on the mechanical respiratory parameters have been scarcely described. In this case-series, we prospectively described the use of venovenous ECMO and its effects on mechanical respiratory parameters in eleven COVID-19 patients with severe ARDS. Implantation of ECMO occurred 6 [3–11] days after the onset of mechanical ventilation. At the time of ECMO implantation, all patients received neuromuscular blocking agents, three (27%) received inhaled nitric oxide and prone positioning was performed in all patients with 4 [3−5] sessions of PP per patient. Under ECMO, the tidal volume was significantly decreased from 6.1 [4.0–6.3] to 3.4 [2.5–3.6] mL/kg of predicted body weight and the positive end-expiratory pressure level was increased by 25 ± 27% whereas the driving pressure and the mechanical power decreased by 33 ± 25% and 71 ± 27%, respectively. The PaO2/FiO2 ratio significantly increased from 68 [58–89] to 168 [137–218] and the oxygenation index significantly decreased from 28 [26–35] to 13 [10–15]. The duration of ECMO was 12 [8–25] days. Nine (82%) patients experienced ECMO-related complications and the main complication was major bleeding requiring blood transfusions. Intensive care unit mortality rate was 55% but no patient died from ECMO-related complications. In COVID-19 patients with severe ARDS, venovenous ECMO allowed ultra-protective ventilation, improved oxygenation and should be considered in highly selected patients with the most severe ARDS.

Oxandrolone in Patients on Venovenous Extracorporeal Membrane Oxygenation: A Case Series

2020 ◽  
Vol 35 (3) ◽  
pp. 514-521
Author(s):  
Stacy L. Pelekhaty ◽  
Mehrnaz Pajoumand ◽  
Kristen S. Omanwa ◽  
Samuel M. Galvagno Jr ◽  
James H. Lantry ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Case Series ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation

A Failure to Oxygenate: A Case for Venovenous Extracorporeal Membrane Oxygenation

2020 ◽  
pp. 221-230
Author(s):  
Cara Agerstrand ◽  
Andrew Pellet
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Life Support ◽  
Metastatic Cancer ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Venovenous Ecmo

This chapter explains the utilization of venovenous extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). Venovenous ECMO provides respiratory support and is the most common ECMO configuration used during ARDS. Patient selection is of the utmost importance for successful use of ECMO. Patients being considered for venovenous ECMO for ARDS should meet criteria for severe ARDS. Best guidance can be taken from the Extracorporeal Life Support Organization recommendations and the multicenter Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome trial. The main contraindication to ECMO is any condition or organ dysfunction that would limit the overall benefit of ECMO, such as severe brain injury, metastatic cancer, or decompensated cirrhosis. Once the ECMO circuit is operational, ventilator settings must be optimized to protect the injured lungs by adhering to an ultra-lung-protective “lung rest” strategy.

scholarly journals Duration of sweep gas off trial for weaning from venovenous extracorporeal membrane oxygenation

2019 ◽  
Vol 13 ◽  
pp. 175346661988813 ◽  
Author(s):  
Soo Jin Na ◽  
Hee Jung Choi ◽  
Chi Ryang Chung ◽  
Yang Hyun Cho ◽  
Kiick Sung ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Gas Flow ◽  
Blood Gases ◽  
Arterial Blood Gases ◽  
Time Points ◽  
Membrane Oxygenation ◽  
Arterial Blood ◽  
Institutional Experience ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Venovenous Ecmo

Background: No data are available on the duration of time needed to assess the adequacy of lung function after stopping sweep gas for weaning of venovenous extracorporeal membrane oxygenation (ECMO). The objective of this study was to investigate changes in arterial blood gases (ABGs) during sweep gas off trials in patients receiving venovenous ECMO. Methods: Data on patients receiving venovenous ECMO, with a weaning trial at least once, were collected prospectively from January 2012 through December 2017. Serial changes in ABGs during sweep gas off trial and clinical outcomes after weaning from venovenous ECMO were evaluated. Results: Over the study period, 192 sweep gas off trials occurred in 93 patients: 115 (60%) failed and 77 (40%) were successful. During the trial, significant changes in blood gases were observed within 1 h in all patients. When serial ABGs were compared according to trial off results, there were no significant differences in the pH, PaCO2, and HCO3− trends across time points between successful and failed trials. However, PaO2 (70.6 versus 93.4 mmHg), SaO2 (91.9 versus 95.2%), and PaO2/FiO2 ratio (164.0 versus 233.4) were significantly lower in failed trials than successful trials within 1 h after stopping sweep gas. After 2 h of trial off, no significant change in blood gases was observed until the end of the trial. Conclusions: No change in blood gases was observed 2 h after stopping sweep gas in patients receiving venovenous ECMO. Based on our institutional experience, however, we suggest monitoring for 2 h or more after stopping sweep gas flow to assess if patients are ready for decannulation. The reviews of this paper are available via the supplemental material section.

