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Barrigoto C, Fortuna P, Silva PE, Bento L. Complications during transport of adult patients on extracorporeal membrane oxygenation. Perfusion 2024; 39:876-883. [PMID: 36940319 DOI: 10.1177/02676591231164877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
INTRODUCTION Transport on extracorporeal membrane oxygenation (ECMO) is a risky and complex procedure. Although most published data support the feasibility of interhospital transport on ECMO, data concerning intra-facility transportation and frequency and severity of complications during ECMO transport of adult patients are still scarce. The aim of this study was to assess transport arrangements and complications during intra and interhospital ECMO-supported patients transport at a high-volume ECMO center. METHODS Retrospective single-center descriptive study evaluating the prevalence and severity of complications associated with the transportation of adult patients on ECMO support between 2014 and 2022 in our ECMO center. RESULTS We performed 393 transfers of patients on ECMO support. Those comprised 206 intra-facility, 147 primary, 39 secondary and one tertiary transports. For primary and tertiary transportations, the average transfer length was 118.6 km (range 2.5-1446) and the mean total transport time was 5 h 40 min. The majority of transportations were made by ambulance (93.2%). Complications occurred in 12.7% of all transports and were more frequent in intra-facility and primary/tertiary transfers. Most complications were patient (46%) and staff related (26%). Risk category two was the most frequent (50%), and only five complications were classified as risk category 1 (10%). No deaths occurred during all patient transport. CONCLUSIONS Most transports carry minor problems that entail a negligible risk to the patient. When ECMO-supported transport is performed by an experienced team, the severe complications are not related with an increased morbimortality.
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Affiliation(s)
- Cleide Barrigoto
- Unidade de Urgência Médica, Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Philip Fortuna
- Unidade de Urgência Médica, Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Pedro Eduardo Silva
- Unidade de Urgência Médica, Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Luís Bento
- Unidade de Urgência Médica, Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
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Belda Hofheinz S, López Fernández E, García Torres E, Arias Dachary J, Boni L, Tajuelo Llopis I, Orozco Gámez R, Carballo Rodríguez L, Martins Bravo M, López Gámez S, García Maellas M, Gijón Mediavilla M. Primary neonatal and pediatric ECMO transport: First experience in Spain. Perfusion 2024; 39:797-806. [PMID: 36881730 DOI: 10.1177/02676591231161268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
INTRODUCTION The organization of primary Extracorporeal membrane oxygenation (ECMO) transport is highly variable. METHODS To present the experience of the first mobile pediatric ECMO program in Spain, we designed a prospective descriptive study of all primary neonatal and pediatric (0-16 years) ECMO transports carried out over 10 years. The main variables recorded include demographic information, patient background, clinical data, ECMO indications, adverse events, and main outcomes. RESULTS 39 primary ECMO transports were carried out with a 66.7% survival to hospital discharge. The median age was 1.24 months[IQR: 0.09-96]. Cannulation was mostly peripheral venoarterial (33/39). The mean response time from the call from the sending center to the departure of the ECMO team was 4 h[2.2-8]. The median inotropic score at the time of cannulation was 70[17.2-206.5], with a median oxygenation index of 40.5[29-65]. In 10% of the cases, ECMO-CPR was performed. Adverse events occurred in 56.4%, mostly related to the means of transport (40% overall). On arrival at the ECMO center, 44% of the patients underwent interventions. The median PICU stay was 20.5 days[11-32]. 5 patients developed neurological sequels. Statistically significant differences between survivors and deceased patients were not found. CONCLUSIONS A good survival rate, with a low prevalence of serious adverse events, suggests a clear benefit of primary ECMO transport when conventional therapeutic measures are exhausted and the patient is too unstable to undergo conventional transport. A nationwide primary ECMO-transport program must therefore be offered to all patients regardless of their location.
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Affiliation(s)
- Sylvia Belda Hofheinz
- ECMO Transport Team, PICU, Hospital 12 de Octubre, Madrid, Spain
- School of Medicine, Complutense University of Madrid, Madrid, Spain
- Mother-Child Health and Development Network (Red SAMID) of Carlos III Health Institute, 12 de Octubre Health Research Institute, Madrid, Spain
| | | | | | | | - Lorenzo Boni
- Pediatric Heart Institute, Hospital 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Susana López Gámez
- Perfusion, Pediatric Heart Institute, Hospital 12 de Octubre, Madrid, Spain
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3
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Brandorff M, Owyang CG, Tonna JE. Extracorporeal membrane oxygenation for cardiac arrest: what, when, why, and how. Expert Rev Respir Med 2023; 17:1125-1139. [PMID: 38009280 PMCID: PMC10922429 DOI: 10.1080/17476348.2023.2288160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) facilitated resuscitation was first described in the 1960s, but only recently garnered increased attention with large observational studies and randomized trials evaluating its use. AREAS COVERED In this comprehensive review of extracorporeal cardiopulmonary resuscitation (ECPR), we report the history of resuscitative ECMO, terminology, circuit configuration and cannulation considerations, complications, selection criteria, implementation and management, and important considerations for the provider. We review the relevant guidelines, different approaches to cannulation, postresuscitation management, and expected outcomes, including neurologic, cardiac, and hospital survival. Finally, we advocate for the participation in national/international Registries in order to facilitate continuous quality improvement and support scientific discovery in this evolving area. EXPERT OPINION ECPR is the most disruptive technology in cardiac arrest resuscitation since high-quality CPR itself. ECPR has demonstrated that it can provide up to 30% increased odds of survival for refractory cardiac arrest, in tightly restricted systems and for select patients. It is also clear, though, from recent trials that ECPR will not confer this high survival when implemented in less tightly protocoled settings and within lower volume environments. Over the next 10 years, ECPR research will explore the optimal initiation thresholds, best practices for implementation, and postresuscitation care.
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Affiliation(s)
- Matthew Brandorff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Clark G. Owyang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, USA
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Daverio M, Belda Hofheinz S, Vida V, Scattolin F, López Fernández E, García Torres E, Tajuelo-Llopis I, Izquierdo-Blasco J, Pàmies-Catalán A, Di Nardo M, De Piero ME, Balcells J, Amigoni A. Pediatric COVID-19 extracorporeal membrane oxygenation transport during the pandemic. Perfusion 2023:2676591231176243. [PMID: 37173806 PMCID: PMC10185475 DOI: 10.1177/02676591231176243] [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: 05/15/2023]
Abstract
INTRODUCTION ExtraCorporeal Membrane Oxygenation (ECMO) in pediatric patients with COVID-19 has a survival rate similar to adults. Occasionally, patients may need to be cannulated by an ECMO team in a referring hospital and transported to an ECMO center. The ECMO transport of a COVID-19 patient has additional risks than normal pediatric ECMO transport for the possible COVID-19 transmissibility to the ECMO team and the reduction of the ECMO team performance due to the need of wearing full personal protective equipment. Since pediatric data on ECMO transport of COVID-19 patients are lacking, we explored the outcomes of the pediatric COVID-19 ECMO transports collected in the EuroECMO COVID_Neo/Ped Survey. METHODS We reported five European consecutive ECMO transports of COVID-19 pediatric patients collected in the EuroECMO COVID_Neo/Ped Survey including 52 European neonatal and/or pediatric ECMO centers and endorsed by the EuroELSO from March 2020 till September 2021. RESULTS The ECMO transports were performed for two indications, pediatric ARDS and myocarditis associated to the multisystem inflammatory syndrome related to COVID-19. Cannulation strategies differed among patients according to the age of the patients, transport distance varied between 8 and 390 km with a total transport duration between 5 to 15 h. In all five cases, the ECMO transports were successfully performed without major adverse events. One patient reported a harlequin syndrome and another patient a cannula displacement both without major clinical consequences. Hospital survival was 60% with one patient reporting neurological sequelae. No ECMO team member developed COVID-19 symptoms after the transport. CONCLUSION Five transports of pediatric patients with COVID-19 supported with ECMO were reported in the EuroECMO COVID_Neo/Ped Survey. All transports were performed by an experienced multidisciplinary ECMO team and were feasible and safe for both the patient and the ECMO team. Further experiences are needed to better characterize these transports and draw insightful conclusions.
