scholarly journals Evaluation of Extra Corporeal Membrane Oxygenation Support in Adult Cardio Respiratory Failure-An Observational Study.

2019 ◽  
pp. 1-10
Keyword(s):  
Respiratory Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Rescue Therapy ◽  
Adult Population ◽  
Vascular Complications ◽  
Limb Ischemia ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Patient Stay

Abstract Extracorporeal life support is a rescue therapy when mechanical ventilation is unable to maintain adequate tissue oxygenation in the setting of acute cardiac or respiratory failure. Outcome is influenced not only by factors independent of ECMO but also by the potential complications related to ECMO. The study is designed to understand the outcomes of Extracorporeal membrane oxygenation in the management of Acute Cardio Respiratory failure in adult population. The study is analytical and the data is prospectively collected from a local registry of ECMO patients and ICU clinical database. Further, clinical details were obtained from prospective review of patient medical records. The study period is from November 2013 and November 2015. A total of 30 patients were included in the study 36.7% were weaned off ECLS and 33.3% survived to hospital discharge. Incidence of Heparin Induced Thrombocytopenia was observed in 3 patients. 27 patients went into renal dysfunction. Both ICU duration (p-0.945) and duration of ECMO (0.736) support did not prove to be significant in predicting mortality. No cannula related vascular complications leading to limb ischemia or need for vascular repair were encountered in any patient. Mean number of blood transfusions required during ECMO support were 15.17 units. Infections acquired on ECMO support, p=0.052; 95% CI=0.007-1.707. Our results endorse the use of ECMO as a rescue therapy in adults, although there are some risks associated with a learning curve as well as an important increase in the days of patient stay. However, ECMO is still marred by frequent and significant complications such as renal derangement, bleeding and nosocomial infections.

Outcomes of extracorporeal life support for respiratory failure in children with primary immunodeficiencies

Perfusion ◽  
2021 ◽  
pp. 026765912110339
Author(s):  
Brandon Michael Henry ◽  
Alexis L Benscoter ◽  
Maria Helena Santos de Oliveira ◽  
Jens Vikse ◽  
Tanya Perry ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Discharge Rate ◽  
Rescue Therapy ◽  
Survival Rates ◽  
Pulmonary Complications ◽  
Primary Immunodeficiencies ◽  
Critically Ill Children ◽  
Cardiac Complications

Objective: Extracorporeal Membrane Oxygenation (ECMO) may serve as a life-saving rescue therapy in critically ill children with respiratory failure. While survival rates of ECMO in children with secondary immunodeficiency is considered relatively poor, survival rates in children with primary immunodeficiencies (PID) has yet to be thoroughly investigated. Design: Retrospective analysis of prospectively collected data from children (29 days–18 years old). PID patients were identified by using International Classification of Diseases (ICD) codes. Setting: Data were retrieved from Extracorporeal Life Support Organization Registry (1989–2018). Interventions: ECMO for a pulmonary support indication. The survival-to-discharge rate was calculated and factors influencing outcomes were compared between survivors and non-survivors. Measurements and main results: A total of 73 eligible ECMO runs were included. The survival-to-discharge rate in pediatric PID patients was 45.2%. No differences were noted in survival based on type of immunodeficiency (p = 0.42) or decade of support (p = 0.98). There was no difference in the rate of pre-ECMO infection in survivors versus non-survivors (p = 0.69). The survival-to-discharge rate in patients with a culture positive infection during the ECMO run was 45.0% versus 45.3% in those with no infection (p = 0.98). In multivariate analysis, only cardiac complications (OR 5.09, 95% CI: 1.15–22.53), pulmonary complications (OR: 13.00, 95% CI: 1.20–141.25), and neurologic complications (OR: 9.86, 95% CI: 1.64–59.21) were independently associated with increased mortality. Conclusion: Children with a PID who require extracorporeal life support due to respiratory failure have a reasonable chance of survival and should be considered candidates for ECMO. The presence of a pre-ECMO infection should not be considered an ECMO contraindication.

