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Guo DW, Gao J, Wu HL, Wu C, Wu JX, Rui Q, Bao Y, Liu ZH, Wang XY, Xu LD, Hu X, Zhang J. Extracorporeal membrane oxygenation combined with minimally invasive surgery for acute respiratory failure and sudden cardiac arrest: A case report. Exp Ther Med 2023; 25:250. [PMID: 37153891 PMCID: PMC10160917 DOI: 10.3892/etm.2023.11949] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/14/2023] [Indexed: 05/10/2023] Open
Abstract
Acute respiratory failure and sudden cardiac arrest caused by acute intrathoracic infection is a fatal clinical condition with a low resuscitation success rate. The present study describes the case of a patient with acute empyema secondary to an acute lung abscess rupture, complicated by acute respiratory failure and sudden cardiac arrest caused by severe hypoxemia. The patient recovered well through the administration of multiple therapeutic measures, including medication and closed chest drainage, cardiopulmonary resuscitation, extracorporeal membrane oxygenation combined with continuous renal replacement therapy, and minimally invasive surgical resection of the lung lesion with persistent alveolar fistula as the clinical manifestation. To the best of our knowledge, the treatment of such a severe condition combined with thoracoscopic surgery has rarely been reported before, and the present study may provide insight regarding therapeutic schedules for acute respiratory failure by intrathoracic infection, and excision of ruptured lung abscess.
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Affiliation(s)
- Da-Wei Guo
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Jun Gao
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Heng-Lan Wu
- Department of Nephrology, The First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Cheng Wu
- Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Jian-Xiang Wu
- Department of Emergency, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Qiang Rui
- Department of Emergency, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Yi Bao
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Zhong-Hua Liu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Xi-Yong Wang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Li-Dong Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Xun Hu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
| | - Jun Zhang
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, P.R. China
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Lin WJ, Chang YL, Weng LC, Tsai FC, Huang HC, Yeh SL, Chen KH. Post-Discharge Depression Status for Survivors of Extracorporeal Membrane Oxygenation (ECMO): Comparison of Veno-Venous ECMO and Veno-Arterial ECMO. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063333. [PMID: 35329031 PMCID: PMC8954682 DOI: 10.3390/ijerph19063333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/16/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is one of the common invasive treatments for the care of critically ill patients with heart failure, respiratory failure, or both. There are two modes of ECMO, namely, veno-venous (VV) and veno-arterial (VA), which have different indications, survival rates, and incidences of complications. This study’s aim was to examine whether depression status differed between patients who had received VV-ECMO or VA-ECMO and had been discharged from the hospital. This was a descriptive, cross-sectional, and correlational study of patients who had been discharged from the hospital at least one month after receiving ECMO at a medical center in northern Taiwan from June 2006 to June 2020 (N = 142). Participants were recruited via convenience and quota sampling. Data were collected in the cardiovascular outpatient department between October 2015–October 2016 (n = 52) and September 2019–August 2020 (n = 90). Participants completed the Hospital Anxiety and Depression Scale–Depression (HADS-D) as a measure of depression status. Post-discharge depression scores for patients who received VV-ECMO (n = 67) was significantly higher (p = 0.018) compared with participants who received VA-ECMO (n = 75). In addition, the mode of ECMO was a predictor of post-discharge depression (p = 0.008) for participants who received VV-ECMO. This study concluded that patients who received VV-ECMO may require greater mental health support. Healthcare professionals should establish a psychological clinical care pathway evaluated by multiple healthcare professionals.
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Affiliation(s)
- Wan-Jung Lin
- Department of Nursing, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
| | - Yu-Ling Chang
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan
| | - Feng-Chun Tsai
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
- College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan
| | - Huei-Chiun Huang
- Department of Cardiovascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City 333, Taiwan; (F.-C.T.); (H.-C.H.)
| | - Shu-Ling Yeh
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City 333, Taiwan
| | - Kang-Hua Chen
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan; (Y.-L.C.); (L.-C.W.)