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Affiliation(s)
- Marco Daverio
- Pediatric Intensive Care Unit, University Hospital of
Padova, Padova, Italy
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
| | - Sylvia Belda Hofheinz
- ECMO Transport Team, Hospital 12 de Octubre, Madrid, Spain
- School of Medicine, Complutense University of
Madrid, Madrid, Spain
- Mother-Child Health and Development
Network (Red SAMID) of Carlos III Health Institute, 12 de Octubre Health Research
Institute, Madrid, Spain
| | - Vladimiro Vida
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
- Pediatric and Congenital Cardiac
Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public
Health, University of Padova Medical
School, Padova, Italy
| | - Fabio Scattolin
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
- Pediatric and Congenital Cardiac
Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public
Health, University of Padova Medical
School, Padova, Italy
| | | | | | | | - Jaume Izquierdo-Blasco
- Pediatric Critical Care Department, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
| | - Antoni Pàmies-Catalán
- Pediatric Cardiac Surgery
Department, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Children’s Hospital Bambino
Gesù, IRCCS, Rome, Italy
| | - Maria Elena De Piero
- Department of Anesthesiology and
Intensive Care, San Giovanni Bosco
Hospital, ASL Città di Torino, Turin, Italy
| | - Joan Balcells
- Pediatric Critical Care Department, Hospital Universitari Vall
d'Hebron, Barcelona, Spain
- Universitat Autònoma de
Barcelona, Barcelona, Spain
| | - Angela Amigoni
- Pediatric Intensive Care Unit, University Hospital of
Padova, Padova, Italy
- Department of Woman’s and Child’s
Health, University Hospital of
Padova, Padova, Italy
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5
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Duangpakdee P, Sakkarat S, Sangkhathat S. Survival Outcome in Critically Ill Patients Receiving Extracorporeal Membrane Oxygenation Support: Early Experience from a University Hospital in Thailand. Surg J (N Y) 2023; 9:e44-e51. [PMID: 36793996 PMCID: PMC9925292 DOI: 10.1055/s-0043-1761444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 02/16/2023] Open
Abstract
Objective Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand. Methods The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses. Results A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%, p -value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days. Conclusion Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.
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Affiliation(s)
- Pongsanae Duangpakdee
- Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand,Address for correspondence Pongsanae Duangpakdee, MD Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla UniversityHat Yai, Songkhla 90110Thailand
| | - Sasitorn Sakkarat
- Department of Surgery, Division of Cardio-Thoracic Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Surasak Sangkhathat
- Department of Surgery and Translational Medicine Research Center, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Tu GW, Chen YS, Huang M, Dobrilovic N, Luo Z. Editorial: Advances in extracorporeal life support in critically ill patients, volume II. Front Med (Lausanne) 2023; 10:1130962. [PMID: 36744133 PMCID: PMC9893482 DOI: 10.3389/fmed.2023.1130962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/09/2023] [Indexed: 01/20/2023] Open
Affiliation(s)
- Guo-wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Guo-wei Tu ✉
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan,Yih-Sharng Chen ✉
| | - Man Huang
- Department of Intensive Care Unit, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China,Man Huang ✉
| | - Nikola Dobrilovic
- Division of Cardiac Surgery, NorthShore University HealthSystem, Chicago, IL, United States,Nikola Dobrilovic ✉
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Critical Care Medicine, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China,Zhe Luo ✉
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Patient-Specific Computational Modeling of Different Cannulation Strategies for Extracorporeal Membrane Oxygenation. ASAIO J 2022; 68:e179-e187. [PMID: 36326700 DOI: 10.1097/mat.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Institution of extracorporeal membrane oxygenation (ECMO) results in unique blood flow characteristics to the end-organ vascular beds. We studied the interplay between cardiac-driven and extracorporeal membrane oxygenation (ECMO)-driven flow to vascular beds in different ECMO configurations using a patient-specific computational fluid dynamics (CFD) analysis. A computational ECMO model (femoral artery cannulation [FAC]) was constructed using patient-specific imaging and hemodynamic data. Following model calibration, we augmented the 3D geometrical model to represent alternative ECMO configurations (ascending aorta cannulation [AAC] and subclavian artery cannulation [SAC]). We performed CFD analyses, including a novel virtual color-dye analysis to compare global and regional blood flow and pressure characteristics as well as contributions of cardiac and ECMO-derived flow to the various vascular beds. Flow waveforms at all the aortic branch vessels were pulsatile, despite low cardiac output and predominant nonpulsatile ECMO-driven hemodynamics. Virtual color-dye analysis revealed differential contribution of cardiac and ECMO-derived flow to the end-organ vascular beds in the FAC model, while this was more evenly distributed in the AAC and SAC models. While global hemodynamics were relatively similar between various ECMO configurations, several distinct hemodynamic indices, in particular wall shear stress and oscillatory shear patterns, as well as differential contribution of ECMO-derived flow to various vascular beds, showed remarkable differences. The clinical impact of this study highlighting the relevance of CFD modeling in assessment of complex hemodynamics in ECMO warrants further evaluation.
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8
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Martinez D, Diaz R, Rufs J, Fajardo C, Valverde C, Salech F. Pediatric Extracorporeal Membrane Oxygenation (ECMO) Transport in a Developing Nation: A Single Center Experience. ASAIO J 2022; 68:e96-e98. [PMID: 34581288 DOI: 10.1097/mat.0000000000001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Daniela Martinez
- From the Unidad de Infectología Pediátrica, Hospital San Borja Arriarán
- Centro de Pacientes Críticos Pediátricos, Clínica Las Condes
| | - Rodrigo Diaz
- Unidad ECMO Clínica Las Condes
- Departamento de Anestesia
| | - Jorge Rufs
- Unidad ECMO Clínica Las Condes
- Departamento de Anestesia
| | - Christian Fajardo
- Unidad ECMO Clínica Las Condes
- Departamento de Cirugía Cardiovascular, Clínica Las Condes
| | - Cristián Valverde
- Centro de Pacientes Críticos Pediátricos, Clínica Las Condes
- Unidad ECMO Clínica Las Condes
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada, Hospital Clínico Universidad de Chile
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9
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Hayes MM, Fallon BP, Barbaro RP, Manusko N, Bartlett RH, Toomasian JM. Membrane Lung and Blood Pump Use During Prolonged Extracorporeal Membrane Oxygenation: Trends From 2002 to 2017. ASAIO J 2021; 67:1062-1070. [PMID: 33528156 PMCID: PMC8316490 DOI: 10.1097/mat.0000000000001368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Extracorporeal life support (ECLS) has grown in its application since its first clinical description in the 1970s. The technology has been used to support a wide variety of mechanical support modalities and diseases, including respiratory failure, cardiorespiratory failure, and cardiac failure. Over many decades and safety and efficacy studies, followed by randomized clinical trials and thousands of clinical uses, ECLS is considered as an accepted treatment option for severe pulmonary and selected cardiovascular failure. Extracorporeal life support involves the use of support artificial organs, including a membrane lung and blood pump. Over time, changes in the technology and the management of ECLS support devices have evolved. This manuscript describes the use of membrane lungs and blood pumps used during ECLS support from 2002 to 2017 in over 65,000 patients reported to the Extracorporeal Life Support Organization Registry. Device longevity and complications associated with membrane lungs and blood pump are described and stratified by age group: neonates, pediatrics, and adults.
