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Glazier HA, Kaki A. Role of Extracorporeal Membrane Oxygenation in the Treatment of Massive Pulmonary Embolism. Int J Angiol 2024; 33:107-111. [PMID: 38846997 PMCID: PMC11152616 DOI: 10.1055/s-0044-1782658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Massive/high-risk pulmonary embolism (PE) is associated with a 30-day mortality rate of approximately 65%. In searching for strategies that may make a dent on this dismal mortality rate, investigators have, over the last decade, shown renewed interest in the potential beneficial role of venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) in the treatment of patients with high-risk PE. There is a dearth of high-quality evidence regarding the value of ECMO in the treatment of massive PE. Studies examining this issue have generally been retrospective, often single center and frequently with small patient numbers. Moreover, these reported studies are not matched with appropriate controls, and, accordingly, it is difficult to regulate for inherent treatment bias. Not surprisingly, there are no randomized controlled trials examining the value of ECMO in the treatment of massive PE, as such trials would pose formidable feasibility challenges. Over the past several years, there has been increasing support for upfront use of V-A ECMO in the treatment of massive PE, when it is complicated by cardiac arrest. In those patients without cardiac arrest, but who have contraindications for thrombolysis, V-A ECMO combined with anticoagulation may be used to stabilize the patient. If after 3 to 5 days, such patients demonstrate persistent right ventricular dysfunction, embolectomy (either surgical or catheter based) should be performed. Well-designed, multicenter, prospective studies are urgently needed to better define the role of V-A ECMO in the treatment of patients with massive PE.
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Affiliation(s)
- Hugh A. Glazier
- Department of Surgery, University Hospital Galway, Galway, Ireland
| | - Amir Kaki
- Division of Cardiology, St. John University Hospital, Detroit, Michigan
- Department of Medicine, Wayne State University, Detroit, Michigan
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2
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Bartlett RH. The Story of ECMO. Anesthesiology 2024; 140:578-584. [PMID: 38349754 DOI: 10.1097/aln.0000000000004843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Extracorporeal Circulation in Neonatal Respiratory Failure: A Prospective Randomized Study. By RH Bartlett, DW Roloff, RG Cornell, AF Andrews, PW Dillon, JB Zwischenberger. Pediatrics 1985; 76:479-87. Extracorporeal membrane oxygenation (ECMO) is the use of mechanical devices to replace cardiac and pulmonary function in critical care. In the 1960s, laboratory research showed that extracorporeal circulation could be maintained for days using a membrane oxygenator. In the 1970s, the first clinical trials showed that ECMO could sustain life in severe cardiac and pulmonary failure for days or weeks, leading to organ recovery. From 1980 to 2000, ECMO became standard practice for neonatal and pediatric respiratory and cardiac failure. The critical clinical trial was a prospective randomized trial of ECMO in newborn respiratory failure, published in 1985. This is the classic article reviewed in this publication. This was the first use of a randomized, adaptive design trial to minimize the potential ethical dilemma inherent to clinical trials in which the endpoint is death. Other randomized trials followed, and ECMO is now standard practice for severe respiratory and cardiac failure in all age groups.
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3
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Aboul-Nour H, Jumah A, Abdulla H, Sharma A, Howell B, Jayaprakash N, Gardner-Gray J. Neurological monitoring in ECMO patients: current state of practice, challenges and lessons. Acta Neurol Belg 2023; 123:341-350. [PMID: 36701079 PMCID: PMC9878494 DOI: 10.1007/s13760-023-02193-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) in critically ill patients serves as a management option for end-stage cardiorespiratory failure in medical and surgical conditions. Patients on ECMO are at a high risk of neurologic adverse events including intracranial hemorrhage (ICH), acute ischemic stroke (AIS), seizures, diffuse cerebral edema, and hypoxic brain injury. Standard approaches to neurological monitoring for patients receiving ECMO support can be challenging for multiple reasons, including the severity of critical illness, deep sedation, and/or paralysis. This narrative literature review provides an overview of the current landscape for neurological monitoring in this population. METHODS A literature search using PubMed was used to aid the understanding of the landscape of published literature in the area of neurological monitoring in ECMO patients. RESULTS Review articles, cohort studies, case series, and individual reports were identified. A total of 73 varied manuscripts were summarized and included in this review which presents the challenges and strategies for performing neurological monitoring in this population. CONCLUSION Neurological monitoring in ECMO is an area of interest to many clinicians, however, the literature is limited, heterogenous, and lacks consensus on the best monitoring practices. The evidence for optimal neurological monitoring that could impact clinical decisions and functional outcomes is lacking. Additional studies are needed to identify effective measures of neurological monitoring while on ECMO.