- Department of Nursing, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City 333, Taiwan;
- Correspondence: ; Tel.: +886-3-211-8800 (ext. 5211)
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Choi E, Kim D, Kim J. Supraglottic airway device and venoarterial extracorporeal membrane oxygenation support for curative surgery in a patient with huge thyroid mass: A case report. Saudi J Anaesth 2022; 16:226-228. [PMID: 35431743 PMCID: PMC9009562 DOI: 10.4103/sja.sja_638_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/30/2022] Open
Abstract
In the case of complete surgical resection of locally aggressive thyroid mass with severely compromised airways, airway management is difficult and can be considerably risky. We report a case of airway management using i-gel™ and cardiopulmonary bypass (CPB) with venoarterial extracorporeal membrane oxygenation (ECMO), which is a safe and feasible method of airway management for providing general anesthesia in a patient with a large thyroid mass.
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Jaber B, Bembea MM, Loftis LL, Spinella PC, Zhang L, Simpson PM, Hanson SJ. Venovenous Versus Venoarterial Extracorporeal Membranous Oxygenation in Inotrope Dependent Pediatric Patients With Respiratory Failure. ASAIO J 2021; 67:457-462. [PMID: 33770001 DOI: 10.1097/mat.0000000000001254] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Patients with respiratory failure requiring inotropes or vasopressors are often placed on venoarterial (VA) extracorporeal membrane oxygenation (ECMO), as venovenous (VV) ECMO does not provide direct circulatory support. This retrospective multicenter study compared outcomes for 103 pediatric patients, with hemodynamic compromise, placed on VV ECMO for respiratory failure to those placed on VA ECMO. The primary outcome was survival to hospital discharge. Fifty-seven (55%) study participants were supported on VV ECMO. The two groups had similar PRISM III scores at pediatric intensive care unit (PICU) admission, and vasoactive-inotropic scores at ECMO cannulation. More VV ECMO patients received inhaled nitric oxide (iNO) (54.4 vs. 34.8%; p = 0.04) and had a higher oxygenation index (median 41.5 vs. 19.5; p = 0.04) pre-ECMO. More VA ECMO patients had cardiac dysfunction and cardiac arrest pre-ECMO (50 vs. 14%; p < 0.0001). In univariable analysis, survival to hospital discharge was higher in the VV vs. VA ECMO group (72 vs. 44%; p = 0.005), however, in multivariable models, cannulation type was confounded by cardiopulmonary resuscitation and was not independently associated with survival. VV survivors had longer ECMO duration compared with VA survivors (median, 7 vs. 4.5 days; p = 0.036) but similar PICU and hospital days. No significant difference was noted in functional outcomes or comorbidities at discharge. Cannulation type is not independently associated with survival to hospital discharge in pediatric patients on vasoactive infusions at the time of ECMO cannulation for respiratory indications.
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Affiliation(s)
- Besma Jaber
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Melania M Bembea
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura L Loftis
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care, Washington University in St Louis, St Louis, MO
| | - Liyun Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Pippa M Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Sheila J Hanson
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
- Department of Pediatric Critical Care, Children's Hospital of Wisconsin, Milwaukee, WI
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Mariscalco G, Salsano A, Fiore A, Dalén M, Ruggieri VG, Saeed D, Jónsson K, Gatti G, Zipfel S, Dell'Aquila AM, Perrotti A, Loforte A, Livi U, Pol M, Spadaccio C, Pettinari M, Ragnarsson S, Alkhamees K, El-Dean Z, Bounader K, Biancari F, Dashey S, Yusuff H, Porter R, Sampson C, Harvey C, Settembre N, Fux T, Amr G, Lichtenberg A, Jeppsson A, Gabrielli M, Reichart D, Welp H, Chocron S, Fiorentino M, Lechiancole A, Netuka I, De Keyzer D, Strauven M, Pälve K. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg 2020; 160:1207-1216.e44. [DOI: 10.1016/j.jtcvs.2019.10.078] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022]
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6
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Implantationstechniken für temporäre ECLS-Systeme. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2020. [DOI: 10.1007/s00398-020-00384-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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Bhardwaj A, Miano T, Geller B, Milewski RC, Williams M, Bermudez C, Vallabhajosyula P, Patel P, Mackay E, Vernick W, Lane-Fall M, Raiten J, McDonald M, Haddle J, Gutsche J. Venovenous Extracorporeal Membrane Oxygenation for Patients With Return of Spontaneous Circulation After Cardiac Arrest Owing to Acute Respiratory Distress Syndrome. J Cardiothorac Vasc Anesth 2019; 33:2216-2220. [PMID: 31182376 DOI: 10.1053/j.jvca.2019.