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Affiliation(s)
- McKenzie M. Hayes
- Extracorporeal Life Support Laboratory, Department of Surgery. University of Michigan, Ann Arbor, MI
| | - Brian P. Fallon
- Extracorporeal Life Support Laboratory, Department of Surgery. University of Michigan, Ann Arbor, MI
| | - Ryan P. Barbaro
- Department of Pediatrics, Division of Critical Care. University of Michigan, Ann Arbor, MI
- Registry Committee, Extracorporeal Life Support Organization, Ann Arbor, MI
| | - Niki Manusko
- Section of General Surgery, Department of Surgery. University of Michigan, Ann Arbor, MI
| | - Robert H. Bartlett
- Extracorporeal Life Support Laboratory, Department of Surgery. University of Michigan, Ann Arbor, MI
| | - John M. Toomasian
- Extracorporeal Life Support Laboratory, Department of Surgery. University of Michigan, Ann Arbor, MI
- . Technology Committee, Extracorporeal Life Support Organization, Ann Arbor, MI
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Lee H, Sung K, Suh GY, Chung CR, Yang JH, Jeon K, Carriere KC, Ahn JH, Cho YH. Outcomes of transported and in-house patients on extracorporeal life support: a propensity score-matching study. Eur J Cardiothorac Surg 2021; 57:317-324. [PMID: 31504394 DOI: 10.1093/ejcts/ezz227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/08/2019] [Accepted: 07/21/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Patients on extracorporeal life support (ECLS), like other critically ill patients, are transported to other institutions for various reasons. However, little has been reported concerning the characteristics and clinical outcomes of transported patients compared with those of in-house patients. METHODS A total of 281 adult patients received ECLS between January 2014 and August 2016. Patients who underwent cannulation at another institution by our team were excluded. Patients were divided into 2 groups: transported group (N = 46) and in-house group (N = 235). All 46 patients were safely transported without serious adverse events. The mean travel distance was 206±140 km, with a mean travel time of 78 ± 57 min. Following propensity score matching, 44 transported patients were matched to 148 in-house patients. RESULTS In the matched population, the mean age was 48 ± 13 years in the transported group and 49 ± 17 years in the in-house group (P = 0.70). The ECLS type (venoarterial/venovenous) comprised 35/9 (79.5/20.5%) in the transported group and 119/29 (80.4/19.6%) in the in-house group (P = 0.93). Seventeen (38.6%) extracorporeal cardiopulmonary resuscitations were performed in the transported group and 59 (39.9%) were performed in the in-house group (P = 0.91). The incidence of limb ischaemia and acute kidney injury was higher in the transported group (P = 0.007 and P = 0.001, respectively). However, the rate of survival to discharge did not differ between the groups (63.6% in the transported group vs 64.2% in the in-house group, P = 0.94) and there was no difference in overall mortality (P = 0.99). CONCLUSIONS Although transported patients had more complications than in-house ECLS patients, clinical outcomes were comparable in the matched population. Transporting ECLS patients to an experienced centre may be justified based on our experience.
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Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keumhee Chough Carriere
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada.,Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Fleissner F, Mogaldea A, Martens A, Natanov R, Rümke S, Salman J, Kaufeld T, Ius F, Beckmann E, Haverich A, Kühn C. ECLS supported transport of ICU patients: does out-of -house implantation impact survival? J Cardiothorac Surg 2021; 16:158. [PMID: 34078397 PMCID: PMC8170971 DOI: 10.1186/s13019-021-01508-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background Extracorporeal life support (ECLS) is an established tool to stabilize severely ill patients with therapy-refractory hemodynamic or respiratory failure. Recently, we established a mobile ECLS retrieval service at our institution. However, data on the outcome of patients receiving ECLS at outside hospitals for transportation into tertiary hospitals is still sparse. Methods We have analyzed all patients receiving ECLS in outside hospitals (Transport group, TG) prior to transportation to our institution and compared the outcome to our in-house ECLS experience (Home Group, HG). Results Between 2012 and 2018, we performed 978 ECLS implantations, 243 of which were performed on-site in tertiary hospitals for ECLS supported transportation. Significantly more veno-venous systems were implanted in TG (n = 129 (53%) vs. n = 327 (45%), p = 0.012). Indication for ECLS support differed between the groups, with more pneumonia; acute respiratory distress syndromes in the TG group and of course, more postcardiotomy patients in HG. Mean age was 47 (± 20) (HG) vs. 48 (± 18) (TG) years, p = 0.477 with no change over time. No differences were seen in ECLS support time (8.03 days ±8.19 days HG vs 7.81 days ±6.71 days TG, p = 0.675). 30-day mortality (n = 379 (52%) (HG) vs. n = 119 (49%) (TG) p = 0.265) and death on ECLS support (n = 322 (44%) (HG) vs. n = 97 (40%) TG, p = 0.162) were comparable between the two groups, despite a more severe SAVE score in the v-a TG (HG: − 1.56 (± 4.73) vs. TG -3.93 (± 4.22) p < 0.001). Mortality rates did not change significantly over the years. Multivariate risk analysis revealed Influenza, Peak Insp. Pressure at implantation, pO2/FiO2 ratio and ECLS Score (SAVE/RESP) as well as ECLS support time to be independent risk factors for mortality. Conclusion Mobile ECLS support is a tremendous challenge. However, it is justified to offer 24 h/7d ECLS standby for secondary and primary hospitals as a tertiary hospital. Increasing indications and total numbers for ECLS support raise the need for further studies to evaluate outcome in these patients.
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Affiliation(s)
- Felix Fleissner
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany.
| | - Alexandru Mogaldea
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Ruslan Natanov
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Stefan Rümke
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Jawad Salman
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Erik Beckmann
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
| | - Christian Kühn
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Carl-Neuberg Strasse 1, 30625, Hannover, Germany
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12
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Abstract
To review our experience with mobile extracorporeal membrane oxygenation (ECMO). Mobile ECMO team included: ECMO-trained surgeon and intensivist, specialist nurse, and perfusionist. Patients were cannulated for venous-arterial (V-A) or venous-venous (V-V) ECMO, depending on clinical indication. Mobile transfers were carried out utilizing a Levitronics Centrimag centrifugal pump and Hico Variotherm 555 heater cooler. From October 2009 to May 2019, 571 patients, 185 (32%) neonates, 95 (17%) pediatric, and 291 (51%) adults, underwent mobile ECMO transfer. Four hundred fifty-three (79%) transfers were completed by road, 76 (13%) by air, and 42 (8%) by road/air combination. Road was the travel mode of choice for journeys with expected duration up to 3 hours one way. Nevertheless, road transfers up to 6 hours duration were performed safely. Average duration of mobile ECMO transfer was 5.5 hours (2-18 hours). Two patients died before arrival of mobile ECMO team, four patients were cannulated during cardio-pulmonary resuscitation, and one of them died of uncontrollable hemorrhage in the right hemithorax. One patient had cardiac arrest after V-V cannulation and required conversion to V-A. Mobile ECMO is safe and reliable to transfer the sickest of patients. Fully trained team with all equipment and disposables is indispensable for reliable mobile ECMO service.
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Affiliation(s)
- Antonio F Corno
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, England, UK
- Cardiovascular Research Centre, University of Leicester, Leicester, United Kingdom
| | - Gail M Faulkner
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, England, UK
| | - Chris Harvey
- East Midlands Congenital Heart Centre, University Hospitals of Leicester, Leicester, England, UK
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13
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Read MD, Nam JJ, Biscotti M, Piper LC, Thomas SB, Sams VG, Elliott BS, Negaard KA, Lantry JH, DellaVolpe JD, Batchinsky A, Cannon JW, Mason PE. Evolution of the United States Military Extracorporeal Membrane Oxygenation Transport Team. Mil Med 2021; 185:e2055-e2060. [PMID: 32885813 DOI: 10.1093/milmed/usaa215] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/01/2020] [Accepted: 07/15/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The use of extracorporeal membrane oxygenation (ECMO) for the care of critically ill adult patients has increased over the past decade. It has been utilized in more austere locations, to include combat wounded. The U.S. military established the Acute Lung Rescue Team in 2005 to transport and care for patients unable to be managed by standard medical evacuation resources. In 2012, the U.S. military expanded upon this capacity, establishing an ECMO program at Brooke Army Medical Center. To maintain currency, the program treats both military and civilian patients. MATERIALS AND METHODS We conducted a single-center retrospective review of all patients transported by the sole U.S. military ECMO program from September 2012 to December 2019. We analyzed basic demographic data, ECMO indication, transport distance range, survival to decannulation and discharge, and programmatic growth. RESULTS The U.S. military ECMO team conducted 110 ECMO transports. Of these, 88 patients (80%) were transported to our facility and 81 (73.6%) were cannulated for ECMO by our team prior to transport. The primary indication for ECMO was respiratory failure (76%). The range of transport distance was 6.5 to 8,451 miles (median air transport distance = 1,328 miles, median ground transport distance = 16 miles). In patients who were cannulated remotely, survival to decannulation was 76% and survival to discharge was 73.3%. CONCLUSIONS Utilization of the U.S. military ECMO team has increased exponentially since January 2017. With an increased tempo of transport operations and distance of critical care transport, survival to decannulation and discharge rates exceed national benchmarks as described in ELSO published data. The ability to cannulate patients in remote locations and provide critical care transport to a military medical treatment facility has allowed the U.S. military to maintain readiness of a critical medical asset.
