Extracorporeal Membrane Oxygenation for ARDS: Optimization of Lung Protective Ventilation

A 27-year-old man, with a history of renal transplantation, presented with acute kidney failure and Pneumocystis jirovecii pneumonia. The patient developed severe acute respiratory failure and required support by veno-venous extracorporeal membrane oxygenation for a total of 59 days. During this period, the patient had extremely low tidal volumes using a lung protective ventilation strategy and intermittent prone positioning was used to optimise oxygenation. There was full recovery of pulmonary and partial recovery of renal function.

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Outcome and Management of Refractory Respiratory Failure With Timely Extracorporeal Membrane Oxygenation: Single-Center Experience With Legionella Pneumonia

Journal of Intensive Care Medicine ◽

10.1177/0885066617700121 ◽

2017 ◽

Vol 34 (4) ◽

pp. 344-350 ◽

Cited By ~ 3

Author(s):

Roberto Roncon-Albuquerque ◽

Rodrigo Vilares-Morgado ◽

Gert-Jan van der Heijden ◽

João Ferreira-Coimbra ◽

Paulo Mergulhão ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Invasive Mechanical Ventilation ◽

Ecmo Support ◽

Lung Protective Ventilation ◽

Survival Prediction ◽

High Survival ◽

Membrane Oxygenation ◽

Legionella Pneumonia

Objective: To analyze the management and outcome of patients with refractory respiratory failure complicating severe Legionella pneumonia rescued with extracorporeal membrane oxygenation (ECMO) in our Center. Design and Setting: Observational study of patients with refractory respiratory failure treated with ECMO in Hospital S.João (Porto, Portugal), between November 2009 and September 2016. Participants: A total of 112 patients rescued with ECMO, of which 14 had Legionella pneumonia. Results: Patients with Legionella pneumonia were slightly older than patients with acute respiratory failure of other etiologies (51 [48-56] vs 45 [35-54]), but with no significant differences in acute respiratory failure severity between groups: Pao2/Fio2 ratio 67 (60-75) versus 69 (55-85) and Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score 4 (1-5) versus 2 (-1-4), respectively. Legionella pneumonia was associated with earlier ECMO initiation (days of invasive mechanical ventilation [IMV] before ECMO: 2.0 [1.0-4.0] vs 5.0 [2.0-9.5]). After IMV adjustment to “lung rest” settings, this group presented higher respiratory system (RS) static compliance (28.7 [18.8-37.4] vs 16.0 [10.0-20.8] mL/cmH2O) but required higher ECMO support (blood flow 5.0 [4.3-5.4] vs 4.2 [3.6-4.8]). Patients with Legionella pneumonia had shorter IMV (16 [14-23] vs 27 [20-42] days) and lower incidence of intensive care unit nosocomial infections (35.7% vs 64.3%), with a trend to higher hospital survival (85.7% vs 62.2%; P = .13). Conclusion: In Legionella pneumonia complicated by refractory respiratory failure, ECMO support allowed patient stabilization under lung protective ventilation and high survival rates. Timely ECMO referral should be considered for Legionella pneumonia failing conventional treatment.

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The Role of Extracorporeal Membrane Oxygenation on Acute Respiratory Distress Syndrome

BioScientia Medicina ◽

10.32539/bsm.v5i10.362 ◽

2021 ◽

Vol 5 (10) ◽

pp. 953-960

Author(s):

Dini Ardiyani ◽

Zen Ahmad

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Lung Injury ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Life Support ◽

Extracorporeal Life Support ◽

Lung Protective Ventilation ◽

Membrane Oxygenation

Acute lung injury and acute respiratory distress syndrome are characterized by rapid-onset respiratory failure following a variety of direct and indirect insults to the parenchyma or vasculature of the lungs. Extracorporeal membrane oxygenation is a form of extracorporeal life support where an external artificial circulator carries venous blood from the patient to a gas exchange device (oxygenator) where blood becomes enriched with oxygen and has carbon dioxide removed. This blood then re-enters the patients circulation. The potential advantages of ECMO over conventional manajement may extend beyond its role in supporting patients with ARDS. ECMO may facilitate and enhance the application of lung-protective ventilation by minimizing ventilator-induced lung injury.

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Massive aspiration syndrome: a possible indication for “emergent” veno-venous extracorporeal membrane oxygenation?: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03050-7 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Emiliano Gamberini ◽

Venerino Poletti ◽

Emanuele Russo ◽

Alessandro Circelli ◽

Marco Benni ◽

...

