scholarly journals Extracorporeal membrane oxygenation (ECMO) for COVID-19 patients

2021 ◽  
Author(s):  
Surat Tongyoo ◽  
Suneerat Kongsayreepong
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Ecmo Support ◽  
Janus Kinase ◽  
Systemic Steroid ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
Rescue Treatment ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Individual

During the current outbreak of coronavirus disease 2019 (COVID-19), Extracorporeal Membrane Oxygenation (ECMO) support could be considered as the rescue treatment from life threatening condition among severe COVID-19 patients who did not respond to mechanical ventilation. We propose that veno-venous ECMO should be considered if patient has persistence PaO2:FiO2 ratio lower than 100 mmHg after appropriate mechanical ventilator adjustment, muscle relaxant and prone position. During ECMO support, treatment against cytokine storm, including non-selective immune suppression with systemic steroid, or selective interleukin-6 inhibition and Janus Kinase inhibition should be considered. Heparin infusion is still the recommended anticoagulant to maintain activated partial thromboplastin time (APTT) ratio range 1.5-2.0. The overall hospital mortality was comparable with respiratory failure patients, requiring ECMO support from other causes, which was reported about 37-50%. The decision to initiate ECMO could be depended on the individual hospital capacity and treatment availability.

scholarly journals Bronchotracheal Stenting Management by Rigid Bronchoscopy under Extracorporeal Membrane Oxygenation (ECMO) Support: 10 Years of Experience in a Tertiary Center

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Sabrina Meyer ◽  
Anne-Sophie Dincq ◽  
Lionel Pirard ◽  
Sebahat Ocak ◽  
Jean-Paul D’Odémont ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Rigid Bronchoscopy ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Tertiary Center ◽  
Airway Stenting ◽  
Life Threatening ◽  
Venovenous Ecmo ◽  
Central Airway

Purpose. Airway stenting offers good palliation and improves the quality of life in patients with inoperable bronchotracheal stenosis. However, in some cases, the management of stenting can be life-threatening. Hence, a strategy for maintaining oxygenation and hemodynamic stability should be anticipated to avoid critical situations. Herein, we report the use of extracorporeal membrane oxygenation (ECMO) in bronchotracheal stenting management to secure oxygenation and facilitate interventions. Methods. We retrospectively reviewed all patients who underwent rigid bronchoscopy under ECMO support for the management of bronchotracheal stenting at CHU UCL Namur hospital (Belgium), between January 2009 and December 2019. Results. We included 14 bronchoscopy cases performed on 11 patients (3 patients underwent 2 bronchoscopies) in this study; 12 were performed on males and 2 on females. The median age was 54 years. There were 11 benign and 3 malignant etiologies for the central airway obstruction/stenosis. Eight cases were supported by venovenous ECMO and six by venoarterial ECMO. The median ECMO time was 267 minutes. The weaning of ECMO support was successful in all cases. In most cases, the procedures were performed effectively and safely. Only two local complications caused by the cannulation of ECMO were reported, and anticoagulation was adapted to avoid bleeding at the operating site and clot formation in the system. Conclusion. Elective ECMO support was helpful and safe for the high-risk management of bronchotracheal stenting with rigid bronchoscopy and was not associated with any additional significant complications.

scholarly journals Respiratory Syncytial Virus Associated Myocarditis Requiring Venoarterial Extracorporeal Membrane Oxygenation

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Anamaria Milas ◽  
Aditya Shah ◽  
Neesha Anand ◽  
Meghan Saunders-Kurban ◽  
Samir Patel
Keyword(s):  
Respiratory Syncytial Virus ◽  
Extracorporeal Membrane Oxygenation ◽  
Fulminant Myocarditis ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Va Ecmo

Severe fulminant myocarditis causing cardiogenic shock can be a rapidly progressing, life threatening condition. Respiratory syncytial virus (RSV) is a very rare infectious culprit infrequently described in medical literature as a cause of myocarditis, particularly in adults. We present a case of acute fulminant myocarditis in a patient with PCR positive RSV infection requiring venoarterial extracorporeal membrane oxygenation (VA-ECMO).

Antithrombin III infusion improves anticoagulation in congenital diaphragmatic hernia patients on extracorporeal membrane oxygenation

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Tanya Perry ◽  
Brandon Henry ◽  
David S Cooper ◽  
Sundeep G Keswani ◽  
Kimberly S Burton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Congenital Diaphragmatic Hernia ◽  
Continuous Infusion ◽  
Diaphragmatic Hernia ◽  
Antithrombin Iii ◽  
Factor Xa ◽  
Heparin Infusion ◽  
Membrane Oxygenation ◽  
At Iii ◽  
Life Threatening