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Affiliation(s)
- Matthew D Read
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Jason J Nam
- US Army Special Operations Command, Bldg X4047 New Dawn Drive, Fort Bragg, NC 78234
| | - Mauer Biscotti
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Lydia C Piper
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Sarah B Thomas
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - Valerie G Sams
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | | | - Kathryn A Negaard
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
| | - James H Lantry
- University of Maryland School of Medicine, 655 W Baltimore St S, Baltimore, MD 21201
| | - Jeffry D DellaVolpe
- Methodist Healthcare System, 8109 Fredericksburg Rd, San Antonio, TX 78229.,Geneva Foundation, 917 Pacific Ave, Tacoma, WA 98402
| | - Andriy Batchinsky
- Autonomous Reanimation and Evacuation Program, The Geneva Foundation, 917 Pacific Ave, Tacoma, WA 98402
| | - Jeremy W Cannon
- University of Pennsylvania and the Presbyterian Medical Center, 3801 Filbert St #212, Philadelphia, PA 19104
| | - Phillip E Mason
- Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234
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14
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Sen A, Blakeman S, DeValeria PA, Peworski D, Lanza LA, Downey FX, Alwardt CM, Dobberpuhl JG, DeMarco M, Callisen H, Shively J, McKay K, Singbartl K, Sell-Dottin KA, D’Cunha J, Patel BM. Practical Considerations for and Outcomes of Interfacility ECMO Transfer of Patients With COVID-19 During a Pandemic: Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2021; 5:525-531. [PMID: 33686378 PMCID: PMC7927641 DOI: 10.1016/j.mayocpiqo.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Interfacility transport of a critically ill patient with acute respiratory distress syndrome (ARDS) may be necessary for a higher level of care or initiation of extracorporeal membrane oxygenation (ECMO). During the COVID-19 pandemic, ECMO has been used for patients with severe ARDS with successful results. Transporting a patient after ECMO cannulation by the receiving facility brings forth logistic challenges, including availability of adequate personal protective equipment for the transport team and hospital capacity management issues. We report our designated ECMO transport team's experience of 5 patients with COVID-19-associated severe ARDS after cannulation at the referring facility. Focusing on transport-associated logistics, creation of checklists, and collaboration with emergency medical services partners is necessary for safe and good outcomes for patients while maintaining team safety.
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Affiliation(s)
- Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix
| | | | | | | | - Louis A. Lanza
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | | | - Cory M. Alwardt
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | | | | | | | | | - Kelly McKay
- Mayo Clinic Center for Military Medicine, Mayo Clinic Arizona, Phoenix
| | - Kai Singbartl
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | | | - Jonathan D’Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix
| | - Bhavesh M. Patel
- Department of Critical Care Medicine, Mayo Clinic Arizona, Phoenix
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15
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Das S, Gupta S, Das D, Dutta N. Basics of extra corporeal membrane oxygenation: a pediatric intensivist's perspective. Perfusion 2021; 37:439-455. [PMID: 33765881 DOI: 10.1177/02676591211005260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Extra Corporeal membrane oxygenation (ECMO) is one of the most advanced forms of life support therapy in the Intensive Care Unit. It relies on the principle where an external artificial circuit carries venous blood from the patient to a gas exchange device (oxygenator) within which blood becomes enriched with oxygen and has carbon dioxide removed. The blood is then returned to the patient via a central vein or an artery. The goal of ECMO is to provide a physiologic milieu for recovery in refractory cardiac/respiratory failure. The technology is not a definitive treatment for a disease, but provides valuable time for the body to recover. In that way it can be compared to a bridge, where patients are initiated on ECMO as a bridge to recovery, bridge to decision making, bridge to transplant or bridge to diagnosis. The use of this modality in children is not backed by a lot of randomized controlled trials, but the use has increased dramatically in our country in last 10 years. This article is not intended to provide an in-depth overview of ECMO, but outlines the basic principles that a pediatric intensive care physician should know in order to manage a kid on ECMO support.
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Affiliation(s)
- Shubhadeep Das
- Department of Pediatric Cardiac Intensive Care, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Sandip Gupta
- Department of Pediatric Intensive Care, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Debasis Das
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
| | - Nilanjan Dutta
- Department of Cardiac Surgery, NH Narayana Superspeciality Hospital, Howrah, West Bengal, India
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16
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Ricarte Bratti JP, Cavayas YA, Noly PE, Serri K, Lamarche Y. Modalities of Left Ventricle Decompression during VA-ECMO Therapy. MEMBRANES 2021; 11:membranes11030209. [PMID: 33809568 PMCID: PMC8002319 DOI: 10.3390/membranes11030209] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 12/22/2022]
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used to sustain circulatory and respiratory support in patients with severe cardiogenic shock or refractory cardiac arrest. Although VA-ECMO allows adequate perfusion of end-organs, it may have detrimental effects on myocardial recovery. Hemodynamic consequences on the left ventricle, such as the increase of afterload, end-diastolic pressure and volume, can lead to left ventricular (LV) distention, increase of myocardial oxygen consumption and delayed LV function recovery. LV distention occurs in almost 50% of patients supported with VA-ECMO and is associated with an increase in morbidity and mortality. Thus, recognizing, preventing and treating LV distention is key in the management of these patients. In this review, we aim to discuss the pathophysiology of LV distention and to describe the strategies to unload the LV in patients supported with VA-ECMO.
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Affiliation(s)
- Juan Pablo Ricarte Bratti
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada; (J.P.R.B.); (Y.A.C.); (P.E.N.); (K.S.)
| | - Yiorgos Alexandros Cavayas
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada; (J.P.R.B.); (Y.A.C.); (P.E.N.); (K.S.)
- Hôpital Sacré-Coeur de Montréal, 5400. Gouin Blvd. West, Montreal, QC H4J 1C5, Canada
| | - Pierre Emmanuel Noly
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada; (J.P.R.B.); (Y.A.C.); (P.E.N.); (K.S.)
| | - Karim Serri
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada; (J.P.R.B.); (Y.A.C.); (P.E.N.); (K.S.)
- Hôpital Sacré-Coeur de Montréal, 5400. Gouin Blvd. West, Montreal, QC H4J 1C5, Canada
| | - Yoan Lamarche
- Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada; (J.P.R.B.); (Y.A.C.); (P.E.N.); (K.S.)
- Hôpital Sacré-Coeur de Montréal, 5400. Gouin Blvd. West, Montreal, QC H4J 1C5, Canada
- Correspondence: ; Tel.: +1-514-376-3330
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17
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Pediatric Extracorporeal Membrane Oxygenation Reach-Out Program: Successes and Insights. ASAIO J 2021; 66:1036-1041. [PMID: 31977355 DOI: 10.1097/mat.0000000000001110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The shortage of dedicated pediatric extracorporeal membrane oxygenation (ECMO) centers and the expanding indications for pediatric ECMO necessitate a regional program for transport of ECMO-supported patients. Data about feasibly and safety of pediatric ECMO transport are scarce. Our aim is to describe our experience with a pediatric ECMO reach-out program and review pertinent literature. Demographic, clinical, and outcome data were collected retrospectively from the charts of all patients cannulated onto ECMO at referring centers and transported to our center from 2003 to 2018. Similar data were recorded for patients who were referred for ECMO support from within the hospital. The cohort included 80 patients cannulated at 17 referring centers. The transport team included a senior pediatric cardiac surgeon and an ECMO specialist. All transfers but one were done by special emergency medical service ambulance. No major complications or deaths occurred during transport, and all patients were stable upon arrival to our unit. Mortality was lower in the ECMO reach-out cohort than in-house patients referred for ECMO support. This is the first study from Israel and one of the largest to date describing a dedicated pediatric ECMO transport program. Extracorporeal membrane oxygenation transport appears to be feasible and safe when conducted by a small, highly skilled mobile team. Successful reach-out program requires open communication between the referring physician and the accepting center. As survival correlates with ECMO volume, maintaining a large ECMO center with 24/7 retrieval capabilities may be the best strategy for pediatric mechanical circulatory support program.