Keyword(s):

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

White Male ◽

Ecmo Support ◽

Circulatory Support ◽

Lung Protective Ventilation ◽

Emergency Setting ◽

Membrane Oxygenation ◽

Va Ecmo ◽

Vv Ecmo

Abstract Background Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is usually performed in cases of severe respiratory failure in which conventional and advanced mechanical ventilation strategies are ineffective in achieving true lung-protective ventilation, thus triggering ventilatory-induced lung injury. If circulatory failure coexists, veno-arterial ECMO (VA-ECMO) may be preferred over VV-ECMO because of its potential for circulatory support. In VA-ECMO, the respiratory contribution is less effective and the complication rate is higher than in the VV configuration. Case presentation The authors present a case in which VV-ECMO was performed in an emergency setting to treat a 68-year-old White male patient who experienced acute respiratory failure after massive aspiration. Despite intubation and intensive care unit admission, multiple organ failure occurred suddenly, thus prompting referral to a level-1 trauma center with an ECMO facility. The patient’s condition slowly improved with VV-ECMO support along with standard treatment for hemodynamic impairment. VV-ECMO was discontinued on day 8. The patient was extubated on day 14 and discharged home fully recovered 34 days after the event. Conclusions Attention was focused on the decision to initiate VV-ECMO support even in the presence of severe hemodynamic derangement, although VA-ECMO could have provided better hemodynamic support but less effective respiratory support.

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Endobronchial One-Way Valve Therapy Facilitates Weaning from Extracorporeal Membrane Oxygenation in a Patient with ARDS and Persistent Air Leak

Case Reports in Critical Care ◽

10.1155/2018/9736217 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Alessandro Ghiani ◽

Matthias Hansen ◽

Konstantinos Tsitouras ◽

Claus Neurohr

Keyword(s):

Mechanical Ventilation ◽

Extracorporeal Membrane Oxygenation ◽

Practical Knowledge ◽

Left Lung ◽

Clinical Problem ◽

Lung Protective Ventilation ◽

Air Leak ◽

Membrane Oxygenation ◽

Protective Ventilation Strategy ◽

Persistent Air Leak

Prolonged pulmonary air leak (PAL) is a common clinical problem, associated with significant morbidity and mortality. There are numerous reports of treatment of PAL using endobronchial valves (EBV) in respiratory stable patients, but only few reports on critically ill patients, and there is virtually no practical knowledge in the treatment of PAL in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), treated with veno-venous extracorporeal membrane oxygenation (vvECMO). We describe a case where EBV placement was performed in a patient with ARDS and PAL, treated with mechanical ventilation and vvECMO. Despite a lung protective ventilation strategy, a persistent air leak along with a large left-sided pneumothorax was observed. After bronchoscopic localisation of the fistula, two endobronchial valves were inserted into the left upper lobe, leading to an immediate decrease in the air flow and reexpansion of the left lung. During the following two weeks, the patient was weaned from vvECMO, and after another three weeks, complete liberation from mechanical ventilation was accomplished. EBV placement seems to be a safe method even in the presence of coagulopathy and may facilitate mechanical ventilation and weaning from vvECMO in patients with ARDS and PAL.

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Extracorporeal membrane oxygenation in COVID-19 patients and in-hospital mortality: results from the Brazilian Registry using a propensity score matched analysis

10.1101/2021.05.05.21256475 ◽

2021 ◽

Author(s):

Daniela Ponce ◽

Milena Soriano Marcolino ◽

Magda Carvalho Pires ◽

Rafael Lima Rodrigues de Carvalho ◽

Heloisa Reniers Vianna ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Conventional Therapy ◽

Life Support ◽

Extracorporeal Life Support ◽

Severe Pneumonia ◽

Ecmo Support ◽

Lung Protective Ventilation ◽

Convenience Sample ◽

Membrane Oxygenation ◽

Number Of Patients

Around 5% of coronavirus disease 2019 (COVID-19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to assess the clinical characteristics and in-hospital outcomes of COVID-19 patients with ARDS refractory to standard lung-protective ventilation and pronation treated with ECMO support and to compare them to patients who did not receive ECMO. Patients were selected from the Brazilian COVID-19 Registry. At the moment of the analysis, 7,646 patients were introduced in the registry, eight of those received ECMO support (0.1%). The convenience sample of patients submitted to ECMO was compared to control patients selected by genetic matching for gender, age, comorbidities, pronation, ARDS and hospital, in a 5:1 ratio. From the 48 patients included in the study, eight received ECMO and 40 were matched controls. There were no significant differences in demographic, clinical and laboratory characteristics. Mortality was higher in the ECMO group (n = 7; 87.5%) when compared with controls (n = 17; 42.5%), (p=0.048). In conclusion, COVID 19 patients with ARDS refractory to conventional therapy who received ECMO support had worse outcomes to patients who did not receive ECMO. Our findings are not different from previous studies including a small number of patients, however there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for our best excellence.

