Extracorporeal membrane oxygenation in life-threatening asthma unresponsive to mechanical ventilation: a comparison of patient demographics and outcomes between a large London-based intensive care unit and an international registry

Objective Recent clinical trials confirmed the corticosteroid dexamethasone as an effective treatment for patients with COVID-19 requiring mechanical ventilation. However, limited attention has been given to potential adverse effects of corticosteroid therapy. The objective of this study was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation. Design Multicenter retrospective cohort study between March 9 and May 17, 2020. The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission. Setting Twelve hospitals in a United States health system. Patients Adults diagnosed with COVID-19 requiring invasive mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation. Interventions None. Measurements and Main Results We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, P < .001). Conclusions In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.

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Extracorporeal membrane oxygenation in intensive care unit: About the first moroccan experience

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2020.10.334 ◽

2021 ◽

Vol 13 (1) ◽

pp. 157

Author(s):

Z. Laraichi ◽

M.A. Berdai ◽

M. Harandou

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation

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Outcomes of pediatric oncology and hematopoietic cell transplant patients receiving extracorporeal membrane oxygenation

Perfusion ◽

10.1177/0267659119842471 ◽

2019 ◽

Vol 34 (7) ◽

pp. 598-604

Author(s):

Danielle K Maue ◽

Michael J Hobson ◽

Matthew L Friedman ◽

Elizabeth AS Moser ◽

Courtney M Rowan

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Extracorporeal Membrane Oxygenation ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Hematopoietic Cell ◽

Cell Transplant ◽

Hematopoietic Cell Transplant ◽

Membrane Oxygenation ◽

Transplant Patients

Background/objectives: There is controversy regarding the utilization of extracorporeal membrane oxygenation in pediatric patients with an underlying oncologic diagnosis or who have undergone hematopoietic cell transplant. We hypothesized that these patients have higher mortality, more bleeding complications, more blood product utilization, and a higher rate of new infections than the general pediatric intensive care unit population supported with extracorporeal membrane oxygenation. Design/methods: This is a retrospective chart review at a single center quaternary care pediatric hospital including all pediatric intensive care unit extracorporeal membrane oxygenation patients from 2011 to 2016. Patients were categorized as either oncology/hematopoietic cell transplant or general pediatric intensive care unit. Patients from the cardiovascular intensive care unit or the neonatal intensive care unit were excluded. Results: A total of 38 patients met inclusion criteria of which 7 were oncology/hematopoietic cell transplant patients. The oncology/hematopoietic cell transplant group had lower platelets at the start of extracorporeal membrane oxygenation (p = 0.02) but other pre-extracorporeal membrane oxygenation characteristics were similar. Extracorporeal membrane oxygenation survival was lower in the oncology/hematopoietic cell transplant group (29% vs 77%, p = 0.02). The incidence of bleeding complications and new infections did not differ. The oncology/hematopoietic cell transplant group received more platelets (median of 15.9 mL/kg/day (interquartile range 8.4, 36.6) vs 7.9 mL/kg/day (3.3, 21.9), p = 0.04) and fresh frozen plasma (14.0 mL/kg/day (3, 15.7) vs 1.8 mL/kg/day (0.5, 5.9), p = 0.04). Conclusion: Oncology and hematopoietic cell transplant patients had a higher mortality and received more blood products while on extracorporeal membrane oxygenation than the general pediatric intensive care unit patients despite similar pre-extracorporeal membrane oxygenation characteristics. Physicians should use caution when deciding whether or not to utilize extracorporeal membrane oxygenation in this population.

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Mobile extracorporeal membrane oxygenation service for severe acute respiratory failure – A review of five years of experience

Journal of the Intensive Care Society ◽

10.1177/1751143719855207 ◽

2019 ◽

Vol 21 (2) ◽

pp. 134-139 ◽

Cited By ~ 2

Author(s):

Ada M Krzak ◽

Jo-Anne Fowles ◽

Alain Vuylsteke

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Qualitative Study ◽

Extracorporeal Membrane Oxygenation ◽

Acute Respiratory Failure ◽

Equipment Failure ◽

Quality And Safety ◽

Regular Reflection ◽

Membrane Oxygenation

Provision of extracorporeal membrane oxygenation as part of support escalation in severe refractory acute respiratory failure in England is provided by five specialist centres that operate within a well-defined quality and safety framework. We conducted a qualitative study of the extracorporeal membrane oxygenation retrieval service provided by one of the five centres. We analysed 176 consecutive debrief reports written between October 2013 and April 2018 by the consultant. Main identified issues were short delays in retrieval predominantly due to insufficient communication or equipment failure. All issues were addressed in subsequent practice. Our results suggest a need for improved communication between the referring intensive care unit and retrieving team. Our findings highlight the value of regular reflection-based evaluation to ensure continued provision of safe and efficient service.

