51
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Zochios V, Brodie D, Charlesworth M, Parhar KK. Delivering extracorporeal membrane oxygenation for patients with COVID-19: what, who, when and how? Anaesthesia 2020; 75:997-1001. [PMID: 32319081 PMCID: PMC7264794 DOI: 10.1111/anae.15099] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Affiliation(s)
- V Zochios
- Department of Cardiothoracic Critical Care and ECMO, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.,University of Birmingham, Institute of Inflammation and Ageing, Birmingham, UK
| | - D Brodie
- Columbia University College of Physicians and Surgeons, New York, NY, USA.,Centre for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
| | - M Charlesworth
- Department of Cardiothoracic Critical Care and ECMO, Wythenshawe Hospital, Manchester, UK
| | - K K Parhar
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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52
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Lim JKB, Qadri SK, Toh TSW, Lin CB, Mok YH, Lee JH. Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review. ANNALS ACADEMY OF MEDICINE SINGAPORE 2020. [DOI: 10.47102/annals-acadmed.sg.202046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Epidemics and pandemics from zoonotic respiratory viruses, such as the 2019 novel coronavirus, can lead to significant global intensive care burden as patients progress to acute respiratory distress syndrome (ARDS). A subset of these patients develops refractory hypoxaemia despite maximal conventional mechanical ventilation and require extracorporeal membrane oxygenation (ECMO). This review focuses on considerations for ventilatory strategies, infection control and patient selection related to ECMO for ARDS in a pandemic. We also summarise the experiences with ECMO in previous respiratory pandemics. Materials and Methods: A review of pertinent studies was conducted via a search using MEDLINE, EMBASE and Google Scholar. References of articles were also examined to identify other relevant publications. Results: Since the H1N1 Influenza pandemic in 2009, the use of ECMO for ARDS continues to grow despite limitations in evidence for survival benefit. There is emerging evidence to suggest that lung protective ventilation for ARDS can be further optimised while receiving ECMO so as to minimise ventilator-induced lung injury and subsequent contributions to multi-organ failure. Efforts to improve outcomes should also encompass appropriate infection control measures to reduce co-infections and prevent nosocomial transmission of novel respiratory viruses. Patient selection for ECMO in a pandemic can be challenging. We discuss important ethical considerations and predictive scoring systems that may assist clinical decision-making to optimise resource allocation. Conclusion: The role of ECMO in managing ARDS during respiratory pandemics continues to grow. This is supported by efforts to redefine optimal ventilatory strategies, reinforce infection control measures and enhance patient selection. Ann Acad Med Singapore 2020;49:199–214 Key words: Acute Respiratory Distress Syndrome, Coronavirus disease 2019, ECMO, Infection control, Mechanical ventilation
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Affiliation(s)
- Joel KB Lim
- KK Women’s and Children’s Hospital, Singapore
| | | | | | | | - Yee Hui Mok
- KK Women’s and Children’s Hospital, Singapore
| | - Jan Hau Lee
- KK Women’s and Children’s Hospital, Singapore
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53
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54
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Worku B, Gaudino M, Avgerinos D, Ramasubbu K, Gambardella I, Gulkarov I, Khin S. A comparison of existing risk prediction models in patients undergoing venoarterial extracorporeal membrane oxygenation. Heart Lung 2020; 49:599-604. [PMID: 32234259 DOI: 10.1016/j.hrtlng.2020.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/01/2020] [Accepted: 03/05/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients undergoing consideration for venoarterial extracorporeal membrane oxygenation (VA-ECMO) require an immediate risk profile assessment in the setting of incomplete information. A number of survival prediction models for critically ill patients and patients undergoing elective cardiac surgery or institution of VA-ECMO support have been designed. We assess the ability of these models to predict outcomes in a cohort of patients undergoing institution of VA-ECMO for cardiogenic shock or cardiac arrest. METHODS Fifty-one patients undergoing institution of VA-ECMO support were retrospectively analyzed. APACHE II, SOFA, SAPS II, Encourage, SAVE, and ACEF scores were calculated. Their ability to predict outcomes were assessed. RESULTS Indications for ECMO support included postcardiotomy shock (25%), ischemic etiologies (39%), and other etiologies (36%). Pre-ECMO arrest occurred in 73% and 41% of patients underwent cannulation during arrest. Survival to discharge was 39%. Three survival prediction model scores were significantly higher in nonsurvivors to discharge than surivors; the Encourage score (25.4 vs 20; p = .04), the APACHE II score (23.6 vs 19.2; p = .05), and the ACEF score (3.1 vs 1.8; p = .03). In ROC analysis, the ACEF score demonstrated the greatest predictive ability with an AUC of 0.7. CONCLUSIONS A variety of survival prediction model scores designed for critically ill ICU and VA-ECMO patients demonstrated modest discriminatory ability in the current cohort of patients. The ACEF score, while not designed to predict survival in critically ill patients, demonstrated the best discriminatory ability. Furthermore, it is the simplest to calculate, an advantage in the emergent setting.