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Extracorporeal Membrane Oxygenation for Acute Respiratory and Cardiac Failure

Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam ◽

10.47972/vjcts.v33i.565 ◽

2021 ◽

Vol 33 ◽

pp. 55-64

Author(s):

Hideshi ITOH ◽

Nguyen The Binh ◽

Le Ngoc Thanh ◽

Hitomi Ando ◽

Naohiro Inagawa ◽

...

Keyword(s):

Extracorporeal Membrane Oxygenation ◽

Cardiac Failure ◽

Rescue Therapy ◽

World Health ◽

Lung Protective Ventilation ◽

Critical Situation ◽

Membrane Oxygenation ◽

The World ◽

Refractory Hypoxemia ◽

Health Organization

Extracorporeal Membrane Oxygenation (ECMO) is widely used for acute respiratory and cardiac failure in critical situations as mechanical circulatory and respiratory support systems. Historically, ECMO had been two arguments both for and against using in critical situation. Despite the widespread adoption of ECMO in critical situation, the use of ECMO remains associated with significant morbidity and mortality. In 2019, an outbreak of pneumonia caused by severe acute respiratory distress syndrome (ARDS) by corona virus 2 (SARS-CoV-2) has occurred in China. SARS-CoV-2 has rapidly spread out the community of whole over the world, and cause severe respiratory failure disease (COVID-19) associated mortality and lack of immunization and treatment. According to the interim guidance formulated by the World Health Organization (WHO), ECMO should be considered as a rescue therapy or COVID-19 with refractory hypoxemia despite lung protective ventilation. The focus of this review will be on the physiological aspects of respiratory and cardiac ECMO.

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Case Report of Patients with Acute Respiratory Distress Syndrome Caused by COVID-19: Successfully Treated by Venovenous Extracorporeal Membrane Oxygenation and an Ultra-Protective Ventilation

Medicina ◽

10.3390/medicina56110570 ◽

2020 ◽

Vol 56 (11) ◽

pp. 570

Author(s):

Mi Hwa Park ◽

Ah Jin Kim ◽

Man-Jong Lee ◽

Young Sam Kim ◽

Jung Soo Kim

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Extracorporeal Membrane Oxygenation ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Peak Inspiratory Pressure ◽

Protective Ventilation ◽

Membrane Oxygenation ◽

Venovenous Extracorporeal Membrane Oxygenation ◽

Vv Ecmo

Coronavirus disease (COVID-19) started in Wuhan (China) at the end of 2019, and then increased rapidly. In patients with severe acute respiratory distress syndrome (ARDS) caused by COVID-19, venovenous extracorporeal membrane oxygenation (VV-ECMO) is considered a rescue therapy that provides adequate gas exchange. The way in which mechanical ventilation is applied during VV-ECMO is not clear, however it is associated with prognosis. Currently, the mortality rate of COVID-19 patients that receive VV-ECMO stands at approximately 50%. Here, we report three patients that successfully recovered from COVID-19-induced ARDS after VV-ECMO and implementation of an ultra-protective ventilation. This ventilation strategy involved maintaining a peak inspiratory pressure of ≤20 cmH2O and a positive end-expiratory pressure (PEEP) of ≤ 10 cmH2O, which are lower values than have been previously reported. Thus, we suggest that this ultra-protective ventilation be considered during VV-ECMO as it minimizes the ventilator-induced lung injury.

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Mechanical Ventilation during Extracorporeal Membrane Oxygenation in Patients with Acute Severe Respiratory Failure

Canadian Respiratory Journal ◽

10.1155/2017/1783857 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10 ◽

Cited By ~ 15

Author(s):

Zhongheng Zhang ◽

Wan-Jie Gu ◽

Kun Chen ◽

Hongying Ni

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Large Body ◽

Conventional Mechanical Ventilation ◽

Protective Ventilation ◽

Severe Respiratory Failure ◽

Membrane Oxygenation ◽

Number Of Patients ◽

Protective Ventilation Strategy

Conventionally, a substantial number of patients with acute respiratory failure require mechanical ventilation (MV) to avert catastrophe of hypoxemia and hypercapnia. However, mechanical ventilation per se can cause lung injury, accelerating the disease progression. Extracorporeal membrane oxygenation (ECMO) provides an alternative to rescue patients with severe respiratory failure that conventional mechanical ventilation fails to maintain adequate gas exchange. The physiology behind ECMO and its interaction with MV were reviewed. Next, we discussed the timing of ECMO initiation based on the risks and benefits of ECMO. During the running of ECMO, the protective ventilation strategy can be employed without worrying about catastrophic hypoxemia and carbon dioxide retention. There is a large body of evidence showing that protective ventilation with low tidal volume, high positive end-expiratory pressure, and prone positioning can provide benefits on mortality outcome. More recently, there is an increasing popularity on the use of awake and spontaneous breathing for patients undergoing ECMO, which is thought to be beneficial in terms of rehabilitation.

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