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 04/17/2019] [Accepted: 04/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine the survival to hospital discharge of patients who were treated with venovenous (VV) extracorporeal membrane oxygenation (ECMO) for respiratory failure after cardiac arrest. DESIGN Retrospective chart review. SETTING University-affiliated tertiary care hospitals. PARTICIPANTS The study comprised 21 patients. INTERVENTIONS Implementation of VV ECMO in patients with return of spontaneous circulation after cardiac arrest owing to respiratory insufficiency. MEASUREMENTS AND MAIN RESULTS The most common etiology of arrest was pneumonia-associated acute respiratory distress syndrome (8/21 [38%]). Overall, 12/21(57%) patients survived to hospital discharge. Two of 12 (17%) patients required hemodialysis upon discharge. CONCLUSION VV ECMO may be an appropriate alternative to venoarterial ECMO in select patients with return of spontaneous circulation after cardiac arrest owing to profound respiratory failure.
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Affiliation(s)
- Abhishek Bhardwaj
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Todd Miano
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bram Geller
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, PA
| | - Rita C Milewski
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Matthew Williams
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Christian Bermudez
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Prashant Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Prakash Patel
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Emily Mackay
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - William Vernick
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Jesse Raiten
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - Michael McDonald
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
| | - John Haddle
- University of Pennsylvania Health System, Philadelphia, PA
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care, University of Pennsylvania Health System, Philadelphia, PA.
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8
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Kim JH, Kim JY, Park S. Successful case of veno-venous extracorporeal membrane oxygenation in an abdominal trauma patient - A case report -. Anesth Pain Med (Seoul) 2019. [DOI: 10.17085/apm.2019.14.1.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jun Hyun Kim
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Ji Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sunghyeok Park
- Department of Anesthesiology and Pain Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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9
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Tu Y, Jin Q, Sun R, Li Q. Extracorporeal membrane oxygenation support for a multitrauma patient with ARDS: A case report and literature review. Exp Ther Med 2017; 15:2062-2065. [PMID: 29434806 DOI: 10.3892/etm.2017.5604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/06/2017] [Indexed: 11/05/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) provides rescue treatment for patients with severe acute respiratory distress syndrome (ARDS) when conventional management fails. The present study reported ECMO as a life-saving treatment for ARDS due to bilateral pulmonary contusion in a 24-year-old male multiple trauma patient. ECMO therapy lasted 7 days for the patient and was successively stopped without any complications. ECMO modality should be chosen according to the respiratory and circulatory condition of each individual. Venoarteria-ECMO may be chosen for multiple trauma patients with ARDS, and respiratory and circulatory failure. Morphological changes are observed with ARDS progression. The injured lungs may recover completely with effective ECMO therapy.
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Affiliation(s)
- Yuexing Tu
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Qi Jin
- Department of Critical Care Medicine, Zhejiang Provincial Tiantai County People's Hospital, Taizhou, Zhejiang 317200, P.R. China
| | - Renhua Sun
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Qian Li
- Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
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Romano TG, Mendes PV, Park M, Costa ELV. Extracorporeal respiratory support in adult patients. J Bras Pneumol 2017; 43:60-70. [PMID: 28380189 PMCID: PMC5790677 DOI: 10.1590/s1806-37562016000000299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/05/2017] [Indexed: 01/19/2023] Open
Abstract
In patients with severe respiratory failure, either hypoxemic or hypercapnic, life support with mechanical ventilation alone can be insufficient to meet their needs, especially if one tries to avoid ventilator settings that can cause injury to the lungs. In those patients, extracorporeal membrane oxygenation (ECMO), which is also very effective in removing carbon dioxide from the blood, can provide life support, allowing the application of protective lung ventilation. In this review article, we aim to explore some of the most relevant aspects of using ECMO for respiratory support. We discuss the history of respiratory support using ECMO in adults, as well as the clinical evidence; costs; indications; installation of the equipment; ventilator settings; daily care of the patient and the system; common troubleshooting; weaning; and discontinuation.