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18
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Czarnik T, Gawda R. Indications for ECMO: we need to look at the patient first. Minerva Anestesiol 2020; 87:147-149. [PMID: 33325221 DOI: 10.23736/s0375-9393.20.15136-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Tomasz Czarnik
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland -
| | - Ryszard Gawda
- Department of Anesthesiology, Intensive Care and Regional ECMO Center, Institute of Medical Sciences, University of Opole, Opole, Poland
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19
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Youngquist ST, Tonna JE, Bartos JA, Johnson MA, Hoareau GL, Hutin A, Lamhaut L. Current Work in Extracorporeal Cardiopulmonary Resuscitation. Crit Care Clin 2020; 36:723-735. [DOI: 10.1016/j.ccc.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Abstract
Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy for severe respiratory and circulatory failure. It is best performed in high-volume centers to optimize resource utilization and outcomes. Regionalization of ECMO might require the implementation of therapy before and during transfer to the high-volume center. The aim of this international survey was to describe the manner in which interhospital ECMO transport care is organized at experienced centers. Fifteen mobile ECMO centers from nine countries participated in this survey. Seven (47%) of them operated under the "Hub-and-Spoke" model. Transport team composition varies from three to nine members, with at least one ECMO specialist (i.e., nurse or perfusionist) participating in all centers, although intensivists and surgeons were present in 69% and 50% of the teams, respectively. All centers responded that the final decision to initiate ECMO is multidisciplinary and made bedside at the referring hospital. Most centers (75%) have a quality control system; all teams practice simulation and water drills. Considering the variability in ECMO transport teams among experienced centers, continuous education, training and quality control within each organization itself are necessary to avoid adverse events and maintain a low mortality rate. A specific international ECMO Transport platform to share data, benchmark outcomes, promote standardization, and provide quality control is required.
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21
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Abstract
Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue to be poor.
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Affiliation(s)
- Nathan W Mick
- Department of Emergency Medicine, Pediatric Emergency Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA; Tufts University School of Medicine, Boston, MA, USA.
| | - Rachel J Williams
- Tufts University School of Medicine, Boston, MA, USA; Pediatric Emergency Medicine, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA
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22
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Carter KT, O'Brien R, Larson SB, Creswell LL, Kutcher M, Baran DA, Copeland JG, Copeland H. Venoarterial extracorporeal membrane oxygenation is a viable option as a bridge to heart transplant. J Thorac Cardiovasc Surg 2020; 163:140-147.e4. [PMID: 32928549 DOI: 10.1016/j.jtcvs.2020.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Venoarterial extracorporeal membrane oxygenation is a rescue therapy for patients in cardiogenic shock. We hypothesize that patients bridged to heart transplant with extracorporeal membrane oxygenation have decreased survival. METHODS The United Network of Organ Sharing database was retrospectively reviewed from January 1, 1999, to March 31, 2018, for heart transplant recipients. Recipients bridged with any form of mechanical support and those without support were compared with recipients bridged with extracorporeal membrane oxygenation. The primary end point was restricted mean survival time through 16.7 years. RESULTS Of 26,918 recipients, 15,076 required no pretransplant mechanical support (56.0%). Support patients included 9321 with left ventricular assist devices (34.6%), 53 with right ventricular assist devices (0.2%), 258 with total artificial hearts (1.0%), 686 with biventricular assist devices (2.6%), 1378 with intra-aortic balloon pumps (5.1%), and 146 who required extracorporeal membrane oxygenation (0.5%). In the first 16.7 years post-transplant, compared with recipients bridged with extracorporeal membrane oxygenation, estimated adjusted restricted mean survival time was higher in patients who required no mechanical support (16.6 months [14.0-19.4]) and patients with a left ventricular assist device (16.5 months [99% confidence interval, 13.9-19.2]), an intra-aortic balloon pump (11.2 months [8.3-14.7]), or a biventricular assist device (6.6 months [3.6-10.3]). Restricted mean survival time in patients with a right ventricular assist device or a total artificial heart was similar to patients with extracorporeal membrane oxygenation. CONCLUSIONS Recipients bridged with extracorporeal membrane oxygenation were estimated to survive 16.6 months less than nonmechanical circulatory support recipients. Bridge to heart transplant with extracorporeal membrane oxygenation is a viable option, and these patients should be considered transplant candidates.
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Affiliation(s)
- Kristen T Carter
- Department of Surgery, University of Mississippi Medical Center, Jackson, Miss
| | - Robert O'Brien
- Department of Surgery, University of Mississippi Medical Center, Jackson, Miss; Department of Data Science, University of Mississippi Medical Center, Jackson, Miss
| | - Sharon B Larson
- Division of Cardiothoracic Surgery, Department of Surgery, University of Iowa, Iowa City, Iowa
| | - Lawrence L Creswell
- Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Miss
| | - Matthew Kutcher
- Department of Surgery, University of Mississippi Medical Center, Jackson, Miss
| | | | - Jack G Copeland
- Division of Cardiothoracic Surgery, University of Arizona, Tucson, Ariz
| | - Hannah Copeland
- Division of Cardiothoracic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, Miss.
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23
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Christian-Miller N, Hadaya J, Nakhla M, Sanaiha Y, Madrigal J, Emami S, Cale M, Sareh S, Benharash P. The impact of obesity on outcomes in patients receiving extracorporeal life support. Artif Organs 2020; 44:1184-1191. [PMID: 32530120 DOI: 10.1111/aor.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/25/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022]
Abstract
Extracorporeal life support (ECLS) has been increasingly utilized to manage cardiac and pulmonary dysfunction. The impact of obesity on outcomes of ECLS is poorly defined. The purpose of the study was to compare in-hospital mortality, resource use, complications, and readmissions in obese versus non-obese patients receiving ECLS. We performed a retrospective cohort study of all adult ECLS patients with and without an obesity diagnosis using the 2010-2016 Nationwide Readmissions Database (NRD). Mortality, length of stay (LOS), hospital charges, complications, and readmissions were evaluated using multivariable logistic and linear regression. Of 23 876, patients who received ECLS, 1924 (8.1%) were obese. Obese patients received ECLS more frequently for respiratory failure (29.5% vs. 23.7%, P = .001). After adjustment for patient and hospital factors, obesity was not associated with increased odds of mortality (AOR = 1.06, P = .44) and was associated with decreased LOS (13.7 vs. 21.2 days, P < .001), hospital charges ($171 866 vs. $211 445, P < .001), and 30-day readmission (AOR = 0.71, P = .03). Obesity was also associated with reduced odds of hemorrhage (AOR = 0.43, P < .001), neurologic complications (AOR = 0.55, P = .004), and acute kidney injury (AOR=0.83, P = .04). After stratification by ECLS indication, obesity remained predictive of shorter LOS (AOR range: 0.53-0.78, all P < .05 ) and did not impact mortality (all P > .05). Respiratory support remains the most common indication for ECLS among obese patients. Among all patients, as well as by individual ECLS indication, obesity was not associated with increased odds of mortality. These findings suggest that obesity should not be considered a high-risk contraindication to ECLS.
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Affiliation(s)
- Nathaniel Christian-Miller
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Morcos Nakhla
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Josef Madrigal
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sara Emami
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mario Cale
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2020; 145:peds.2019-1361. [PMID: 31727859 DOI: 10.1542/peds.2019-1361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.
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25
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Extracorporeal Life Support in Adult Patients: A Global Perspective of the Last Decade. Dimens Crit Care Nurs 2019; 38:123-130. [PMID: 30946118 DOI: 10.1097/dcc.0000000000000351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Extracorporeal life support (ECLS) is an external medical device to treat critically ill patients with cardiovascular and respiratory failure. In a nutshell, ECLS is only a "bridging" mechanism that provides life support while the heart and/or the lungs is recovering either by therapeutic medical interventions, transplantation, or spontaneously. Extracorporeal life support has been developed since 1950s, and many studies were conducted to improve ECLS techniques, but unfortunately, the survival rate was not improved. Because of Dr Bartlett's success in using ECLS to treat neonates with severe respiratory distress in 1975, ECLS is made as a standard lifesaving therapy for neonates with severe respiratory distress. However, its use for adult patients remains debatable. The objectives of this study are to outline and provide a general overview of the use of ECLS especially for adult patients for the past 10 years and to elaborate on the challenges encountered by each stakeholder involved in ECLS. The data used for this study were extracted from the ELSO Registry Report of January 2018. Results of this study revealed that the number of ECLS centers and the use of ECLS are increasing over the year for the past decade. There was also a shift of the patient's age category from neonatal to adult patients. However, the survival rates for adult patients are relatively low especially for cardiac and extracorporeal cardiopulmonary resuscitation cases. To date, the complications are still the major challenge of ECLS. Other challenges encountered by the stakeholders in ECLS are the limited amount of well-trained and experienced ECLS teams and centers, the limited government expenditure on health, and the lack of improvement and development of ECLS techniques and devices. Further studies are needed to evaluate the value of ECLS for adult patients.
