Extracorporeal Membrane Oxygenation: Current Use and Future Directions

1990 ◽  
Vol 1 (2) ◽  
pp. 348-364 ◽  
Author(s):  
Beth Kaplan McDermott ◽  
Martha A. Q. Curley
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Population ◽  
Critical Care Nursing ◽  
Nursing Management ◽  
Ecmo Patient ◽  
Future Directions ◽  
Membrane Oxygenation ◽  
Critically Ill Neonates ◽  
Cardiac System

Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed

scholarly journals Evaluation of the Effects of Extracorporeal Membrane Oxygenation on Antiepileptic Drug Serum Concentrations in Pediatric Patients

2017 ◽  
Vol 22 (5) ◽  
pp. 352-357 ◽  
Author(s):  
Nicholas O. Dillman ◽  
Mindl M. Messinger ◽  
Kimberly N. Dinh ◽  
Jennifer L. Placencia ◽  
Brady S. Moffett ◽  
...  
Keyword(s):  
Serum Concentration ◽  
Extracorporeal Membrane Oxygenation ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Volume Of Distribution ◽  
Serum Concentrations ◽  
Inclusion Criteria ◽  
Lower Serum ◽  
Membrane Oxygenation ◽  
Dosing Strategies

OBJECTIVES Patients supported on extracorporeal membrane oxygenation (ECMO) have an increased incidence of seizures. Phenobarbital (PB) and fosphenytoin (fos-PHT) are common antiepileptic drugs (AEDs) used to manage seizures in the pediatric population; however, it is unknown what effect ECMO has on the serum concentrations of AEDs. The purpose of this study is to evaluate the effect of ECMO on AED serum concentrations. METHODS A retrospective, matched-cohort study was performed in patients younger than 18 years who received ECMO and were treated with intravenous (IV) PB or fos-PHT at Texas Children's Hospital between 2004 and 2014. Patients receiving IV AED therapy and ECMO were matched, based on age, sex, and weight, with patients receiving IV AED therapy without ECMO. The 24-hour cumulative AED dose, serum concentrations, number of doses per serum concentration drawn ratio, volume of distribution, therapeutic serum concentrations, and time to therapeutic serum concentration were compared between both groups. The fos-PHT and PB groups were analyzed in all patients and in neonates only. RESULTS Fourteen patients met inclusion criteria. The fos-PHT neonatal (20.1 vs 11.3 mg/kg/day, p = 0.044), PB composite (33.9 vs 21.6 mg/kg/day, p = 0.012), and PB neonatal (40.3 vs 20 mg/kg/day, p = 0.04) had larger 24-hour cumulative doses compared with non-ECMO patients. Lower serum concentrations were observed in the PB composite ECMO group (19.1 vs 35.4 mg/L, p < 0.001) and the PB neonatal ECMO group (20.5 vs 27.8 mg/L, p = 0.01) compared with non-ECMO patients. CONCLUSION Pediatric patients receiving PB on ECMO and neonatal patients receiving fos-PHT on ECMO required larger doses, and in pediatric patients achieved lower serum concentrations, suggesting the necessity for alternative dosing strategies in these populations.

scholarly journals Nutrition in Pediatric Extracorporeal Membrane Oxygenation: A Narrative Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Theresa S. W. Toh ◽  
Chengsi Ong ◽  
Yee Hui Mok ◽  
Palen Mallory ◽  
Ira M. Cheifetz ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Medical Literature ◽  
Pediatric Intensive Care ◽  
Narrative Review ◽  
Nutrition Support ◽  
Critically Ill Children ◽  
Future Directions ◽  
Membrane Oxygenation ◽  
Pros And Cons ◽  
Optimal Approach

Extracorporeal membrane oxygenation (ECMO) support is increasingly utilized in quaternary pediatric intensive care units. Metabolic derangements and altered nutritional requirements are common in critically ill children supported on ECMO. However, there remains no consensus on the optimal approach to the prescription of nutrition in these patients. This narrative review aims to summarize the current medical literature on various aspects of nutrition support in pediatric patients on ECMO. These include: (1) nutritional adequacy, (2) pros and cons of feeding on ECMO, (3) enteral vs. parenteral nutrition, and (4) proposed recommendations and future directions for research in this area.