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

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.

scholarly journals EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) – IN THE TREATMENT OF SEVERE, LIFE-THREATENING RESPIRATORY FAILURE

2019 ◽  
Vol 72 (9) ◽  
pp. 1822-1828
Author(s):  
Krystian Ślusarz ◽  
Paulina Kurdyś ◽  
Paul Armatowicz ◽  
Piotr Knapik ◽  
Ewa Trejnowska
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Invasive Mechanical Ventilation ◽  
Lung Damage ◽  
Respiratory Support ◽  
Membrane Oxygenation ◽  
Clinical Complications ◽  
Life Threatening

Extracorporeal membrane oxygenation (ECMO) is a technique involving oxygenation of blood and elimination of carbon dioxide in patients with life-threatening, but potentially reversible conditions. Thanks to the modification of extracorporeal circulation used during cardiac surgeries, this technique can be used in intensive care units. Venovenous ECMO is used as a respiratory support, while venoarterial ECMO as a cardiac and/or respiratory support. ECMO does not cure the heart and/or lungs, but it gives the patient a chance to survive a period when these organs are inefficient. In addition, extracorporeal membrane oxygenation reduces or eliminates the risk of lung damage associated with invasive mechanical ventilation in patients with severe ARDS (acute respiratory distress syndrome). ECMO is a very invasive therapy, therefore it should only be used in patients with extremely severe respiratory failure, who failed to respond to conventional therapies. According to the Extracorporeal Life Support Organization (ELSO) Guidelines, inclusion criteria are: PaO2 / FiO2 < 80 for at least 3 hours or pH < 7.25 for at least 3 hours. Proper ECMO management requires advanced medical care. This article discusses the history of ECMO development, clinical indications, contraindications, clinical complications and treatment outcomes.

scholarly journals Rationale of Hemoadsorption during Extracorporeal Membrane Oxygenation Support

2019 ◽  
Vol 48 (3) ◽  
pp. 203-214 ◽  
Author(s):  
L. Christian Napp ◽  
Stephan Ziegeler ◽  
Detlef Kindgen-Milles
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Organ Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Underlying Disease ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Lung Failure ◽  
Molecular Patterns ◽  
Inflammatory Molecules

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support are increasingly used for treating various forms of shock, lung failure, protected interventions and life support including resuscitation. Most patients on ECMO are affected by a systemic inflammatory response caused by the underlying disease as well as the ECMO support itself, which contributes to vasoplegia, multi-organ failure, deterioration and death. Unfortunately, effective strategies for control of inflammation and related organ failure and shock on ECMO are lacking. Recently, a new polystyrene-based device for hemoadsorption, which aims to reduce excessive levels of inflammatory molecules such as interleukins, cytokines as well as damage- and pathogen-associated molecular patterns, has become available. Here we summarize the rationale, available data and technical aspects of polystyrene-based hemoadsorption during ECMO support, and give recommendations based on existing experience.

scholarly journals Extracorporeal membrane oxygenation support in individuals with thoracic insufficiency

Perfusion ◽  
2018 ◽  
Vol 33 (8) ◽  
pp. 696-698
Author(s):  
Shelley Hancock ◽  
Curtis Froehlich ◽  
Veronica Armijo-Garcia ◽  
Andrew D. Meyer
Keyword(s):  
Case Report ◽  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Oxygenation Index ◽  
Healthy Population ◽  
Jeune Syndrome ◽  
Membrane Oxygenation ◽  
Significant Difference

Introduction: Respiratory failure is the leading cause of mortality in individuals with congenital spine and rib deformities. We present a case report of a child with Jeune syndrome surviving respiratory failure using extracorporeal membrane oxygenation (ECMO). We also summarize thoracic insufficiency syndrome cases reported in the Extracorporeal Life Support Organization (ELSO) registry. Case Report: A two-year-old male with a chest circumference less than a third percentile for age was admitted with influenza pneumonia developing a peak oxygenation index of 103.5. The child survived to baseline pulmonary function after nine days of venous-arterial ECMO support. Discussion: The ELSO registry contained 27 individuals with a surrogate diagnosis of thoracic insufficiency (0.05%). There was no significant difference in survival to discharge for thoracic insufficiency patients (52%) compared to a previously healthy population supported with ECMO. Conclusion: ECMO is safe and may be effective in supporting individuals with thoracic insufficiency.