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Affiliation(s)
- Hassan Aboul-Nour
- grid.189967.80000 0001 0941 6502Department of Neurology, Emory University, Atlanta, GA USA ,grid.413103.40000 0001 2160 8953Department of Neurology, Henry Ford Hospital, Detroit, MI USA
| | - Ammar Jumah
- grid.413103.40000 0001 2160 8953Department of Neurology, Henry Ford Hospital, Detroit, MI USA
| | - Hafsa Abdulla
- grid.413103.40000 0001 2160 8953Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI USA
| | - Amreeta Sharma
- grid.413103.40000 0001 2160 8953Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI USA
| | - Bradley Howell
- grid.413103.40000 0001 2160 8953Department of Neurology, Henry Ford Hospital, Detroit, MI USA
| | - Namita Jayaprakash
- grid.413103.40000 0001 2160 8953Department of Emergency Medicine, Critical Care Medicine, Henry Ford Hospital, Detroit, MI USA
| | - Jayna Gardner-Gray
- grid.413103.40000 0001 2160 8953Division of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI USA ,grid.413103.40000 0001 2160 8953Department of Emergency Medicine, Critical Care Medicine, Henry Ford Hospital, Detroit, MI USA
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4
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Griffith BP, Wu ZJ, Zhang J. Pasta for all: Abiomed Breethe extracorporeal membrane oxygenation system. JTCVS OPEN 2021; 8:108-113. [PMID: 36004106 PMCID: PMC9390355 DOI: 10.1016/j.xjon.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Bartley P. Griffith
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Md
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
- Address for reprints: Bartley P. Griffith, MD, FACS, FRCS, Division of Cardiac Surgery, University of Maryland School of Medicine, 110 S Paca St, 7th Floor, Baltimore, MD 21201.
| | - Zhongjun Jon Wu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
| | - Jiafeng Zhang
- Department of Surgery, University of Maryland School of Medicine, Baltimore, Md
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5
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Rabie AA, Asiri A, Rajab M, Mufti HN, Alsherbiny M, Azzam MH, Abdelbary A, Zakhary B, Arabi Y, Alharthy A, Futaih M, Sobhy M, Alenazi I, Bafaqeeh F. Beyond Frontiers: Feasibility and Outcomes of Prolonged Veno-Venous Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome. ASAIO J 2021; 67:339-344. [PMID: 33627610 DOI: 10.1097/mat.0000000000001367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) use in acute respiratory failure is increasing. We aim to compare characteristics and outcomes of patients with prolonged (≥21 days) veno-venous (VV) ECMO runs (pECMO), to patients with short (<21 days) VV ECMO runs (sECMO). The observational retrospective single-center study compared patients who received VV ECMO from January 2018 to June 2019 at Prince Mohamed Bin Abdulaziz Center in Riyadh, Saudi Arabia. Forty-three patients were supported with VV ECMO during the study period, of whom 37 are included as six patients were still receiving ECMO at time of data collection: 24 sECMO and 13 pECMO patients. Baseline characteristics and comorbidities were similar except pECMO patients were older and had a lower P/F ratio (61 [58-68] vs. 71[58-85.5], p = 0.05). Survival to hospital discharge (69% vs. 83%, p = 0.32; pECMO vs. sECMO) and 90 day survival (62% vs. 75%, p = 0.413; pECMO vs. sECMO) were similar among groups. At 1 year follow-up, all patients were still alive and independently functioning except for one patient in the pECMO group who required a walking aid related to trauma. In this single-center study, patients requiring pECMO had similar short- and long-term survival to those requiring sECMO duration.