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Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2019; 140:e904-e914. [PMID: 31722551 DOI: 10.1161/cir.0000000000000731] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.
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Design of an entrustable professional activity for adult extracorporeal membrane oxygenation. Surg Open Sci 2019; 2:42-45. [PMID: 33981980 PMCID: PMC8083009 DOI: 10.1016/j.sopen.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/30/2019] [Accepted: 09/09/2019] [Indexed: 12/04/2022] Open
Abstract
Background Extracorporeal membrane oxygenation supports severe cardiac or pulmonary failure. There are currently no competency-based standards for extracorporeal membrane oxygenation training. Methods Extracorporeal membrane oxygenation experts were interviewed using a structured interview. Responses were audio recorded, transcribed, and validated by respondents. Interviews were coded using grounded theory with a constant comparison method. Themes were developed and used to construct the entrustable professional activity, which was reviewed by the extracorporeal membrane oxygenation experts. Results Nine experts were interviewed; all had experience with trainees. Interview themes identified include patient selection, circuit and medical management, multidisciplinary communication, problem-based learning and simulation, and entrustment decisions. Essential functions of the entrustable professional activity were patient selection, circuit management, cannula selection, responding to circuit emergencies/complications, anticoagulation management, weaning, and family/team communication. Conclusions Essential functions of an extracorporeal membrane oxygenation entrustable professional activity were defined using data from structured interviews. The resultant entrustable professional activity could be implemented by critical-care programs as a scaffolding for competency-based fellow training. A structured interview is an effective method for an EPA creation. Nine experts with a median 14 years of ECMO experience were interviewed. The essential functions for ECMO care were defined. The ECMO EPA could be used for competency-based critical care education.
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Burgos CM, Frenckner B, Fletcher-Sandersjöö A, Broman LM. Transport on extracorporeal membrane oxygenation for congenital diaphragmatic hernia: A unique center experience. J Pediatr Surg 2019; 54:2048-2052. [PMID: 30824238 DOI: 10.1016/j.jpedsurg.2018.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/21/2018] [Accepted: 11/25/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Support on Extracorporeal oxygenation membrane (ECMO) represents the last therapeutic option in the management of respiratory failure and pulmonary hypertension refractory to treatment in patients with congenital diaphragmatic hernia (CDH). AIM The objective of this work was to present our experience of all the cases of CDH that we have transported on ECMO. MATERIAL AND METHODS Medical records of patients, national and international, with CDH transported by our service on ECMO from 1997 to 2018 were reviewed. RESULTS During 22 years, we performed 40 ECMO transports of newborns with CDH, 39 primary and one secondary. In 10% (4/40) we transferred patients from their primary hospital after the implantation of cannulae and commencement of ECMO to another center abroad owing to the lack of beds in our unit. Twenty (50%) of the transports were from a foreign country. Median transport distance was 560 (428-1381) km and the median transport time was 4.5 (4.2-6.3) h. The mode of transport was ground ambulance in 20%, helicopter in 10%, fixed wing aircraft in 62.5% and ground ambulance in Freight aircraft in 7.5%. In 40% of the transports, 20 complications occurred. In one of every four transports with complications, more than one event occurred. Most frequent complication was loss of tidal volumes (35%) and in 30% of the complications another patient related event was recorded. Equipment failure occurred in 20%, and climate problems and transport vehicle problems in 15%. No deaths occurred during transport. Venoarterial ECMO was used in 39 of the 40 cases. Survival to discharge was 87% for the entire period and long-term survival was 77%. CONCLUSIONS Long and short distance interhospital transports of CDH patients on ECMO can be performed safely. Despite occurrence of adverse events, the risk of mortality is very low. The personnel involved must be highly competent in intensive care, physiology and physics of ECMO, cannulation, intensive care transport and air transport medicine. They must also be trained to recognize risk factors in these patients. LEVEL OF EVIDENCE III Retrospective cohort study.
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Affiliation(s)
- Carmen Mesas Burgos
- Department of Pediatric Surgery, Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden; ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| | - Björn Frenckner
- Department of Pediatric Surgery, Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden; ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lars Mikael Broman
- ECMO Center Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Past and present role of extracorporeal membrane oxygenation in combat casualty care: How far will we go? J Trauma Acute Care Surg 2019; 84:S63-S68. [PMID: 29443864 DOI: 10.1097/ta.0000000000001846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Advanced extracorporeal therapies have been successfully applied in the austere environment of combat casualty care over the previous decade. In this review, we describe the historic underpinnings of extracorporeal membrane oxygenation, review the recent experience with both partial and full lung support during combat operations, and critically assess both the current status of the Department of Defense extracorporeal membrane oxygenation program and the way forward to establish long-range lung rescue therapy as a routine capability for combat casualty care.
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Trends in mortality and resource utilization for extracorporeal membrane oxygenation in the United States: 2008–2014. Surgery 2019; 165:381-388. [DOI: 10.1016/j.surg.2018.08.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/19/2018] [Accepted: 08/12/2018] [Indexed: 11/23/2022]
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Sandhu HS, Fortenberry JD, MacLaren G. Editorial: Improving Extracorporeal Life Support Outcomes in Children. Front Pediatr 2019; 7:140. [PMID: 31058119 PMCID: PMC6478657 DOI: 10.3389/fped.2019.00140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 03/26/2019] [Indexed: 01/19/2023] Open
Affiliation(s)
- Hitesh S Sandhu
- Division of Pediatric Critical Care, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
| | - James D Fortenberry
- Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Graeme MacLaren
- Cardiothoracic ICU, National University Hospital, Singapore, Singapore.,Paediatric ICU, Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
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Broman LM. Interhospital Transport on Extracorporeal Membrane Oxygenation of Neonates-Perspective for the Future. Front Pediatr 2019; 7:329. [PMID: 31448250 PMCID: PMC6691167 DOI: 10.3389/fped.2019.00329] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/22/2019] [Indexed: 01/30/2023] Open
Abstract
In recent years the number of extracorporeal membrane oxygenation (ECMO) cases in neonates has been relatively constant. Future expansion lays in new indications for treatment. Regionalization to high-volume ECMO centers allows for optimal utilization of resources, reduction in costs, morbidity, and mortality. Mobile ECMO services available "24-7" are needed to provide effective logistics and reliable infrastructure for patient safety. ECMO transports are usually high-risk and complex. To reduce complications during ECMO transport communication using time-out, checklists, and ECMO A-B-C are paramount in any size mobile program. Team members' education, clinical training, and experience are important. For continuing education, regular wet-lab training, and simulation practices in teams increase performance and confidence. In the future the artificial placenta for the extremely premature infant (23-28 gestational weeks) will be introduced. This will enforce the development and adaptation of ECMO devices and materials for increased biocompatibility to manage the high-risk prem-ECMO (28-34 weeks) patients. These methods will likely first be introduced at a few high-volume neonatal ECMO centers. The ECMO team brings bedside competence for assessment, cannulation, and commencement of therapy, followed by a safe transport to an experienced ECMO center. How transport algorithms for the artificial placentae will affect mobile ECMO is unclear. ECMO transport services in the newborn should firstly be an out-reach service led and provided by ELSO member centers that continuously report transport data to an expansion of the ELSO Registry to include transport quality follow-up and research. For future development and improvement follow-up and sharing of data are important.