scholarly journals Surgical extraction after thrombosis around the Avalon dual lumen cannula

2014 ◽  
Vol 96 (1) ◽  
pp. e01-e03 ◽  
Author(s):  
V Kalem ◽  
D Buchwald ◽  
J Strauch ◽  
A Sidiropoulos ◽  
R Meindl ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Jugular Vein ◽  
Surgical Removal ◽  
Continuous Administration ◽  
Membrane Oxygenation ◽  
Respiratory Parameters ◽  
Surgical Extraction ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Spinal Contusion ◽  
The Right

The use of a dual lumen cannula (DLC) for venovenous extracorporeal membrane oxygenation (ECMO) has several advantages and reports of complications are rare. We present a case of thrombosis around and inside the Avalon Elite™ bicaval DLC (Avalon Laboratories, Rancho Dominguez, CA, US), for which simple removal by retraction was impossible. A 30-year-old man had experienced an unstable C6/7 fracture with spinal contusion and haematoma in the spinal canal with incomplete neurological paraplegia and thoracic trauma. He developed acute respiratory failure due to posttraumatic systemic inflammatory response syndrome and venovenous extracorporeal membrane oxygenation (ECMO) support was indicated. The cannulation was performed with an Avalon Elite™ cannula (31Fr) in the right jugular vein under fluoroscopy. After 18 days of ECMO therapy, despite the continuous administration of heparin (400iu/h), ECMO was discontinued because of the formation of a massive thrombus in the oxygenator. At that time, the patient’s haemodynamic and respiratory parameters were stable, and we were able to induce a rapid weaning from ECMO. The surgical removal of the cannula became necessary and was performed using a small neck incision without complications. We report this case to emphasise that any resistance encountered during an attempt to extract the Avalon Elite™ cannula may cause serious complications. In such cases, surgical removal must be considered.

scholarly journals Effects of Prone Positioning on Respiratory Mechanics and Oxygenation in Critically Ill Patients With COVID-19 Requiring Venovenous Extracorporeal Membrane Oxygenation

2022 ◽  
Vol 8 ◽  
Author(s):  
Driss Laghlam ◽  
Julien Charpentier ◽  
Zakaria Ait Hamou ◽  
Lee S. Nguyen ◽  
Frédéric Pene ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Mechanics ◽  
Oxygenation Index ◽  
Driving Pressure ◽  
Prone Positioning ◽  
Membrane Oxygenation ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Induced Changes ◽  
First Time ◽  
Vv Ecmo

Background:The effect of prone positioning (PP) on respiratory mechanics remains uncertain in patients with severe acute respiratory distress syndrome (ARDS) requiring venovenous extracorporeal membrane oxygenation (VV-ECMO).Methods:We prospectively analyzed the effects of PP on respiratory mechanics from continuous data with over a thousand time points during 16-h PP sessions in patients with COVID-19 and ARDS under VV-ECMO conditions. The evolution of respiratory mechanical and oxygenation parameters during the PP sessions was evaluated by dividing each PP session into four time quartiles: first quartile: 0–4 h, second quartile: 4–8 h, third quartile: 8–12 h, and fourth quartile: 12–16 h.Results:Overall, 38 PP sessions were performed in 10 patients, with 3 [2–5] PP sessions per patient. Seven (70%) patients were responders to at least one PP session. PP significantly increased the PaO2/FiO2 ratio by 14 ± 21% and compliance by 8 ± 15%, and significantly decreased the oxygenation index by 13 ± 18% and driving pressure by 8 ± 12%. The effects of PP on respiratory mechanics but not on oxygenation persisted after supine repositioning. PP-induced changes in different respiratory mechanical parameters and oxygenation started as early as the first-time quartile, without any difference in PP-induced changes among the different time quartiles. PP-induced changes in driving pressure (−14 ± 14 vs. −6 ± 10%, p = 0.04) and mechanical power (−11 ± 13 vs. −0.1 ± 12%, p = 0.02) were significantly higher in responders (increase in PaO2/FiO2 ratio > 20%) than in non-responder patients.Conclusions:In patients with COVID-19 and severe ARDS, PP under VV-ECMO conditions improved the respiratory mechanical and oxygenation parameters, and the effects of PP on respiratory mechanics persisted after supine repositioning.

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