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Affiliation(s)
- Ahmed A Rabie
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ayed Asiri
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
| | - Mostafa Rajab
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
| | - Hani N Mufti
- Cardiac Surgery Department, King Faisal Cardiac Center, King Saud Bin Abdulaziz University for Health Sciences, MNGHA Jeddah, Saudi Arabia
| | - Medhat Alsherbiny
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
| | - Mohamed H Azzam
- Critical Care Department, King Abdullah Medical Complex, Ministry of Health, Jeddah, Saudi Arabia
| | | | - Bishoy Zakhary
- Division of Pulmonary and Critical Care, Oregon Health and Science University, Portland, Oregon
| | - Yaseen Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Mohamed Futaih
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
| | - Mohamed Sobhy
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
| | - Ismael Alenazi
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
| | - Fahad Bafaqeeh
- From the Critical Care Department, Prince Mohamed Bin Abdelaziz Hospital, Riyadh, Saudi Arabia
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6
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Redwan B, Freermann C, Akil A, Fischer S. [Extracorporeal Lung Support in Thoracic Surgery: Basics and Pathophysiology]. Pneumologie 2021; 75:60-66. [PMID: 33461235 DOI: 10.1055/a-1172-7202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Extracorporeal lung support (ECLS) is of increasing importance in general thoracic surgery. Different modes of ECLS may be applied in several situations throughout the perioperative phase and are adapted to the individual patient's needs and the planned surgical procedures. ECLS is not a static procedure and should be always evaluated according to the present condition of the patient. Therefore, it is essential to understand the pathophysiology of the disease and the different ECLS modes, as well as the different cannulation options, in order to be able to use the different escalation and de-escalation techniques in accordance with the clinical situation.
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Affiliation(s)
- B Redwan
- Sektion für Thoraxchirurgie, Universitätsklinik Münster, Deutschland
| | - C Freermann
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
| | - A Akil
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
| | - S Fischer
- Klinik für Thoraxchirurgie und Lungenunterstützung, Klinikum Ibbenbüren, Deutschland
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7
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Bautista-Rodriguez C, Sanchez-de-Toledo J, Da Cruz EM. The Role of Echocardiography in Neonates and Pediatric Patients on Extracorporeal Membrane Oxygenation. Front Pediatr 2018; 6:297. [PMID: 30416991 PMCID: PMC6212474 DOI: 10.3389/fped.2018.00297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
Indications for extracorporeal membrane oxygenation (ECMO) and extracorporeal cardiopulmonary resuscitation (ECPR) are expanding, and echocardiography is a tool of utmost importance to assess safety, effectiveness and readiness for circuit initiation and separation. Echocardiography is key to anticipating complications and improving outcomes. Understanding the patient's as well as the ECMO circuit's anatomy and physiology is crucial prior to any ECMO echocardiographic evaluation. It is also vital to acknowledge that the utility of echocardiography in ECMO patients is not limited to the evaluation of cardiac function, and that clinical decisions should not be made exclusively upon echocardiographic findings. Though echocardiography has specific indications and applications, it also has limitations, characterized as: prior to and during cannulation, throughout the ECMO run, upon separation and after separation from the circuit. The use of specific and consistent echocardiographic protocols for patients on ECMO is recommended.
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Affiliation(s)
- Carles Bautista-Rodriguez
- Pediatric Cardiology Department, Hospital Sant Joan de Deu Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Joan Sanchez-de-Toledo
- Pediatric Cardiology Department, Hospital Sant Joan de Deu Barcelona, Universitat de Barcelona, Barcelona, Spain
- Division of Cardiac Intensive Care, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Eduardo M. Da Cruz
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, School of Medicine, University of Colorado Denver, Aurora, CO, United States
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8
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Morales-Quinteros L, Artigas A. Extracorporeal membrane oxygenation in acute respiratory distress syndrome: does it really help? J Thorac Dis 2018; 10:S3166-S3168. [PMID: 30370105 DOI: 10.21037/jtd.2018.07.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Luis Morales-Quinteros
- Intensive Care Unit, Hospital Universitario Sagrado Corazón, Barcelona, Spain.,Intensive Care Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.,Critical Care Centre-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain
| | - Antonio Artigas
- Intensive Care Unit, Hospital Universitario Sagrado Corazón, Barcelona, Spain.,Critical Care Centre-Corporació Sanitària i Universitària Parc Taulí, Sabadell, Spain.,Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
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9
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Keebler ME, Haddad EV, Choi CW, McGrane S, Zalawadiya S, Schlendorf KH, Brinkley DM, Danter MR, Wigger M, Menachem JN, Shah A, Lindenfeld J. Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock. JACC-HEART FAILURE 2018; 6:503-516. [PMID: 29655828 DOI: 10.1016/j.jchf.2017.11.017] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/13/2017] [Accepted: 11/13/2017] [Indexed: 01/19/2023]
Abstract
Venoarterial extracorporeal membrane oxygenation has emerged as a viable treatment for patients in cardiogenic shock with biventricular failure and pulmonary dysfunction. Advances in pump and oxygenator technology, cannulation strategies, patient selection and management, and durable mechanical circulatory support have contributed to expanded utilization of this technology. However, challenges remain that require investigation to improve outcomes.