Purpose Achieving effective anticoagulation during neonatal extracorporeal membrane oxygenation (ECMO) without increasing the risk of hemorrhage remains challenging. The use of antithrombin III (AT-III) for this purpose has been examined, but studies have been limited to intermittent bolus dosing. We aimed to evaluate the efficacy and safety of an institutionally developed AT-III continuous infusion protocol in neonates receiving ECMO for the treatment of congenital diaphragmatic hernia (CDH). Methods In this single center, retrospective study, all neonates with a CDH who received ECMO support during the study period were included. Data on anticoagulation labs and therapy, life-threatening bleeding, and circuit changes were analyzed. Results Eleven patients were divided into two groups: patients with AT-III continuous infusion ( n = 5) and without ( n = 6). There were no differences in the gestational age ( p = 0.29), sex ( p = 1.00), ECMO duration ( p = 0.59), or initial AT-III levels ( p = 0.76) between groups. Patients in the AT-III infusion group had on average 18.5% higher AT-III levels ( p < 0.0001). Patients receiving continuous AT-III infusions spent a significantly higher percentage of ECMO time within the therapeutic range, measured using anti-Factor Xa levels (64.9±4.2% vs. 29.1±8.57%, p = 0.008), and required fewer changes to the heparin infusion rate (6.48±0.88 vs 2.38±0.36 changes/day changes/day, p = 0.005). Multivariate analysis revealed continuous infusion of AT-III did not increase the rate of intracranial or surgical bleeding ( p = 0.27). Conclusion AT-III as a continuous infusion in CDH neonates on ECMO provides a decreased need to modify heparin infusion and more consistent therapeutic anticoagulation without increasing the risk of life-threatening bleeding.

The First Case of Multisystem Inflammatory Syndrome in Children Successfully Treated with Combined Therapies Including Extracorporeal Membrane Oxygenation and Plasmapheresis

2021 ◽  
Author(s):  
Capan Konca ◽  
Ayse B. Anil ◽  
Onur Isik ◽  
Emine P. Kulluoglu ◽  
Doga Luleyap ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Severe Disease ◽  
Anticoagulation Therapy ◽  
Definitive Treatment ◽  
Membrane Oxygenation ◽  
First Case ◽  
Threatening Condition ◽  
Child Patient ◽  
Life Threatening ◽  
Inflammatory Syndrome

AbstractMultisystem inflammatory syndrome in children (MIS-C) is a severe disease that can lead to death. There is no definitive treatment for MIS-C yet. It has been reported that intravenous immunoglobulin, intravenous methylprednisolone, fluid supplements, antibiotics, inotropics, extracorporeal membrane oxygenation (ECMO), plasmapheresis, biological therapy, and anticoagulation therapy can be used for treatment. In this article, we presented an 8-year-old girl child patient who survived due to timely administered ECMO and combined therapies including plasmapheresis without any sequela despite her life-threatening condition due to MIS-C.

scholarly journals Successful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation

2013 ◽  
Vol 8 ◽  
Author(s):  
Jong Hoo Lee ◽  
Su Wan Kim
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Warfarin Therapy ◽  
Ventilatory Support ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Vein Thrombosis ◽  
Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening ◽  
Chest X Ray

Although diffuse alveolar hemorrhage complicating warfarin therapy is rare, it generally has a worsening clinical course and can be a life threatening condition. A 56-year-old male who had undergone a pulmonary lobectomy for lung cancer 2 years before had received warfarin for about 5 months due to pulmonary vein thrombosis. The patient presented with severe dyspnea and had prolonged anticoagulation values. Chest X-ray and computed tomography revealed diffuse pulmonary consolidations, and bronchoalveolar lavage demonstrated diffuse alveolar hemorrhage. The reversal of anticoagulation was initiated, and extracorporeal membrane oxygenation was performed for refractory respiratory failure that did not improve despite maximal mechanical ventilatory support. The diffuse alveolar infiltrations resolved after 5 days, and we successfully weaned off both extracorporeal membrane oxygenation and mechanical ventilation. Herein we report the detailed course of a case that was successfully treated with extracorporeal membrane oxygenation as a bridge-to-recovery for warfarin- exacerbated diffuse alveolar hemorrhage.

scholarly journals Fulminant myocarditis: use of echocardiography from diagnosis to extracorporeal membrane oxygenation

2020 ◽  
Vol 7 (3) ◽  
pp. K21-K26
Author(s):  
Na Hyun Park ◽  
Hazem Lashin ◽  
Rosalba Spiritoso
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Early Recognition ◽  
Heart Function ◽  
Thrombus Formation ◽  
Fulminant Myocarditis ◽  
High Dose ◽  
List Type ◽  
Membrane Oxygenation ◽  
Threatening Condition ◽  
Life Threatening

Summary Fulminant myocarditis can present with life-threatening arrhythmias and cardiogenic shock due to ventricular failure. The diagnosis of myocarditis usually requires histological and immunological information, as its aetiology may be infectious (viral or non-viral), autoimmune or drug related. The treatment of fulminant myocarditis depends on the underlying cause but usually includes high dose systemic steroids as well as physiological support. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) can be used to support patients as a bridge to recovery by supporting biventricular function and decompressing the heart. V-A ECMO carries risks and complications of its own such as thrombus formation or bleeding. Different diagnostic modalities, such as transthoracic echocardiogram (TTE) and transoesophageal echocardiogram (TOE), are central to the monitoring of progression of disease and recovery of heart function. This case highlights the importance of early recognition and early support with V-A ECMO in fulminant myocarditis, as well as the role of repeated echocardiography when weaning from physiological support. Learning points: Myocarditis is a life-threatening condition and early recognition of cardiac failure can be assisted with a bedside echocardiogram. Extracorporeal membrane oxygenation is used as a bridging method of treatment for patients with cardiogenic failure in myocarditis but has its own risks related to anticoagulation and the procedure itself. There are currently no standardised guidelines of when to wean a patient off extracorporeal membrane oxygenation, but echocardiography acts as an important guide to detect complications as well as cardiac recovery.