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Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA; Department of Cardiothoracic Surgery, New York Presbyterian Weil Cornell Medical Center, New York, NY, 10021, USA.
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, New York Presbyterian Weil Cornell Medical Center, New York, NY, 10021, USA
| | - Dimitrios Avgerinos
- Department of Cardiothoracic Surgery, New York Presbyterian Weil Cornell Medical Center, New York, NY, 10021, USA
| | - Kumudha Ramasubbu
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA
| | - Ivancarmine Gambardella
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA; Department of Cardiothoracic Surgery, New York Presbyterian Weil Cornell Medical Center, New York, NY, 10021, USA
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA; Department of Cardiothoracic Surgery, New York Presbyterian Weil Cornell Medical Center, New York, NY, 10021, USA
| | - Sandi Khin
- Department of Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, 11215, USA
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55
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Pulton D, Kiefer J, Vernick W, Gutsche JT, Raiten J. Prognostication of Patients on Venovenous Extracorporeal Membrane Oxygenation for Influenza-Induced Respiratory Failure: Best Practice and Holistic Implications. J Cardiothorac Vasc Anesth 2020; 34:1431-1433. [PMID: 32209290 DOI: 10.1053/j.jvca.2020.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Danielle Pulton
- Department of Anesthesiology and Critical Care, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jesse Kiefer
- Department of Anesthesiology and Critical Care, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - William Vernick
- Department of Anesthesiology and Critical Care, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | - Jesse Raiten
- Department of Anesthesiology and Critical Care, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
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56
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Zayton TM, El-Reweny EM, Tammam HM, Gharbeya KM. Predicting successful weaning in patients treated with venovenous extracorporeal membrane oxygenation. ALEXANDRIA JOURNAL OF MEDICINE 2020. [DOI: 10.1080/20905068.2020.1728881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Tayseer M. Zayton
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehab M. El-Reweny
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Haitham M. Tammam
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kareem M. Gharbeya
- Department of Critical Care Medicine, Alexandria Armed Forces Hospital, Alexandria, Egypt
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57
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Cardiac Arrest Prior to Initiation of Veno-Venous Extracorporeal Membrane Oxygenation Is Not Associated with Increased In-Hospital Mortality. ASAIO J 2020; 66:e79-e81. [PMID: 32479713 DOI: 10.1097/mat.0000000000001135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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58
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Parikh S, Singh H, Devendra A, Dheenadhayalan J, Sethuraman AS, Sabapathy R, Rajasekaran S. The use of the Ganga Hospital Score to predict the treatment and outcome of open fractures of the tibia. Bone Joint J 2020; 102-B:26-32. [PMID: 31888373 DOI: 10.1302/0301-620x.102b1.bjj-2019-0853.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Open fractures of the tibia are a heterogeneous group of injuries that can present a number of challenges to the treating surgeon. Consequently, few surgeons can reliably advise patients and relatives about the expected outcomes. The aim of this study was to determine whether these outcomes are predictable by using the Ganga Hospital Score (GHS). This has been shown to be a useful method of scoring open injuries to inform wound management and decide between limb salvage and amputation. METHODS We collected data on 182 consecutive patients with a type II, IIIA, or IIIB open fracture of the tibia who presented to our hospital between July and December 2016. For the purposes of the study, the patients were jointly treated by experienced consultant orthopaedic and plastic surgeons who determined the type of treatment. Separately, the study team (SP, HS, AD, JD) independently calculated the GHS and prospectively collected data on six outcomes for each patient. These included time to bony union, number of admissions, length of hospital stay, total length of treatment, final functional score, and number of operations. Spearman's correlation was used to compare GHS with each outcome. Forward stepwise linear regression was used to generate predictive models based on components of the GHS. Five-fold cross-validation was used to prevent models from over-fitting. RESULTS The mean follow-up was 11.4 months (3 to 31). The mean time to union was 9.7 months (3 to 21), the mean number of operations was 2.8 (1 to 11), the mean time in hospital was 17.7 days (5 to 84), the mean length of treatment was 92.7 days (5 to 730), the mean number of admissions was 1.7 (1 to 6), and the mean functional score (Lower Extremity Functional Score (LEFS)) was 60.13 (33 to 80). There was a significant correlation between the GHS and each of the outcome measures. A predictive model was generated from which the GHS could be used to predict the various outcome measures. CONCLUSION The GHS can be used to predict the outcome of patients who present with an open fracture of the tibia. Our model generates a numerical value for each outcome measure that can be used in clinical practice to inform the treating team and to advise patients. Cite this article: Bone Joint J 2020;102-B(1):26-32.