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Central Airway Obstruction due to Mediastinal Malignant Lymphoma Requiring Venovenous-Extracorporeal Membrane Oxygenation

Case Reports in Acute Medicine ◽

10.1159/000501649 ◽

2019 ◽

Vol 2 (2) ◽

pp. 42-47 ◽

Cited By ~ 1

Author(s):

Yoshihiro Ueda ◽

Ichiro Hirayama ◽

Ryohei Horie ◽

Kent Doi ◽

Naoto Morimura

Keyword(s):

Intensive Care ◽

Extracorporeal Membrane Oxygenation ◽

Airway Obstruction ◽

Malignant Lymphoma ◽

Hematological Malignancy ◽

Central Airway Obstruction ◽

Membrane Oxygenation ◽

Life Threatening ◽

Central Airway ◽

Ecmo Therapy

Extracorporeal membrane oxygenation (ECMO) therapy might be controversial when patients with advanced malignant disease develop heart or lung failure refractory to conventional management. Especially as for the hematological malignancy patients, the induction of ECMO therapy must be considered carefully, since it is often associated with bleeding complications or infectious diseases. Here, we report a case of life-threatening airway obstruction requiring ECMO. The trachea of the patient was narrowed by an anterior mediastinal tumor too highly to ventilate both lungs, so she had to be connected to venovenous-ECMO (VV-ECMO) before pathological examination and radical treatment were planned. During the intensive care with ECMO, she was diagnosed with malignant lymphoma and the chemotherapy was started. The chemotherapy brought such an immediate result that the trachea regained its patency and ECMO was disconnected 9 days after the initiation of the chemotherapy. Then, the patient was able to leave the intensive care unit with no sequelae. Central airway obstruction is a life-threatening situation, in which prompt decisions are essential. On the other hand, if the airway is impaired by hematological malignancy, it might be generally challenging to consider ECMO as a bridge until the chemotherapy takes an effect. The prognosis of hematological malignancy differs according to its subtype or stage, so it may be reasonable to take ECMO therapy into consideration for some population.

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Quality of life post extracorporeal membrane oxygenation in one Australian intensive care unit

Australian Critical Care ◽

10.1016/j.aucc.2013.10.007 ◽

2014 ◽

Vol 27 (1) ◽

pp. 44

Author(s):

B. Foster ◽

S. Knowles ◽

C. Reynolds ◽

H. Buscher

Keyword(s):

Quality Of Life ◽

Intensive Care Unit ◽

Intensive Care ◽

Extracorporeal Membrane Oxygenation ◽

Membrane Oxygenation

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Physical Rehabilitation of Patients in the Intensive Care Unit Requiring Extracorporeal Membrane Oxygenation: A Small Case Series

Physical Therapy ◽

10.2522/ptj.20120336 ◽

2013 ◽

Vol 93 (2) ◽

pp. 248-255 ◽

Cited By ~ 38

Author(s):

Rod A. Rahimi ◽

Julie Skrzat ◽

Dereddi Raja S. Reddy ◽

Jennifer M. Zanni ◽

Eddy Fan ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Respiratory Failure ◽

Extracorporeal Membrane Oxygenation ◽

Physical Function ◽

Case Series ◽

Physical Rehabilitation ◽

Care Utilization ◽

Rehabilitation Therapy ◽

Membrane Oxygenation

Background and Purpose Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy shortly after ICU admission improves physical function and reduces health care utilization. Recently, there is increasing interest and utilization of extracorporeal membrane oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients. Case Description This case report describes 3 patients with respiratory failure requiring ECMO who received physical rehabilitation to illustrate and discuss relevant feasibility and safety issues. Outcomes In case 1, sedation and femoral cannulation limited rehabilitation therapy while on ECMO. In the 2 subsequent cases, minimizing sedation and utilizing a single bicaval dual lumen ECMO cannula placed in the internal jugular vein allowed patients to be alert and participate in active physical therapy while on ECMO, illustrating feasible rehabilitation techniques for these patients. Discussion Although greater experience is needed to more fully evaluate the safety of rehabilitation on ECMO, these initial cases are encouraging. We recommend systematically and prospectively tracking safety events and patient outcomes during rehabilitation on ECMO to provide greater evidence in this area.

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