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Affiliation(s)
- Mary E Keebler
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Elias V Haddad
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chun W Choi
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stuart McGrane
- Division of Anesthesiology Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sandip Zalawadiya
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kelly H Schlendorf
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - D Marshall Brinkley
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew R Danter
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Wigger
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan N Menachem
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ashish Shah
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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[Extracorporeal life support and heart-lung transplant in children]. Presse Med 2018; 47:611-619. [PMID: 29580908 DOI: 10.1016/j.lpm.2018.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/17/2018] [Indexed: 11/22/2022] Open
Abstract
Extracorporeal life support and heart and/or lung transplant are the last resort in children with end-stage cardiac and/or pulmonary failure and short-term life threaten. Currently, circulatory support is used as a bridge to recovery or as a bridge to transplant but not as a destination therapy. The Excor Berlin Heart is the long-lasting external pneumatic ventricular assist system that is currently available from infancy to adulthood. Long-term prognosis after pediatric cardiac and/or pulmonary transplant is conditioned by the occurrence of graft failure, coronary disease of the cardiac graft, viral infections and bronchiolitis obliterans of the pulmonary graft, the incidence of which increase with time. The scarcity of grafts and the risk of acute rejection due to lack of compliance with immunosuppressive treatment require the transplant specialized teams to choose the best candidates according to psychosocial and biological criteria. The next expected developments concern mainly long-term ventricular assistance with systems that allow for greater autonomy and a return to the child's home.
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11
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Harris DD, Saha SP. Extracorporeal membrane oxygenation as a rescue measure after thoracic surgery. Asian Cardiovasc Thorac Ann 2018; 26:203-206. [DOI: 10.1177/0218492318760694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Extracorporeal membrane oxygenation is used for many different conditions including respiratory distress, cardiogenic shock, and trauma. In these patient groups, extracorporeal membrane oxygenation has been extensively studied. Recently, it has been used as a rescue measure in patients experiencing acute respiratory distress after thoracic surgery. The goal of our study was to examine the efficacy and cost-effectiveness of extracorporeal membrane oxygenation as a rescue measure after thoracic surgery at a single center. Methods We conducted a retrospective review of all patients who received extracorporeal membrane oxygenation after thoracic surgery at the University of Kentucky from January 9, 2012 to January 9, 2017. Eight patients were identified. Results The average time on extracorporeal membrane oxygenation was 9.125 days, and the average hospital stay was 65.125 days. Of the 8 patients placed on extracorporeal membrane oxygenation, 3 survived to discharge. Of the 3 patients who survived to discharge, 1 died within 6 months and 2 have been followed up for less than 4 months. The average total charge per patient was calculated to be $1,053,551, and the average charge per day was $16,177. The contribution margin was $109,200 per case. Conclusions Extracorporeal membrane oxygenation is a tool that saves lives in many different patient populations but it does not appear to be as effective in patients experiencing acute respiratory distress syndrome after thoracic surgery. Extracorporeal membrane oxygenation in this group also uses a tremendous amount of hospital resources.