scholarly journals Nursing Management of Severe COVID-19 Patients Undergoing Extracorporeal Membrane Oxygenation Combined with Prone Position Ventilation

2020 ◽  
Vol 23 (4) ◽  
pp. E422-E425
Author(s):  
Qing Nie ◽  
Aiwu Ye ◽  
Shixiong WeiW
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Lung Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Respiratory Distress Syndrome ◽  
Prone Position ◽  
Distress Syndrome ◽  
Nursing Management ◽  
Membrane Oxygenation ◽  
Oxygenation Level ◽  
Ecmo Treatment

Acute respiratory distress syndrome (ARDS) is a serious lung injury in patients with severe coronavirus disease 2019 (COVID-19). This process often is difficult to reverse, eventually leading to the death of patients. Extracorporeal membrane oxygenation (ECMO) treatment can provide patients with cardiopulmonary function support and buy time for clinicians' treatment. However, some patients still suffer from poor oxygenation after ECMO treatment. At this time, nurses can change the patient's position to prone position to improve oxygenation level and promote sputum excretion. It is a great challenge for COVID-19 patients to change their postures while receiving ECMO treatment. This article provides suggestions for this process by reviewing our hospital's experience in treating severe COVID-19 patients.

scholarly journals Acquired factor XIII deficiency in two patients with bleeding events during veno-venous extracorporeal membrane oxygenation treatment

2019 ◽  
Vol 23 (3) ◽  
pp. 283-287 ◽  
Author(s):  
Asami Ito ◽  
Yoshiaki Iwashita ◽  
Ryo Esumi ◽  
Ken Sasaki ◽  
Masahiro Yukimitsu ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Factor Xiii ◽  
Bloody Stool ◽  
Ecmo Patient ◽  
Bleeding Events ◽  
Factor Xiii Deficiency ◽  
Blood Tests ◽  
Membrane Oxygenation ◽  
Coagulation Tests ◽  
Routine Coagulation

AbstractWe report two cases of acquired factor XIII deficiency with bleeding events during veno-venous extracorporeal membrane oxygenation (ECMO). Case 1: A 76-year-old man diagnosed with aspiration pneumonia after near-drowning was started on ECMO. Later, the patient presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 29%. Although the patient recovered after receiving 1200 International Units of factor XIII concentrate, the patient had another episode of decreased factor XIII activity and bloody stool and was treated again with factor XIII concentrate. Case 2: A 48-year-old female diagnosed with pneumonia was started on ECMO. Soon after, she presented with hemoptysis and anemia. Blood tests showed a decreased factor XIII activity of 39%. The patient was treated with 720 IU of factor XIII concentrate with good recovery. Acquired factor XIII deficiency cannot be detected by routine coagulation tests, therefore it may be under-diagnosed in the ICU. Detection of acquired factor XIII deficiency is essential when treating a bleeding ECMO patient.

scholarly journals Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

Circulation ◽  
2019 ◽  
Vol 140 (24) ◽  
pp. 2019-2037 ◽  
Author(s):  
Peter M. Eckman ◽  
Jason N. Katz ◽  
Aly El Banayosy ◽  
Erin A. Bohula ◽  
Benjamin Sun ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
End Of Life ◽  
Pediatric Population ◽  
Adult Patients ◽  
Ethical Considerations ◽  
Membrane Oxygenation ◽  
Cardiopulmonary Failure ◽  
Practical Management ◽  
Exit Strategies

Extracorporeal membrane oxygenation has evolved, from a therapy that was selectively applied in the pediatric population in tertiary centers, to more widespread use in diverse forms of cardiopulmonary failure in all ages. We provide a practical review for cardiovascular clinicians on the application of veno-arterial extracorporeal membrane oxygenation in adult patients with cardiogenic shock, including epidemiology of cardiogenic shock, indications, contraindications, and the extracorporeal membrane oxygenation circuit. We also summarize cannulation techniques, practical management and troubleshooting, prognosis, and weaning and exit strategies, with attention to end of life and ethical considerations.