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59
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Assanangkornchai N, Vichitkunakorn P, Bhurayanontachai R. Characteristics and Outcomes of Severe ARDS Patients Receiving ECMO in Southern Thailand. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2019; 13:1179548419885137. [PMID: 31700253 PMCID: PMC6826929 DOI: 10.1177/1179548419885137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/07/2019] [Indexed: 12/15/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a treatment option considered for acute respiratory distress syndrome (ARDS) patients who are refractory to conventional treatments. However, treatment with ECMO has not shown significant reduction of mortality which may be due to inappropriate selection criteria. Thus, we aim to evaluate the treatment outcomes of patients treated with ECMO in our center and determine an optimal cutoff level of the Respiratory ECMO Survival Prediction (RESP) score for case selection. This was a retrospective case-control study conducted at Songklanagarind Hospital, Thailand, from January 2014 to August 2018. ECMO patients were randomly matched to a control group of patients with severe ARDS within the same time period. There were 19 cases diagnosed with ARDS and treated with ECMO and 57 controls with ARDS. The patients in both groups had an average APACHE II score of 30.2 (SD = 4.7) and mainly had bacterial pneumonia. The in-hospital mortality was not significantly different between the cases and controls (68.4% vs 63.2%, respectively); however, the ECMO cases had a significantly longer length of intensive care unit stay and cost of hospitalization. Active malignancy, male gender, PaO2/FiO2 ratio, and hypotension needing vasopressors were the risk factors for mortality. The RESP score did not discriminate between the survivors and nonsurvivors. Thus, more patient is needed to construct a better selection criterion.
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Affiliation(s)
- Nawaporn Assanangkornchai
- Critical Care Medicine Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Polathep Vichitkunakorn
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rungsun Bhurayanontachai
- Critical Care Medicine Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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60
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Knudson KA, Gustafson CM, Sadler LS, Whittemore R, Redeker NS, Andrews LK, Mangi A, Funk M. Long-term health-related quality of life of adult patients treated with extracorporeal membrane oxygenation (ECMO): An integrative review. Heart Lung 2019; 48:538-552. [DOI: 10.1016/j.hrtlng.2019.08.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
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61
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Predicting Survival of Adult Respiratory Failure Patients Receiving Prolonged (≥14 Days) Extracorporeal Membrane Oxygenation. ASAIO J 2019; 66:825-833. [DOI: 10.1097/mat.0000000000001067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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62
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Worku B, Khin S, Gaudino M, Avgerinos D, Gambardella I, D'Ayala M, Ramasubbu K, Gulkarov I, Salemi A. A Simple Scoring System to Predict Survival after Venoarterial Extracorporeal Membrane Oxygenation. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2019; 51:133-139. [PMID: 31548734 PMCID: PMC6749168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
Patients undergoing consideration for venoarterial extracorporeal membrane oxygenation (VA ECMO) require an immediate risk profile assessment in the setting of incomplete or no information. A retrospective cohort study of 100 patients undergoing VA ECMO placement at three institutions was carried out. Variables strongly associated with survival to discharge were used to calculate a risk stratification score. Indications for VA ECMO support included postcardiotomy shock (24%), ischemic etiologies (33%), nonischemic cardiomyopathy (32%), and other etiologies (11%). Pre-VA ECMO arrest occurred in 69%, and 30% of patients underwent cannulation during arrest. Survival to discharge was 38%. Three variables demonstrated a strong trend toward predicting survival to discharge: lactate >10 mmol/L (p = .054), albumin <3 g/dL (p = .062), and platelet count <180 K/uL (p = .064), and these variables were included in a scoring system. The extremes of age and duration of pre-VA ECMO ventilation were associated with a dismal prognosis and were also included. These five variables were used to construct a mortality prediction score. A score of 0 was associated with 10% expected mortality, whereas a score of 4+ was associated with 100% expected mortality. Mortality increased in a stepwise fashion with increasing scores. The expected mortality closely paralleled the observed mortality. A simple scoring system composed of easily collected variables may help predict mortality. However, it is not intended to replace an experienced clinician's judgment, but to enhance it.