scholarly journals Extracorporalis membránoxigenizáció intenzív osztályon

2021 ◽  
Vol 162 (11) ◽  
pp. 425-431
Author(s):  
Éva Zöllei ◽  
Gábor Bari ◽  
Ivett Blaskovics ◽  
Kinga Bodó ◽  
Zsófia Csorba ◽  
...  
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Apache Ii ◽  
Therapeutic Modality ◽  
Circulatory Support ◽  
Apache Ii Score ◽  
Tracheal Reconstruction ◽  
Membrane Oxygenation

Összefoglaló. Az extracorporalis membránoxigenizációt egyre gyakrabban alkalmazzák világszerte refrakter légzési és/vagy keringési elégtelenség kezelésében. Intézetünkben 2015-ben kezdtük meg a program előkészítését és felépítését. Célunk az extracorporalis membránoxigenizációs kezelés élettani alapjainak rövid ismertetése, különös tekintettel a venovenosus konfigurációra, és az eddig kezelt eseteink eredményeinek összefoglalása. Az irodalom szisztematikus áttekintése és a kezelt esetek adatainak retrospektív értékelése voltak a módszereink. 2016 óta összesen 14 beteg esetében használtunk extracorporalis membránoxigenizációt (8 férfi, 6 nő, életkor 51 ± 15 év, APACHE II. score 24 ± 7). Az indikáció 9 esetben súlyos refrakter hypoxaemiás légzési elégtelenség, 1 esetben tracheooesophagealis fistula és légzési elégtelenség, 1 esetben műtét alatti támogatás tervezett trachearekonstrukció során és 3 beteg esetében refrakter cardiogen shock volt. Az extracorporalis membránoxigenizáció 11 betegben a légzés, 3 betegben a keringés támogatását szolgálta, 13 venovenosus, 1 venoarteriosus konfigurációban. Az extracorporalis támogatás ideje légzéstámogatás esetében 14 ± 6 nap, a cardialis támogatások esetében 5 ± 4 nap volt. Az intenzív osztályos ápolási idő 27 ± 13, illetve 21 ± 17 nap volt a két betegcsoportban. 9 beteget jó funkcionális állapotban bocsátottunk el, 5 beteg halt meg osztályunkon, további 3 később a kórházi bennfekvés során. Az extracorporalis membránoxigenizációs program regionális centrumokban Magyarországon is megvalósítható. A nemzetközi ajánlások, oktatási módszerek alkalmazásával a nemzetközi irodalomban közölt túlélési eredményekhez hasonló eredmények érhetők el hazánkban is. Orv Hetil. 2021; 162(11): 425–431. Summary. Extracorporeal membrane oxygenisation is commonly used worldwide for refractory respiratory and circulatory failure. We started to organise the introduction of this therapeutic modality in 2015. Our aim is to give a short review about extracorporeal life support, especially veno-venous extracorporeal membrane oxygenation, and to present our first results. We provide a systematic review of the currently available literature and a summary of our first treatments. As of 2016, we supported 14 patients with extracorporeal membrane oxygenisation (8 men, age 51 ± 15 years, APACHE II score 24 ± 7). The indications were refractory hypoxaemic respiratory failure in 9, tracheo-oesophageal fistula and respiratory failure in 1, support during surgery for planned tracheal reconstruction in 1, and refractory cardiogenic shock in 3 patients. We provided respiratory support in 11, circulatory support in 3 cases, with 13 veno-venous and 1 veno-arterial configuration. The support lasted for 14 ± 6 days in respiratory, and for 5 ± 4 days in cardiac cases. Intensive care length of stay was 27 ± 13 and 21 ± 17 days in the two patient groups. We discharged 9 patients in good functional state, 5 patients died during intensive care and further 3 later, during the hospital stay. Our results show that the implementation of an extracoporeal membrane oxygenation program is feasible in Hungarian tertiary centers. In line with international recommendations and adapting international training courses, the survival is very similar to that reported in the literature. Orv Hetil. 2021; 162(11): 425–431.

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