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Affiliation(s)
- Thiago Gomes Romano
- . Disciplina de Nefrologia, Faculdade de Medicina do ABC, Santo André (SP) Brasil.,. Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Pedro Vitale Mendes
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital Sírio-Libanês, São Paulo (SP) Brasil
| | - Marcelo Park
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Eduardo Leite Vieira Costa
- . Hospital Sírio-Libanês, São Paulo (SP) Brasil.,. UTI Respiratória, Divisão de Pneumologia, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Kon ZN, Bittle GJ, Pasrija C, Pham SM, Mazzeffi MA, Herr DL, Sanchez PG, Griffith BP. Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation for Adult Patients With Acute Respiratory Distress Syndrome Requiring Precannulation Hemodynamic Support: A Review of the ELSO Registry. Ann Thorac Surg 2017; 104:645-649. [DOI: 10.1016/j.athoracsur.2016.11.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/28/2016] [Accepted: 11/07/2016] [Indexed: 12/12/2022]
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Sorokin V, MacLaren G, Vidanapathirana PC, Delnoij T, Lorusso R. Choosing the appropriate configuration and cannulation strategies for extracorporeal membrane oxygenation: the potential dynamic process of organ support and importance of hybrid modes. Eur J Heart Fail 2017; 19 Suppl 2:75-83. [DOI: 10.1002/ejhf.849] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Vitaly Sorokin
- Department of Surgery, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
- Department of Cardiac, Thoracic and Vascular Surgery; National University Heart Center; Singapore
| | - Graeme MacLaren
- Department of Surgery, Yong Loo Lin School of Medicine; National University of Singapore; Singapore
- Department of Cardiac, Thoracic and Vascular Surgery; National University Heart Center; Singapore
- Pediatric Intensive Care Unit, Department of Pediatrics; The Royal Children's Hospital; University of Melbourne Australia
| | | | - Thijs Delnoij
- Department of Cardiology; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Intensive Care Unit; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department; Maastricht University Medical Centre; Maastricht The Netherlands
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Gehrmann LP, Hafner JW, Montgomery DL, Buckley KW, Fortuna RS. Pediatric Extracorporeal Membrane Oxygenation: An Introduction for Emergency Medicine Physicians. J Emerg Med 2015; 49:552-60. [PMID: 25980372 DOI: 10.1016/j.jemermed.2015.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/19/2014] [Accepted: 02/17/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) therapy has supported critically ill pediatric patients in the intensive care unit setting with cardiac and respiratory failure. This therapy is beginning to transition to the emergency department setting. OBJECTIVE OF REVIEW This article describes the fundamentals of ECMO and familiarizes the emergency medicine physician with its use in critically ill pediatric patients. DISCUSSION ECMO can be utilized as either venoarterial (VA) or venovenous (VV), to support oxygenation and perfusion in respiratory failure, sepsis, cardiac arrest, and environmental hypothermia.