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Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Sandi Khin
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Dimitrios Avgerinos
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Ivan Gambardella
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Marcus D'Ayala
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Kumudha Ramasubbu
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Iosif Gulkarov
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
| | - Arash Salemi
- Department of Cardiothoracic Surgery, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York
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63
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Balke L, Panholzer B, Haneya A, Bewig B. [ECMO treatment in acute lung failure : Who profits?]. Med Klin Intensivmed Notfmed 2019; 115:682-689. [PMID: 31363799 DOI: 10.1007/s00063-019-0597-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/18/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
In intensive care medicine, rapid technical developments that are often beneficial to patients are taking place. On the other hand, there are also voices that generally criticize an increasing "interventionalism". This area of tension includes other important questions regarding usefulness, quality, ethical compliance, scientific evidence, structural capacities and economy. The treatment of acute respiratory distress syndrome (ARDS) using extracorporeal membrane oxygenation (ECMO) is an example of these considerations. Although ECMO has rarely been prospectively evaluated according to scientific criteria, it is still used with an increasing tendency, not least since the documented register survival rates in ECMO patients with severe ARDS are 60%. However, the implementation of this therapy means an immense effort. The necessary centralization and certification for ECMO treatment is currently under intensive discussion. Closely related to this are considerations about which criteria represent good quality in patient care. In order to be able to guarantee high quality, a precise indication is the first step. And here indications and contraindications still need to be defined. It has not yet been sufficiently clarified which prognosis factors need to be taken into account. This article summarizes what is known about ECMO prognosis and indication criteria. In conclusion, parameters are identified that should be developed scientifically in the future.
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Affiliation(s)
- L Balke
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Deutschland. .,Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
| | - B Panholzer
- Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.,Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A Haneya
- Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.,Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B Bewig
- Klinik für Innere Medizin 1, Universitätsklinikum Schleswig Holstein, Campus Kiel, Rosalind-Franklin-Straße 12, 24105, Kiel, Deutschland.,Interdisziplinäres ARDS-ECMO-Zentrum, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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64
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Li HY, Mendes PV, Melro LMG, Joelsons D, Besen BAMP, Costa ELV, Hirota AS, Barbosa EVS, Foronda FK, Azevedo LCP, Romano TG, Park M. Characterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil. Rev Bras Ter Intensiva 2018; 30:317-326. [PMID: 30328986 PMCID: PMC6180471 DOI: 10.5935/0103-507x.20180052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/30/2018] [Indexed: 01/05/2023] Open
Abstract
Objective To characterize the transport of severely ill patients with extracorporeal
respiratory or cardiovascular support. Methods A series of 18 patients in the state of São Paulo, Brazil is
described. All patients were consecutively evaluated by a multidisciplinary
team at the hospital of origin. The patients were rescued, and
extracorporeal membrane oxygenation support was provided on site. The
patients were then transported to referral hospitals for extracorporeal
membrane oxygenation support. Data were retrieved from a prospectively
collected database. Results From 2011 to 2017, 18 patients aged 29 (25 - 31) years with a SAPS 3 of 84
(68 - 92) and main primary diagnosis of leptospirosis and influenza A (H1N1)
virus were transported to three referral hospitals in São Paulo. A
median distance of 39 (15 - 82) km was traveled on each rescue mission
during a period of 360 (308 - 431) min. A median of one (0 - 2) nurse, three
(2 - 3) physicians, and one (0 - 1) physical therapist was present per
rescue. Seventeen rescues were made by ambulance, and one rescue was made by
helicopter. The observed complications were interruption in the energy
supply to the pump in two cases (11%) and oxygen saturation < 70% in two
cases. Thirteen patients (72%) survived and were discharged from the
hospital. Among the nonsurvivors, there were two cases of brain death, two
cases of multiple organ dysfunction syndrome, and one case of irreversible
pulmonary fibrosis. Conclusions Transportation with extracorporeal support occurred without serious
complications, and the hospital survival rate was high.
