The Integration of an Extra-Corporal Life Support (ECLS) Service at Austin Health

2019 ◽  
pp. 168-203
Author(s):  
Yvonne Ballueer
Keyword(s):  
Patient Outcome ◽  
Intensive Care ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Adult Population ◽  
Treatment Options ◽  
Austin Health ◽  
Extra Corporal Membrane Oxygenation ◽  
Established Treatment

Extra-corporal membrane oxygenation (ECMO), also known as extracorporeal life support (ECLS), is a globally established treatment option in modern intensive care medicine for patients suffering from severe but reversible respiratory and/or cardiac failure. If refractory to other advanced treatment options, early instatement of ECLS therapy is closely associated with reduced mortality and improved long-term patient outcome. ECLS, in many ways, has replaced other, less effective treatments and future modelling predicts increased demand. ECLS has routinely and successfully been applied to neonates and pediatrics for many years. This field study however will exhibit focus only on the viability of the introduction of ECLS therapy in the Victorian adult population at Austin Health.

Veno-venous extracorporeal life support for blastomycosis-associated acute respiratory distress syndrome

Perfusion ◽  
2019 ◽  
Vol 34 (8) ◽  
pp. 660-670
Author(s):  
Abdulrahman Al-Fares ◽  
Eddy Fan ◽  
Shahid Husain ◽  
Matteo Di Nardo ◽  
Marcelo Cypel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Life Support ◽  
Extracorporeal Life Support

Background: Blastomyces is a dimorphic fungus endemic to regions of North America, which can lead to pneumonia and fatal severe acute respiratory diseases syndrome in up to 89% of patients. Extracorporeal life support can provide adequate oxygenation while allowing the lungs to rest and heal, which might be an ideal therapy in this patient group, although long-term clinical and radiological outcomes are not known. Clinical features: We report on five consecutive patients admitted to Toronto General Hospital intensive care unit between January 2012 and September 2016, with progressive respiratory failure requiring veno-venous extracorporeal life support within 24-96 hours following mechanical ventilation. Ultra-lung protective mechanical ventilation was achieved within 24 hours. Recovery was the initial goal in all patients. Extracorporeal life support was provided for a prolonged period (up to 49 days), and four patients were successfully discharged from the intensive care unit. Long-term radiological assessment in three patients showed major improvement within 2 years of follow-up with some persistent disease-related changes (bronchiectasis, fibrosis, and cystic changes). In two patients, long-term functional and neuropsychological outcomes showed similar limitations to what is seen in acute respiratory distress syndrome patients who are not supported with extracorporeal life support and in acute respiratory distress syndrome patients without blastomycosis, but worse pulmonary function outcomes in the form of obstructive and restrictive changes that correlated with the radiological imaging. Conclusion: Veno-venous extracorporeal life support can effectively provide prolonged support for patients with blastomycosis-associated acute respiratory distress syndrome that is safe and associated with favorable long-term outcomes.

The new role of the perfusionist in adult extracorporeal life support

Perfusion ◽  
2010 ◽  
Vol 25 (1) ◽  
pp. 21-24 ◽  
Author(s):  
Robert M. McCoach ◽  
Larry D. Baer ◽  
Robert K. Wise ◽  
Karl R. Woitas ◽  
David A. Palanzo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
The Other ◽  
Centrifugal Pumps ◽  
Basic Form ◽  
Unique Position

Adult and pediatric extracorporeal life support (ECLS) has been transformed by the European1 and Australian 2 experiences with a reduction of the circuit to its most basic form (Figure 1). Many factors have converged at this point in time to allow us to offer this support. The availability in the U.S.A. of an advanced oxygenator (QuadroxD) (Maquet Inc., Bridgewater, NJ), long-term centrifugal pumps and circuit coatings offers us the means to provide ECLS. The other equally important factor is the intensivist trained in extracorporeal therapies. Once the intensive care unit registered nurse (ICU RN) is trained to safely and effectively manage both the patient and ECLS circuit, this support may be offered. The perfusionist is in an unique position to educate and mentor the ICU RN in ECLS. There is, perhaps, no one in a better position to explain this equipment and its uses in an interdisciplinary-oriented pediatric and adult ECLS program than a perfusionist.

