Mobilization of Patients Receiving Extracorporeal Membrane Oxygenation Before Lung Transplant

2021 ◽  
Vol 41 (4) ◽  
pp. 39-45
Author(s):  
Kelly Patrick ◽  
Anthony Adams

Background Extracorporeal membrane oxygenation is increasingly used to provide cardiopulmonary support to patients awaiting lung transplant. Although studies have shown that these patients benefit from early mobilization, the care team often has concerns about related complications, particularly for patients requiring femoral cannulation. Objective To assess the safety of mobilizing patients receiving extracorporeal membrane oxygenation before lung transplant using a standardized mobility protocol. Methods A retrospective review was performed of the electronic health records of patients receiving extracorporeal membrane oxygenation before or immediately after lung transplant who were mobilized according to a standardized protocol from April through October 2018. The setting was an 18-bed cardiothoracic intensive care unit in a Magnet-designated teaching hospital. Patients were helped to ambulate by an interdisciplinary team, with careful assessment for any related complications. Results During the study period, 37 patients received extracorporeal membrane oxygenation, and 9 were mobilized. Two hundred forty-two therapy sessions were conducted involving 47 700 feet of ambulation. Patients experienced the following complications: chugging (1 patient), decrease in flow rate (2 patients), bleeding at the cannula site (2 patients), neck hyperextension (1 patient), fear/anxiety (1 patient), and shortness of breath (2 patients). Bleeding and neck hyperextension led to discontinuation of therapy until the problems were resolved. No changes were made to the protocol. Conclusions Patients receiving extracorporeal membrane oxygenation before lung transplant, including those with femoral cannulation, can be mobilized safely with the use of an interprofessional ambulation protocol. Further evaluation is indicated, including research on clinical outcomes.

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Liu Minqiang ◽  
Gao Hong ◽  
Chen Jingyu ◽  
Wang Yanjuan ◽  
Xu Bo ◽  
...  

Extracorporeal membrane oxygenation (ECMO) is a widely used cardiopulmonary support method that is usually implemented after anesthesia during the period of lung transplantation (LTx). In severe pulmonary arterial hypertension (PAH) patients, however, anesthesia induction is a high-risk phase and can result in severe cardiorespiratory failure. Herein, we describe two severe PAH patients who received ECMO support before anesthesia and whose preoperative evaluations indicated that the risk was too high to safely survive the anesthesia induction period before LTx. The strategy was successful, and in both patients, hemodynamics was stable and no ECMO-related complications occurred.


2017 ◽  
Vol 26 (4) ◽  
pp. 314-316 ◽  
Author(s):  
Nadia Bouabdallaoui ◽  
Denis Bouchard ◽  
E. Marc Jolicoeur ◽  
Alexandra Chronopoulos ◽  
Pierre Y Garneau ◽  
...  

Extracorporeal membrane oxygenation has been extensively used for cardiopulmonary support in cardiogenic shock. However, its clinical value in the management of pheochromocytoma crisis remains unclear. We report a rare case of life-threatening cardiogenic shock managed with peripheral venoarterial extracorporeal membrane oxygenation combined with endovascular left ventricular venting, in a 40-year-old female patient, in the setting of unknown adrenal pheochromocytoma. We highlight the life-saving role of extracorporeal membrane oxygenation in undiagnosed endocrine emergencies, allowing cardiac and end-organ recovery, and giving time for accurate diagnosis and specific treatment in such unusual situations.


Circulation ◽  
2018 ◽  
Vol 138 (20) ◽  
pp. 2298-2300 ◽  
Author(s):  
Peter Moritz Becher ◽  
Benedikt Schrage ◽  
Christoph R. Sinning ◽  
Bastian Schmack ◽  
Nina Fluschnik ◽  
...  

Perfusion ◽  
2019 ◽  
Vol 35 (3) ◽  
pp. 197-201
Author(s):  
Andrew Brazier ◽  
Edward Seville ◽  
Wesley Hesford ◽  
Bryce Pate ◽  
Paul Exton ◽  
...  

Extracorporeal membrane oxygenation is a safe modality of cardiorespiratory support for lung transplantation, with a reduction in coagulopathy and transfusion requirement when compared with cardiopulmonary bypass. In some scenarios, in lung transplantation, there are advantages to the use of cardiopulmonary bypass, which allows cardiac decompression, filtering of embolic air, easy addition and removal of volume, and a means to immediately reintroduce lost blood into circulation. We describe a novel circuit which allows safe and easy switch between modalities without prolonged interruption of flow. This circuit offers a safety net during surgery to minimise the risks influencing the use of extracorporeal membrane oxygenation.


2018 ◽  
Vol 54 (2) ◽  
pp. 341-347 ◽  
Author(s):  
Matthieu Glorion ◽  
Olaf Mercier ◽  
Delphine Mitilian ◽  
Alexandra De Lemos ◽  
Lilia Lamrani ◽  
...  

2021 ◽  
Vol 42 (03) ◽  
pp. 380-391
Author(s):  
John W. Stokes ◽  
Whitney D. Gannon ◽  
Matthew Bacchetta

AbstractExtracorporeal membrane oxygenation (ECMO) is a cardiopulmonary technology capable of supporting cardiac and respiratory function in the presence of end-stage lung disease. Initial experiences using ECMO as a bridge to lung transplant (ECMO-BTLT) were characterized by high rates of ECMO-associated complications and poor posttransplant outcomes. More recently, ECMO-BTLT has garnered success in preserving patients' physiologic condition and candidacy prior to lung transplant due to technological advances and improved management. Despite recent growth, clinical practice surrounding use of ECMO-BTLT remains variable, with little data to inform optimal patient selection and management. Although many questions remain, the use of ECMO-BTLT has shown promising outcomes suggesting that ECMO-BTLT can be an effective strategy to ensure that complex and rapidly decompensating patients with end-stage lung disease can be safely transplanted with good outcomes. Further studies are needed to refine and inform practice patterns, management, and lung allocation in this high-risk and fragile patient population.


Author(s):  
J. Kyle Bohman ◽  
Gregory J. Schears

This chapter examines the indications, applications, and complications of modern extracorporeal membrane oxygenation (ECMO). The safety profile of ECMO has improved through advancements in devices, components, and routine management, resulting in improved outcomes and an expanded range of applications. Currently, ECMO can provide cardiopulmonary support in reversible conditions, such as post-cardiotomy shock, acute respiratory failure, extracorporeal cardiopulmonary resuscitation, bridge to transplant, complex airway repairs, and massive pulmonary embolism, among others. The chapter focuses on the primary factors involved in using ECMO successfully: appropriate patient selection, optimal cannulation strategy, and availability of comprehensive medical resources (or a referral agreement with a comprehensive ECMO center) to handle emergent ECMO complications and to absorb the substantial resource requirements of treating patients with ECMO.


Sign in / Sign up

Export Citation Format

Share Document