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Affiliation(s)
- Ho Yeh Li
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Pedro Vitale Mendes
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Oncológica, Hospital São Luiz, Rede D'Or - São Paulo (SP), Brasil
| | - Livia Maria Garcia Melro
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Hospital TotalCor - São Paulo (SP), Brasil
| | - Daniel Joelsons
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Oncológica, Hospital São Luiz, Rede D'Or - São Paulo (SP), Brasil
| | - Eduardo Leite Viera Costa
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Hospital Sírio Libanês - São Paulo (SP), Brasil
| | - Adriana Sayuri Hirota
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | | | - Flavia Krepel Foronda
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Luciano Cesar Pontes Azevedo
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Hospital Sírio Libanês - São Paulo (SP), Brasil
| | - Thiago Gomes Romano
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva Oncológica, Hospital São Luiz, Rede D'Or - São Paulo (SP), Brasil
| | - Marcelo Park
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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65
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Mazzeffi MA, Gutsche JT. Forecasting Extracorporeal Membrane Oxygenation Outcomes: Rain or Shine? J Cardiothorac Vasc Anesth 2018; 33:918-919. [PMID: 30651165 DOI: 10.1053/j.jvca.2018.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Michael A Mazzeffi
- Department of Anesthesiology, School of Medicine, University of Maryland, Baltimore, MD
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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66
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Montero S, Slutsky AS, Schmidt M. The PRESET-Score: the extrapulmonary predictive survival model for extracorporeal membrane oxygenation in severe acute respiratory distress syndrome. J Thorac Dis 2018; 10:S2040-S2044. [PMID: 30023113 DOI: 10.21037/jtd.2018.05.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Santiago Montero
- Acute and Intensive Cardiovascular Care Unit, Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Keenan Research Center for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris, France
| | - Arthur S Slutsky
- Keenan Research Center for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Matthieu Schmidt
- Medical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre-et-Marie-Curie, Paris, France
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67
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Ahuja A, Shekar K. Patient selection for VV ECMO: have we found the crystal ball? J Thorac Dis 2018; 10:S1979-S1981. [PMID: 30023096 DOI: 10.21037/jtd.2018.05.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Abhilasha Ahuja
- Adult Intensive Care Services, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Critical Care Research Group, Brisbane, Australia.,Centre of Research Excellence for Advanced Cardio-respiratory Therapies Improving OrgaN Support (ACTIONS), Brisbane, Australia
| | - Kiran Shekar
- Adult Intensive Care Services, the Prince Charles Hospital, Brisbane, Queensland, Australia.,Critical Care Research Group, Brisbane, Australia.,Centre of Research Excellence for Advanced Cardio-respiratory Therapies Improving OrgaN Support (ACTIONS), Brisbane, Australia.,University of Queensland, Brisbane, Queensland, Australia.,Bond University, Gold Coast, Queensland, Australia
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Enger TB, Müller T. Predictive tools in VVECMO patients: handicap or benefit for clinical practice? J Thorac Dis 2018; 10:1347-1351. [PMID: 29708164 DOI: 10.21037/jtd.2018.03.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Tone B Enger
- Clinic of Surgery, St. Olav University Hospital, Trondheim, Norway
| | - Thomas Müller
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
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69
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Riessen R, Janssens U, John S, Karagiannidis C, Kluge S. [Organ assist devices in the future : Limits and perspectives]. Med Klin Intensivmed Notfmed 2018; 113:277-283. [PMID: 29632968 DOI: 10.1007/s00063-018-0420-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 11/30/2022]
Abstract
In the last decade, extracorporeal organ assist devices (extracorporeal membrane oxygenation [ECMO]) have been increasingly applied to treat the most severe forms of respiratory failure and cardiogenic shock, although the underlying scientific evidence is still limited and the methods carry a high risk of complications despite all technical improvements. The selection of those patients who most benefit from these devices is still a great challenge for intensivists and all other involved disciplines. Besides the severity of the acute organ failure, it is important to thoroughly evaluate etiology and treatment options of the underlying disease, comorbidities, and the functional status of the patients in an interdisciplinary team. This also includes ethical challenges. Because of the complexity of the treatment and the high organizational demands it is reasonable to concentrate ECMO treatments in specifically qualified centers and to promote a comprehensive scientific analysis of the treatment data.