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Affiliation(s)
- Lynn P Gehrmann
- Department of Emergency Medicine, Ministry Medical Group Saint Mary's Hospital, Rhinelander, Wisconsin
| | - John W Hafner
- Department of Emergency Medicine, University of Illinois College of Medicine at Peoria, Peoria, Illinois; Department of Emergency Medicine, Children's Hospital of Illinois at OSF Saint Francis Medical Center, Peoria, Illinois
| | - Daniel L Montgomery
- Emergency Medicine Residency Program, University of Illinois College of Medicine at Peoria, Peoria, Illinois
| | - Klayton W Buckley
- Department of Perfusion, Children's Hospital of Illinois at OSF Saint Francis Medical Center, Peoria, Illinois
| | - Randall S Fortuna
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, Illinois; Extracorporeal Life Support (ECMO) Services, Congenital Heart Center, Children's Hospital of Illinois at OSF Saint Francis Medical Center, Peoria, Illinois; Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois
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14
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Venovenous extracorporeal membrane oxygenation is effective against post-cardiotomy acute respiratory failure in adults. Gen Thorac Cardiovasc Surg 2013; 61:402-8. [PMID: 23436039 DOI: 10.1007/s11748-013-0226-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 02/12/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Acute respiratory failure is a serious issue that occasionally occurs after weaning from cardiopulmonary bypass (CPB) after heart surgery. This condition can be refractory to mechanical ventilation and the mortality rate is high. Venovenous extracorporeal membrane oxygenation (VV-ECMO) is applied to treat acute lung failure after CPB at our institution. This report describes the use of VV-ECMO after cardiac surgery at a single institution. METHODS We analyzed the outcomes of 11 patients who developed severe acute respiratory failure requiring VV-ECMO after undergoing heart surgery with a cardiopulmonary bypass. RESULTS Four (36.4%) patients died in hospital. One patient required conversion from VV- to venoarterial (VA-) ECMO because of circulatory instability. One patient each died of respiratory failure and heart failure and two died of ischemic colitis. Lung damage secondarily developed in these four patients to other disabled organs. Seven (63.6%) patients whose lungs were primarily disabled were weaned from VV-ECMO upon recovery from respiratory failure and were ambulatory at the time of discharge from hospital. The ratio of PaO2/FIO2 (P/F) at 24 h after starting VV-ECMO did not significantly differ between survivors and non-survivors (187.9 ± 57.7 vs. 135.5 ± 20.5, p = 0.10), but tended to be higher in survivors. Non-survivors were significantly older than survivors. CONCLUSION Patients who develop severe acute respiratory failure after undergoing heart surgery using cardiopulmonary bypass derive a survival benefit from VV-ECMO.
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15
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Ma DS, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Outcomes of venovenous extracorporeal membrane oxygenation support for acute respiratory distress syndrome in adults. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:91-4. [PMID: 22500278 PMCID: PMC3322191 DOI: 10.5090/kjtcs.2012.45.2.91] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/30/2011] [Indexed: 01/11/2023]
Abstract
Background Despite improved managements for acute respiratory distress syndrome (ARDS), its mortality remains high. Extracorporeal membrane oxygenation (ECMO) has emerged as the final option for the treatment of ARDS unresponsive to conventional measures. This study describes our experiences of venovenous ECMO support for the treatment of ARDS. Materials and Methods Between 2007 and 2010, 56 patients (aged 56.6±13.4 years, 43 males) received venovenous ECMO for the treatment of ARDS. The detailed clinical records were retrospectively reviewed. Results Before the institution of ECMO support, 35 patients (55.4%) required nitric oxide inhalation, 35 patients (55.4%) received continuous renal replacement therapy, and 20 patients (35.7%) were in shock status. The median duration of ECMO support was 164 hours (range, 5 to 1,413 hours). 27 (48%) patients could be successfully weaned from ECMO. Of them, 7 (13%) survived to discharge. On logistic regression analysis, a requirement for higher inspiratory pressure before ECMO support was the only significant factor that could predict ECMO weaning failure. Conclusion The outcome of venovenous ECMO support for the treatment of ARDS was suboptimal. Further improvements in outcomes should be made through the accumulation of experience and establishment of a standardized protocol for the management of ECMO.
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Affiliation(s)
- Dae Sung Ma
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea
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Kaushik M, Wojewodzka-Zelezniakowicz M, Cruz DN, Ferrer-Nadal A, Teixeira C, Iglesias E, Kim JC, Braschi A, Piccinni P, Ronco C. Extracorporeal Carbon Dioxide Removal: The Future of Lung Support Lies in the History. Blood Purif 2012; 34:94-106. [DOI: 10.1159/000341904] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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