The quality of life in extracorporeal life support survivors: single-center experience of a long-term follow-up

2018 ◽  
Vol 35 (2) ◽  
pp. 227-235 ◽  
Author(s):  
Valentina Di Leo ◽  
Paolo Biban ◽  
Federico Mercolini ◽  
Francesco Martinolli ◽  
Andrea Pettenazzo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Single Center ◽  
Single Center Experience ◽  
Long Term Follow Up

scholarly journals Cardiorespiratory physiological perturbations after acute smoke-induced lung injury and during extracorporeal membrane oxygenation support in sheep

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 769
Author(s):  
Saul Chemonges
Keyword(s):  
Intensive Care ◽  
Lung Injury ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Lung Compliance ◽  
Smoke Inhalation ◽  
Biological Information ◽  
Arterial Oxygen ◽  
Physiological Data ◽  
Coronary Perfusion

Background: Numerous successful therapies developed for human medicine involve animal experimentation. Animal studies that are focused solely on translational potential, may not sufficiently document unexpected outcomes. Considerable amounts of data from such studies could be used to advance veterinary science. For example, sheep are increasingly being used as models of intensive care and therefore, data arising from such models must be published. In this study, the hypothesis is that there is little information describing cardiorespiratory physiological data from sheep models of intensive care and the author aimed to analyse such data to provide biological information that is currently not available for sheep that received extracorporeal life support (ECLS) following acute smoke-induced lung injury. Methods: Nineteen mechanically ventilated adult ewes undergoing intensive care during evaluation of a form of ECLS (treatment) for acute lung injury were used to collate clinical observations. Eight sheep were injured by acute smoke inhalation prior to treatment (injured/treated), while another eight were not injured but treated (uninjured/treated). Two sheep were injured but not treated (injured/untreated), while one received room air instead of smoke as the injury and was not treated (placebo/untreated). The data were then analysed for 11 physiological categories and compared between the two treated groups. Results: Compared with the baseline, treatment contributed to and exacerbated the deterioration of pulmonary pathology by reducing lung compliance and the arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio. The oxygen extraction index changes mirrored those of the PaO2/FiO2 ratio. Decreasing coronary perfusion pressure predicted the severity of cardiopulmonary injury. Conclusions: These novel observations could help in understanding similar pathology such as that which occurs in animal victims of smoke inhalation from house or bush fires, aspiration pneumonia secondary to tick paralysis and in the management of the severe coronavirus disease 2019 (COVID-19) in humans.

scholarly journals Long-Term Cognitive Outcomes and Sleep in Adults After Extracorporeal Life Support

2021 ◽  
Vol 3 (4) ◽  
pp. e0390
Author(s):  
Marietou Daou ◽  
Claire Lauzon ◽  
E. Caroline Bullen ◽  
Irene Telias ◽  
Eddy Fan ◽  
...  
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Cognitive Outcomes

scholarly journals Extracorporeal Membrane Oxygenation: The First 10 Years Experience of a Portuguese Pediatric Intensive Care Unit

2021 ◽  
Vol 34 (6) ◽  
pp. 435
Author(s):  
Daniel Meireles ◽  
Francisco Abecasis ◽  
Leonor Boto ◽  
Cristina Camilo ◽  
Miguel Abecasis ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Overall Survival ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Patients ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Pediatric Intensive Care ◽  
Overall Survival Rate ◽  
Clinical Complications

Introduction: In Portugal, extracorporeal membrane oxygenation (ECMO) is used in pediatric patients since 2010. The aim of this study was to describe the clinical characteristics of patients, indications, complications and mortality associated with the use of ECMO during the first 10-years of experience in the Pediatric Intensive Care Unit located in Centro Hospitalar Universitário Lisboa Norte.Material and Methods: Retrospective observational cohort study of all patients supported with ECMO in a Pediatric Intensive Care Unit, from the 1st of May 2010 up to 31st December 2019.Results: Sixty-five patients were included: 37 neonatal (≤ 28 days of age) and 28 pediatric patients (> 28 days). In neonatal cases, congenital diaphragmatic hernia was the main reason for ECMO (40% of neonatal patients and 23% of total). Among pediatric patients, respiratory distress was the leading indication for ECMO (47% of total). The median length of ECMO support was 12 days. Clinical complications were more frequent than mechanical complications (65% vs 35%). Among clinical complications, access site bleeding was the most prevalent with 38% of cases. The overall patient survival was 68% at the time of discharge (65% for neonatal and 71% for pediatric cases), while the overall survival rate in Extracorporeal Life Support Organization registry was 61%. The number of ECMO runs has been increasing since 2011, even though in a non-linear way (three cases in 2010 to 11 cases in 2019).Discussion: In the first 10 years we received patients from all over the country. Despite continuous technological developments, circuitrelated complications have a significant impact. The overall survival rate in the Pediatric Intensive Care Unit was not inferior to the one reported by the Extracorporeal Life Support Organization.Conclusion: The overall survival of our Pediatric Intensive Care Unit is not inferior to one reported by other international centers. Our experience showed the efficacy of the ECMO technique in a Portuguese centre.