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Affiliation(s)
- Dwight D Harris
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Sibu P Saha
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky, USA
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12
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Corno AF, Karamlou T. Editorial: Extra-Corporeal Membrane Oxygenation in Pediatric Cardiac Patients. Front Pediatr 2018; 6:204. [PMID: 30105222 PMCID: PMC6077222 DOI: 10.3389/fped.2018.00204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/28/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio F Corno
- Cardiovascular Research Center, University of Leicester, Leicester, United Kingdom.,East Midlands Congenital Heart Center, University Hospitals Leicester, Leicester, United Kingdom
| | - Tara Karamlou
- Mayo Clinic and Phoenix Children's Hospital, Phoenix, AZ, United States.,Phoenix Children's Hospital, Phoenix, AZ, United States
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13
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Affiliation(s)
- Robert Bartlett
- University of Michigan Health Systems, B560B MSRB II, SPC 5686, 1150 West Medical Center Drive, Ann Arbor, MI 4819-5686, USA
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14
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Kabrhel C, Rosovsky R, Channick R, Jaff MR, Weinberg I, Sundt T, Dudzinski DM, Rodriguez-Lopez J, Parry BA, Harshbarger S, Chang Y, Rosenfield K. A Multidisciplinary Pulmonary Embolism Response Team. Chest 2016; 150:384-93. [DOI: 10.1016/j.chest.2016.03.011] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 02/05/2016] [Accepted: 03/01/2016] [Indexed: 11/28/2022] Open
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15
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Early Experience with a Novel Cannulation Strategy for Left Ventricular Decompression during Nonpostcardiotomy Venoarterial ECMO. ASAIO J 2016; 62:e30-4. [DOI: 10.1097/mat.0000000000000333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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16
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Burke CR, McMullan DM. Extracorporeal Life Support for Pediatric Heart Failure. Front Pediatr 2016; 4:115. [PMID: 27812522 PMCID: PMC5071357 DOI: 10.3389/fped.2016.00115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/05/2016] [Indexed: 11/15/2022] Open
Abstract
Extracorporeal life support (ECLS) represents an essential component in the treatment of the pediatric patient with refractory heart failure. Defined as the use of an extracorporeal system to provide cardiopulmonary support, ECLS provides hemodynamic support to facilitate end-organ recovery and can be used as a salvage therapy during acute cardiorespiratory failure. Support strategies employed in pediatric cardiac patients include bridge to recovery, bridge to therapy, and bridge to transplant. Advances in extracorporeal technology and refinements in patient selection have allowed wider application of this therapy in pediatric heart failure patients.
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Affiliation(s)
- Christopher R Burke
- Division of Cardiac Surgery, Seattle Children's Hospital , Seattle, WA , USA
| | - D Michael McMullan
- Division of Cardiac Surgery, Seattle Children's Hospital , Seattle, WA , USA
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17
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Abstract
Cardiopulmonary bypass (CPB) is indispensable for cardiac surgery but leads to systemic inflammatory responses and leukocyte activation, possibly due to blood contact with the surface of the CPB unit, surgical, ischemic reperfusion injury, etc. Systemic inflammatory responses during CPB result in increased morbidity and mortality. Activation of leukocytes is an important part of this process and directly contributes to coagulopathy and hemorrhage. This inflammatory response may contribute to the development of postoperative complications, including myocardial dysfunction, respiratory failure, renal and neurologic dysfunction, altered liver function and ultimately, multiple organ failure. Various pharmacologic and mechanical strategies have been developed to minimize the systemic inflammatory response during CPB. For example, leukocyte removal filters were developed in the 1990s for incorporation into the CPB circuit. However, studies of this approach have yielded conflicting findings. The purpose of this was to review the studies of a novel leukocyte removal filter in patients undergoing CPB.
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Affiliation(s)
- Yutaka Fujii
- a Department of Artificial Organs , National Cerebral and Cardiovascular Center Research Institute , Osaka , Japan
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18
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Gibbons of the world, dream on. J Thorac Cardiovasc Surg 2015; 151:13-4. [PMID: 26434703 DOI: 10.1016/j.jtcvs.2015.09.005] [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: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 11/23/2022]
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19
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Khan S, Jehangir W. Evolution of Artificial Hearts: An Overview and History. Cardiol Res 2014; 5:121-125. [PMID: 28348709 PMCID: PMC5358116 DOI: 10.14740/cr354w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 11/21/2022] Open
Abstract
The heart is a muscular organ which pumps blood through blood vessels to different organs of the body. It is the most significant and vital organ in the human body. Without this organ, life is unimaginable. Doctors and scientists have been trying for a long time to create something similar or equivalent to the heart. The purpose is to develop a temporary machine or pump for a person who has a disease of the heart and their survival without transplant is impossible. These temporary devices can provide enough time for the patient until a donor heart is available. The purpose of this review is to provide an overview and history of how man has developed an artificial heart for survival.
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Affiliation(s)
- Sanna Khan
- Drexel University College of Medicine, Philadelphia, PA, USA
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