Application of Standardized Nursing Procedures Combined with Specialized Management Education in Extracorporeal Membrane Oxygenation in ICU

2021 ◽  
Vol 7 (4) ◽  
pp. 647-654
Author(s):  
Min Zhang ◽  
Lingling Wu ◽  
Weihong Shen ◽  
Ying Shen
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Completion Time ◽  
Management Education ◽  
Control Group ◽  
Average Weight ◽  
Efficacy Rate ◽  
Observation Group ◽  
Nursing Management ◽  
Preparation Time ◽  
Membrane Oxygenation

To analyze the application effect of standardized nursing procedures combined with specialized management education in extracorporeal membrane oxygenation (ECMO) in ICU. 18 patients treated with ECMO in our department from July 1, 2020 to December 30, 2020 were chosen as observation group, and 18 patients receiving ECMO in our department (January 2017-June 2018) were selected as control group. The control group received routine procedures in the implementation of ECMO nursing while the observation group received standardized ECMO nursing procedures combined with specialized management education to analyze the effect of different nursing management methods on ECMO patients by comparing the indexes before and after nursing management. There were no obvious differences in gender ratio, average age, average weight, average BMI, marital status, education and residence between the two groups (P > 0.05). Personnel arrival time, start time of rescue, preparation time of items, pipeline prefilling time and catheter completion time in observation group were obviously better compared with control group (P < 0.001). The total clinical efficacy rate in observation group was obviously higher compared with control group (P < 0.05). There were no significant differences in the Pa02, SP02 and PaC02 levels between the two groups before nursing management (P > 0.05), and the levels in observation group were obviously higher compared with control group after nursing management (P < 0.001). The clinical nursing satisfaction in observation group was obviously higher compared with control group (P < 0.05). The sequential organ failure assessment (SOFA) score in observation group after nursing management was obviously lower compared with control group (P < 0.001). The incidence of complications in observation group was obviously lower compared with control group (P < 0.05). The implementation of standardized nursing procedures combined with specialized management education for ECMO patients can effectively shorten rescue time, the preparation time before catheterization and catheter completion time, improve the therapeutic effect, and improve blood gas indicators, safe and effective. At the same time, it can facilitate the doctor-nurse cooperation, worthy of promotion and application.

scholarly journals Efficacy of extracorporeal membrane oxygenation before surgery of a post-infarction ventricular septal rupture in cardiogenic shock

2020 ◽  
Vol 31 (5) ◽  
pp. 727-728
Author(s):  
Hidenobu Takaki ◽  
Kenichi Hashizume ◽  
Tadashi Matsuoka ◽  
Koki Ikebata
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Septal Defect ◽  
Bridge To Surgery ◽  
Ventricular Septal Rupture ◽  
High Mortality Risk ◽  
Membrane Oxygenation

Abstract A 73-year-old man with an acute myocardial infarction experienced severe cardiogenic shock due to an inferior ventricular septal rupture with a massive left-to-right shunt. Emergency surgery was considered a too high mortality risk. The patient was implanted with an extracorporeal membrane oxygenation system as a bridge to surgery. On the seventh day after admission, the ventricular septal defect was successfully repaired. Our case study demonstrates that extracorporeal membrane oxygenation could be an option in cases of ventricular septal rupture as a bridge for stabilizing patients.

scholarly journals Venovenous Extracorporeal Membrane Oxygenation in Intractable Pulmonary Insufficiency: Practical Issues and Future Directions

2016 ◽  
Vol 2016 ◽  
pp. 1-13 ◽  
Author(s):  
T. S. R. Delnoij ◽  
R. Driessen ◽  
A. S. Sharma ◽  
E. A. Bouman ◽  
U. Strauch ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Pulmonary Insufficiency ◽  
Organ Support ◽  
Future Directions ◽  
Theoretical Concepts ◽  
Membrane Oxygenation ◽  
Technical Advances ◽  
Invasive Method ◽  
Venovenous Extracorporeal Membrane Oxygenation ◽  
Vv Ecmo

Venovenous extracorporeal membrane oxygenation (vv-ECMO) is a highly invasive method for organ support that is gaining in popularity due to recent technical advances and its successful application in the recent H1N1 epidemic. Although running a vv-ECMO program is potentially feasible for many hospitals, there are many theoretical concepts and practical issues that merit attention and require expertise. In this review, we focus on indications for vv-ECMO, components of the circuit, and management of patients on vv-ECMO. Concepts regarding oxygenation and decarboxylation and how they can be influenced are discussed. Day-to-day management, weaning, and most frequent complications are covered in light of the recent literature.

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