Factors That Enable or Complicate End-of-Life Transitions in Critical Care

2005 ◽  
Vol 14 (6) ◽  
pp. 513-521 ◽  
Author(s):  
James M. Badger
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Life Support ◽  
Treatment Options ◽  
Acute Care Hospital ◽  
Life Transitions ◽  
Care Hospital ◽  
Comfort Care ◽  
Life Threatening Illness ◽  
Medical Intensive Care

• Background Nurses in medical intensive care units are routinely involved in negotiations to maintain or withdraw life support. How nurses move from aggressively attempting to extend life to letting life end is not well understood. • Objective To explore nurses’ experiences of moving from cure- to comfort-oriented care and to describe factors that inhibit or facilitate such transitions. • Method A descriptive qualitative research design with brief observation of participants and focus group interviews was used. Participants were 19 female and 5 male nurses in an 18-bed medical intensive care unit in a 719-bed acute care hospital in the northeastern United States. • Results The transition point between cure- and comfort-oriented care was unclear. Nurses reported that the patient’s age, misunderstanding of the illness by the patient’s family, family discord, and shifting medical care decisions made end-of-life transitions difficult. Conversely, developing a consensus among patients, patients’ families, and staff about the direction of medical therapy; exhausting treatment options; and patients’ lack of response to aggressive medical interventions helped nurses move toward comfort care. • Conclusions The most distressing situations for staff were dealing with younger patients with an acute life-threatening illness and performing futile care on elderly patients. End-of-life transitions were difficult when patients’ families had conflicts or were indecisive about terminating treatment and when physicians kept offering options that were unlikely to change patients’ prognosis. The most important factor enabling nurses to move from cure- to comfort-oriented care was developing a consensus about the treatment.

Long term veno-venous extracorporeal life support without intravenous anticoagulation for diffuse alveolar hemorrhage

Perfusion ◽  
2019 ◽  
Vol 34 (6) ◽  
pp. 523-525 ◽  
Author(s):  
Samuel M Galvagno ◽  
Nirav G Shah ◽  
Christopher R Cornachione ◽  
Kristopher B Deatrick ◽  
Michael A Mazzeffi ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Systemic Anticoagulation

Introduction: Diffuse alveolar damage is the histologic hallmark for the acute phase of acute respiratory distress syndrome and can occasionally present as diffuse alveolar hemorrhage. Case report: We report a patient with diffuse alveolar hemorrhage and acute respiratory distress syndrome requiring veno-venous extracorporeal life support for 210 days, who was successfully treated for a period of 130 consecutive days without intravenous anticoagulation. Discussion: Although there are a few brief reports detailing long extracorporeal life support runs, the literature is largely devoid of data regarding long-term extracorporeal life support without full systemic anticoagulation. Regular inspection of the extracorporeal membrane oxygenation circuit is critical because externally visible thrombi may predict internal thrombus generation with the potential for systemic embolization or abrupt oxygenator failure. In our case, multiple circuit and oxygenators changes were required. Conclusion: We have demonstrated that a patient with a contraindication for systemic anticoagulation can safely have veno-venous extracorporeal life support for prolonged periods without catastrophic thrombotic complications.

Extracorporeal Life Support for Critical Enterovirus 71 Rhombencephalomyelitis: Long-Term Neurologic Follow-Up

2012 ◽  
Vol 46 (4) ◽  
pp. 225-230 ◽  
Author(s):  
Hsiu-Fen Lee ◽  
Ching-Shiang Chi ◽  
Sheng-Ling Jan ◽  
Yun-Ching Fu ◽  
Fang-Liang Huang ◽  
...  
Keyword(s):  
Life Support ◽  
Extracorporeal Life Support ◽  
Enterovirus 71
Sign in / Sign up

Export Citation Format

Share Document