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Affiliation(s)
- Lars Mikael Broman
- Department of Pediatric Perioperative Medicine and Intensive Care, Extracorporeal Membrane Oxygenation Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Di Nardo M, Lonero M, Pasotti E, Cancani F, Perrotta D, Cecchetti C, Stoppa F, Pirozzi N, La Salvia O, Nicolini A, Amodeo A, Patroniti N, Pesenti A. The first five years of neonatal and pediatric transports on extracorporeal membrane oxygenation in the center and south of Italy: The pediatric branch of the Italian "Rete Respira" network. Perfusion 2018; 33:24-30. [PMID: 29788844 DOI: 10.1177/0267659118766829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Neonatal and pediatric ECMO is a high-risk procedure that should be performed only in expert centers. Children who are eligible for ECMO and are managed in hospitals without ECMO capabilities should be referred to the closest ECMO center before the severity of illness precludes safe conventional transport. When the clinical situation precludes safe conventional transport, ECMO should be provided on site with the patient transported on ECMO. METHODS We retrospectively reviewed our institutional database of all ECMO transports for neonatal and pediatric respiratory failure from February 2013 to February 2018. RESULTS Over the last 5 years, we provided 24 transports covering all requests from the center and south of Italy except for the islands. Of these transports, 20 were performed on ECMO and 4 without ECMO. No patient died during transportation. Five complications were reported only during the ECMO transports, and all of these were managed without compromising the patient's safety. The preferred modes of transport were by ambulance (70%) and ambulance transported into the fixed wing aircraft (30%) for longer national distances. The survival to hospital discharge of the patients transported with ECMO was 75% among the neonatal transports and 83.3% among the pediatric transports. The survival to hospital discharge of the four patients transported without ECMO was 100% for both neonates and children. CONCLUSIONS Neonatal and pediatric ECMO transports can be safely performed with a dedicated team that maintains stringent adherence to well-designed management protocols.
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Affiliation(s)
- Matteo Di Nardo
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Margherita Lonero
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Elisabetta Pasotti
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Federica Cancani
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Daniela Perrotta
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Corrado Cecchetti
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Francesca Stoppa
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Nicola Pirozzi
- 1 Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Ondina La Salvia
- 2 Department of Medical Cardiology and Pediatric Cardiac Surgery, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Antonella Nicolini
- 2 Department of Medical Cardiology and Pediatric Cardiac Surgery, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Antonio Amodeo
- 3 ECMO and VAD Unit, Children's Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Nicolo' Patroniti
- 4 Department of Surgical Sciences and Integrated Diagnostics, Ospedale Policlinico San Martino, IRCCS for Oncology, University of Genoa, Genoa, Italy
| | - Antonio Pesenti
- 5 Department of Pathophysiology and Transplantation, Ospedale Maggiore Policlinico, IRCCS, Milan, Italy
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Seeing Is Believing: Revealing Cardiopulmonary Resuscitation Quality Through Video Monitoring. Pediatr Crit Care Med 2018; 19:899-900. [PMID: 30180126 DOI: 10.1097/pcc.0000000000001670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bailey KL, Downey P, Sanaiha Y, Aguayo E, Seo YJ, Shemin RJ, Benharash P. National trends in volume-outcome relationships for extracorporeal membrane oxygenation. J Surg Res 2018; 231:421-427. [PMID: 30278962 DOI: 10.1016/j.jss.2018.07.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/21/2018] [Accepted: 07/03/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The use of extracorporeal membrane oxygenation (ECMO) has emerged as a common therapy for severe cardiopulmonary dysfunction. We aimed to describe the relationship of institutional volume with patient outcomes and examine transfer status to tertiary ECMO centers. MATERIALS AND METHODS Using the National Inpatient Sample, we identified adult patients who received ECMO from 2008 to 2014. Individual hospital volume was calculated as tertiles of total institutional discharges for each year independently. RESULTS Of the total 18,684 adult patients placed on ECMO, 2548 (13.6%), 5278 (28.2%), and 10,858 (58.1%) patients were admitted to low-, medium-, and high-volume centers, respectively. Unadjusted mortality at low-volume hospitals was less than that of medium- (43.7% versus 50.3%, P = 0.03) and high-volume hospitals (43.7% versus 55.6%, P < 0.001). Length of stay and cost were reduced at low-volume hospitals compared to both medium- and large-volume institutions (all P < 0.001). In high-volume institutions, transferred patients had greater postpropensity-matched mortality (58.5% versus 53.7%, P = 0.05) and cost ($190,299 versus $168,970, P = 0.009) compared to direct admissions. On exclusion of transferred patients from propensity analysis, mortality remained greater in high-volume compared to low-volume centers (50.2% versus 42.8%, P = 0.04). Predictors of mortality included treatment at high-volume centers, respiratory failure, and cardiogenic shock (all P < 0.001). CONCLUSIONS Our findings show increased in-hospital mortality in high-volume institutions and in patients transferred to tertiary centers. Whether this phenomenon represents selection bias or transfer from another facility deserves further investigation and will aid with the identification of surrogate markers for quality of high-risk interventions.
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Affiliation(s)
- Katherine L Bailey
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Peter Downey
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Yas Sanaiha
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Esteban Aguayo
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Young-Ji Seo
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Richard J Shemin
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Peyman Benharash
- Division of Cardiac Surgery, Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
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Guilló Moreno V, Gutiérrez Martínez A, Romero Berrocal A, Sánchez Castilla M, García-Fernández J. Experience in the management of ECMO therapy as a mortality risk factor. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2018; 65:90-95. [PMID: 29110890 DOI: 10.1016/j.redar.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/13/2017] [Accepted: 09/20/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The extracorporeal oxygenation membrane (ECMO) is a system that provides circulatory and respiratory assistance to patients in cardiac or respiratory failure refractory to conventional treatment. It is a therapy with numerous associated complications and high mortality. Multidisciplinary management and experienced teams increase survival. OBJECTIVE Our purpose is to evaluate and analyse the effect of the learning curve on mortality. METHODS Retrospective and observational study of 31 patients, from January 2012 to December 2015. Patients were separated into 2periods. These periods were divided by the establishment of an ECMO protocol. We compared the quantitative variables by performing the Mann-Whitney U test. For the categorical qualitative variables we performed the chi-square test or Fisher exact statistic as appropriate. The survival curve was computed using the Kaplan-Meier method, and the analysis of statistical significance using the Log-rank test. Data analysis was performed with the STATA programme 14. RESULTS Survival curves show the tendency to lower mortality in the subsequent period (P=0.0601). The overall mortality rate in the initial period was higher than in the subsequent period (P=0.042). In another analysis, we compared the characteristics of the 2groups and concluded that they were homogeneous. CONCLUSION The degree of experience is an independent factor for mortality. The application of a care protocol is fundamental to facilitate the management of ECMO therapy.
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Affiliation(s)
- V Guilló Moreno
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España.
| | - A Gutiérrez Martínez
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - A Romero Berrocal
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - M Sánchez Castilla
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - J García-Fernández
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
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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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38
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Fitzgerald DC, Darling EM, Cardona MF. Staffing, Equipment, Monitoring Considerations for Extracorporeal Membrane Oxygenation. Crit Care Clin 2017; 33:863-881. [PMID: 28887933 DOI: 10.1016/j.ccc.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although the reasons for the recent growth in adult extracorporeal membrane oxygenation (ECMO) are multifactorial, much of the success may be attributed to the development of well-trained staff and the technological innovations in equipment and monitoring devices used during extracorporeal support. In this article, the authors discuss general educational formats for the ECMO bedside provider, staffing support models, and devices designed to best meet the needs of the patient while simultaneously ensuring the proper delivery of ECMO-related care.
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Affiliation(s)
- David C Fitzgerald
- Division of Cardiovascular Perfusion, MUSC College of Health Professions, Medical University of South Carolina, 151B Rutledge Avenue MSC962, Charleston, SC 29425, USA.
| | - Edward M Darling
- Department of Cardiovascular Perfusion, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Monika F Cardona
- Medical University of South Carolina, 165 Ashley Avenue, CH 846, Charleston, SC 29425, USA
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Niziolek KC, Preston TJ, Osborn EC. Transport While on Extracorporeal Membrane Oxygenation Support. Crit Care Clin 2017; 33:883-896. [PMID: 28887934 DOI: 10.1016/j.ccc.2017.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) support for severe acute respiratory failure has been increasing. Evidence suggests that higher volume centers have better outcomes, leading to a need for specialized ECMO transport teams. The inherent nature of the prehospital environment adds an additional layer of complexity; however, the experience of multiple centers has demonstrated that cannulating and transporting a patient on ECMO can be performed safely. The purpose of this review article is to discuss the state of knowledge with respect to ECMO transport with special emphasis given to how to actually undertake such complex transports.