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Affiliation(s)
- R Riessen
- Internistische Intensivstation, Department für Innere Medizin, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - U Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland
| | - S John
- Abteilung Internistische Intensivmedizin, Medizinische Klinik 8, Paracelsus Medizinische Privatuniversität Nürnberg, Klinikum Nürnberg-Süd, Universität Erlangen-Nürnberg, Breslauer Str. 201, 90471, Nürnberg, Deutschland
| | - C Karagiannidis
- ARDS- und ECMO-Zentrum Köln-Merheim, Kliniken der Stadt Köln, Krankenhaus Merheim, Universität Witten/Herdecke, Ostmerheimer Str. 200, 51109, Köln, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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70
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Cruz FF, Ball L, Rocco PRM, Pelosi P. Ventilator-induced lung injury during controlled ventilation in patients with acute respiratory distress syndrome: less is probably better. Expert Rev Respir Med 2018; 12:403-414. [PMID: 29575957 DOI: 10.1080/17476348.2018.1457954] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Mechanical ventilation is required to support respiratory function in the acute respiratory distress syndrome (ARDS), but it may promote lung damage, a phenomenon known as ventilator-induced lung injury (VILI). Areas covered: Several mechanisms of VILI have been described, such as: inspiratory and/or expiratory stress inducing overdistension (volutrauma); interfaces between collapsed or edema-filled alveoli with surrounding open alveoli, acting as stress raisers; alveoli that repetitively open and close during tidal breathing (atelectrauma); and peripheral airway dynamics. In this review, we discuss: the definition and classification of ARDS; ventilatory parameters that act as VILI determinants (tidal volume, respiratory rate, positive end-expiratory pressure, peak, plateau, driving and transpulmonary pressures, energy, mechanical power, and intensity); and the roles of prone positioning and muscle paralysis. We seek to provide an up-to-date overview of the evidence in the field from a clinical perspective. Expert commentary: To prevent VILI, mechanical ventilation strategies should minimize inspiratory/expiratory stress, dynamic/static strain, energy, mechanical power, and intensity, as well as mitigate the hemodynamic consequences of positive-pressure ventilation. In patients with moderate to severe ARDS, prone positioning can reduce lung damage and improve survival. Overall, volutrauma seems to be more harmful than atelectrauma. Extracorporeal support should be considered in selected cases.
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Affiliation(s)
- Fernanda Ferreira Cruz
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Lorenzo Ball
- b Department of Surgical Sciences and Integrated Diagnostics , Ospedale Policlinico San Martino, IRCCS for Oncology, University of Genoa , Genoa , Italy
| | - Patricia Rieken Macedo Rocco
- a Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics , Federal University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Paolo Pelosi
- b Department of Surgical Sciences and Integrated Diagnostics , Ospedale Policlinico San Martino, IRCCS for Oncology, University of Genoa , Genoa , Italy
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71
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Pappalardo F, Crivellari M. Predicting outcome of venovenous ECMO: look outside the lung! J Thorac Dis 2018; 10:1356-1360. [PMID: 29708154 DOI: 10.21037/jtd.2018.02.78] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Federico Pappalardo
- San Raffaele Scientific Institute, Vita-Salute University Milan, Milano, Italy
| | - Martina Crivellari
- San Raffaele Scientific Institute, Vita-Salute University Milan, Milano, Italy
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72
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Yeo HJ, Cho WH. A novel survival prediction model of ECMO in acute respiratory distress syndrome: things to consider for optimal use. J Thorac Dis 2018; 10:1149-1151. [PMID: 29708146 DOI: 10.21037/jtd.2018.03.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Hye Ju Yeo
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University, Yangsan Hospital, Yangsan, Republic of Korea
| | - Woo Hyun Cho
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University, Yangsan Hospital, Yangsan, Republic of Korea
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73
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Granholm A, Perner A, Jensen AKG, Møller MH. Trustworthy or flawed clinical prediction rule? Crit Care 2018; 22:31. [PMID: 29415758 PMCID: PMC5804002 DOI: 10.1186/s13054-018-1961-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/18/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Anders Granholm
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Anders Perner
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Centre for Research in Intensive Care, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Aksel Karl Georg Jensen
- Centre for Research in Intensive Care, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Centre for Research in Intensive Care, Blegdamsvej 9, 2100 Copenhagen, Denmark
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