scholarly journals Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage Caused by Idiopathic Pulmonary Hemosiderosis: A Case Report and a Review of the Literature

2019 ◽  
Vol 08 (03) ◽  
pp. 181-186 ◽  
Author(s):  
Shotaro Matsumoto ◽  
Satoshi Nakagawa
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Rescue Therapy ◽  
Diffuse Alveolar Hemorrhage ◽  
Alveolar Hemorrhage ◽  
Membrane Oxygenation ◽  
Pulmonary Hemosiderosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Systemic Anticoagulation ◽  
Idiopathic Pulmonary Hemosiderosis

AbstractDiffuse alveolar hemorrhage (DAH) is a life-threatening condition presenting with hemoptysis, anemia, and diffuse radiographic pulmonary infiltrates; it causes acute respiratory failure. Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of DAH occurring predominantly in children. Bleeding is often considered to be a contraindication for extracorporeal membrane oxygenation (ECMO) due to systemic anticoagulation. We present an 8-year-old girl with DAH caused by IPH. Unfractionated heparin was administered to maintain an activated clotting time of 150 to 180 seconds. The DAH resolved with immunosuppressive therapy, and the patient survived to decannulation. ECMO may be applied as a rescue therapy for DAH even with systemic anticoagulation.

The effects of propofol on extracorporeal membrane oxygenation oxygenator exchange

2021 ◽  
pp. 039139882110160
Author(s):  
Kelsey L Browder ◽  
Ayesha Ather ◽  
Komal A Pandya
Keyword(s):  
Cohort Study ◽  
Extracorporeal Membrane Oxygenation ◽  
Cumulative Dose ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Ecmo Support ◽  
Single Center ◽  
Membrane Oxygenation ◽  
Vv Ecmo

The objective of this study was to determine if propofol administration to veno-venous (VV) extracorporeal membrane oxygenation (ECMO) patients was associated with more incidents of oxygenator failure when compared to patients who did not receive propofol. This was a single center, retrospective cohort study. The primary outcome of the study is oxygenator exchanges per ECMO day in patients who received propofol versus those who did not receive propofol. Patients were 18 years or older on VV-ECMO support between January 1, 2015 and January 31, 2018. Patients were excluded if they required ECMO support for less than 48 h or greater than 21 days. There were five patients in the propofol arm that required oxygenator exchanges and seven patients in the control arm. The total number of oxygenator exchanges per ECMO day was not significantly different between groups ( p = 0.50). When comparing those who required an oxygenator exchange and those who did not, there was no difference in the cumulative dose of propofol received per ECMO hour (0.64 mg/kg/h vs 0.96 mg/kg/h; p = 0.16). Propofol use in patients on VV-ECMO does not appear to increase the number of oxygenator exchanges.

Traumatic respiratory failure and veno-venous extracorporeal membrane oxygenation support

Perfusion ◽  
2021 ◽  
pp. 026765912110128
Author(s):  
Ismael A Salas De Armas ◽  
Bindu Akkanti ◽  
Pratik B Doshi ◽  
Manish Patel ◽  
Sachin Kumar ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Extracorporeal Membrane Oxygenation ◽  
Injury Severity ◽  
Invasive Mechanical Ventilation ◽  
Ecmo Support ◽  
Trauma Patients ◽  
Membrane Oxygenation ◽  
Trauma Service ◽  
Proper Patient Selection ◽  
Vv Ecmo

Background: Respiratory failure (RF) is a common cause of death and morbid complication in trauma patients. Extracorporeal membrane oxygenation (ECMO) is increasingly used in adults with RF refractory to invasive mechanical ventilation. However, use of ECMO remains limited for this patient population as they often have contraindications for anticoagulation. Study design: Medical records were retroactively searched for all adult patients who were admitted to the trauma service and received veno-venous ECMO (VV ECMO) support between June 2015 and August 2018. Survival to discharge and ECMO-related complications were collected and analyzed. Results: Fifteen patients from a large Level I trauma center met the criteria. The median PaO2/FiO2 ratio was 53.0 (IQR, 27.0–76.0), median injury severity score was 34.0 (IQR, 27.0–43.0), and the median duration of ECMO support was 11 days (IQR, 7.5–20.0). For this cohort, the survival-to-discharge rate was 87% (13/15). The incidence of neurologic complications was 13%, and deep vein thrombosis was reported in two cases (13%). Conclusions: Survival rates of trauma patients in this study are equivalent to, or may exceed, those of non-trauma patients who receive ECMO support for other types of RF. With the employment of a multidisciplinary team assessment and proper patient selection, early cannulation, traumatic RF may be safely supported with VV ECMO in experienced centers.

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