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Affiliation(s)
- Kyle C Niziolek
- Critical Care Medicine, Cooper University Hospital, One Cooper Plaza, D427C, Camden, NJ 08103, USA.
| | - Thomas J Preston
- Innovative ECMO Concepts, Inc, 13181 Waterrock Lane, Arcadia, OK 73007, USA
| | - Erik C Osborn
- Pulmonary Critical Care Sleep Medicine, Fort Belvoir Army Hospital, 9300 DeWitt Loop, FT Belvoir, VA 22060, USA; Uniformed Services University of Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Díaz R, Fajardo C, Rufs J. HISTORIA DEL ECMO (OXIGENACIÓN POR MEMBRANA EXTRACORPÓREA O SOPORTE VITAL EXTRACORPÓREO). REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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41
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Long-Term Morbidity and Mortality in Children After Cardiac Extracorporeal Membrane Oxygenation. Pediatr Crit Care Med 2017; 18:811-812. [PMID: 28796709 DOI: 10.1097/pcc.0000000000001242] [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: 11/25/2022]
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42
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Principle and basic property of the sequential flow pump. J Artif Organs 2017; 20:215-220. [PMID: 28424884 DOI: 10.1007/s10047-017-0959-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
In the emergency care field, early treatment of acute heart or respiratory failure has been a global concern. In severe cases, patients are frequently required to be on an extracorporeal membrane oxygenator (ECMO) life support. To make the ECMO system more compact and portable, we proposed a sequential flow-type centrifugal pump named the sequential flow pump (SFP). In this study, principle and basic properties of this novel blood pump were examined by computational fluid dynamic (CFD) analysis and an experimental model. In the SFP, fluid is given centrifugal force sequentially twice with a single closed impeller. This sequential pressurization mechanism enables high-pressure output without high impeller speed. To realize easy integration of a blood pump with an artificial lung, the inlet and outlet ports are located at lateral side and center of the pump, respectively, which is the reverse configuration of conventional centrifugal pumps. The computational model was composed for CFD analysis and the experimental model was developed for the experiment of the actual pump. For both models, dimension of the impeller and volute was designed to be equal. In the CFD analysis, the SFP could generate higher performance than the single pressurization model with the same rotational speed of the impeller. Basic property of the experimental model was very similar to that of the computational model. The results showed the possibility that the SFP would be more suitable for the compact ECMO system than conventional centrifugal pumps.
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Orrego R, Díaz R. REANIMACIÓN CARDIOPULMONAR EXTRACORPÓREA: LA ÚLTIMA FRONTERA. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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44
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Ericsson A, Frenckner B, Broman LM. Adverse Events during Inter-Hospital Transports on Extracorporeal Membrane Oxygenation. PREHOSP EMERG CARE 2017; 21:448-455. [PMID: 28166435 DOI: 10.1080/10903127.2017.1282561] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) may be a lifesaving rescue therapy in refractory, severe respiratory, and/or circulatory failure. To provide the best cost efficiency to the population served and patient outcome, ECMO therapy should be provided by specialized high volume ECMO centers. This requires dedicated transport teams to organize and perform these complex transports. Concerning adverse events and complications during these transfers, only a minimal amount of data has been published. METHODS To shed light on this matter, all medical transport records from transports on ECMO between January 2010 and June 2016 were analyzed. The data was classified in constituent groups and categorized to risk groups. RESULTS During the study period, 536 transports on ECMO were performed. The transport records could be identified in 514 of these cases (95.9%). In 163 (31.7%) transports 206 adverse events occurred. In 34 transports two or more adverse events passed on the same trip. No deaths occurred during transport. Sixty-five percent (134) of the complications were Patient related; the most prominent was loss of tidal volume with or without fluid flooding of the lung (n = 57, 43%). Lack of control of equipment was the most common Staff related flaw. Causes due to Equipment/technical (n = 30) could be traced to 14.6% of the events. Vehicle/transportation related complications were reported from 26 transfers, a sub-group in which 50% of the reports concerned malfunction of Ambulance utility/electrical, or Wrong ambulance size at hospital or airport. CONCLUSIONS If transporting on ECMO high-risk or sudden threat-of-life situations are inevitable and have to be dealt with immediately, sometimes within seconds. A well-trained staff and an experienced high-volume organization are recommended. Key words: extra corporeal membrane oxygenation; ECMO, transport; adverse event; complication.
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Yetimakman AF, Tanyildiz M, Kesici S, Kockuzu E, Bayrakci B. Continuous Renal Replacement Therapy Applications on Extracorporeal Membrane Oxygenation Circuit. Indian J Crit Care Med 2017; 21:355-358. [PMID: 28701841 PMCID: PMC5492737 DOI: 10.4103/ijccm.ijccm_128_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Continuous venovenous hemofiltration or hemodiafiltration is used frequently in pediatric patients, but experience of continuous renal replacement therapy (CRRT) application on extracorporeal membrane oxygenation (ECMO) circuit is still limited. Among several methods used for applying CRRT on ECMO patients, we aim to share our experience on inclusion of a CRRT device in the ECMO circuit which we believe is easier and safer to apply. MATERIALS AND METHODS The data were collected on demographics, outcomes, and details of the treatment of ECMO patients who had CRRT. During the study period of 3 years, venous cannula of ECMO circuit before pump was used for CRRT access for both the filter inlet and outlet of CRRT machine to minimize the thromboembolic complications. The common indication for CRRT was fluid overload. RESULTS CRRT was used in 3.68% of a total number of patients admitted and 43% of patients on ECMO. The patients have undergone renal replacement therapy for periods of time ranging between 24 h and 25 days (260 h mean). The survival rate of this group of patients with multiorgan failure was 33%. Renal recovery occurred in all of the survivors. Complications such as electrolyte imbalance, hypothermia, and bradykinin syndrome were easily managed. CONCLUSIONS Adding a CRRT device on ECMO circuit is a safe and effective technique. The major advantages of this technique are easy to access, applying CRRT without extra anticoagulation process, preventing potential hemodynamic disturbances, and increased clearance of solutes and fluid overload using larger hemofilter.
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Affiliation(s)
- Ayse Filiz Yetimakman
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Murat Tanyildiz
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Department of Pediatric Intensive Care Medicine, Dr. Sami Ulus Maternity and Children's Training and Research Hospital, Ankara, Turkey
| | - Esra Kockuzu
- Department of Pediatric Intensive Care Medicine, Hacettepe University, Ankara, Turkey
| | - Benan Bayrakci
- Center for Life Support Clinics and Research, Hacettepe University, Ankara, Turkey
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Öztürk E, Yıldız O, Çine N, Tüzün B, Onan S, Ergül Y, Güzeltaş A, Haydin S, Yeniterzi M, Bakır İ. The use of neonatal extracorporeal life support in pediatric cardiac intensive care unit. J Matern Fetal Neonatal Med 2016; 30:1397-1401. [PMID: 27432486 DOI: 10.1080/14767058.2016.1214706] [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] [Indexed: 10/21/2022]
Abstract
AIM The aim of the study is to evaluate extracorporeal life support system (ECLS) employed in neonates in pediatric cardiac intensive care unit. MATERIAL AND METHODS Twenty-five neonates that required ECLS in between November 2010 and November 2015 were evaluated. RESULTS The median age was 12 days (range 3-28 days) and the median body weight was 3 kg (range 2.5-5 kg). Venoarterial ECLS was performed in all of the cases. Ascendan aorta-right atrial cannulation in 22 patients and neck cannulation in three patients were performed. The reason for ECLS was E-CPR in two patients, inability to wean from cardiopulmonary bypass (CPB) in seven patients, respiratory insufficiency and hypoxia in nine patients, low cardiac output (LCOS) in seven patients. Median duration of ECLS was four days (range 1-15). Hemorrhagic complications developed in 15, renal complications in 13, pulmonary complications in 12, infectious complications in 11, neurologic complications in three and mechanical complications in two of the patients. Weaning was successful in 15 of the patients. Eleven patients were successfully discharged. CONCLUSION ECLS is an important treatment option that is performed successfully in many centers around the world to maintain life support in patients unresponsive to medical treatment. The utilization of this modality especially in newborns with congenital heart disease should be taken into consideration.
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Affiliation(s)
- Erkut Öztürk
- a Department of Pediatric Cardiology , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey and
| | - Okan Yıldız
- b Department of Pediatric Cardiovascular Surgery , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey
| | - Nihat Çine
- b Department of Pediatric Cardiovascular Surgery , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey
| | - Behzat Tüzün
- b Department of Pediatric Cardiovascular Surgery , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey
| | - Selen Onan
- b Department of Pediatric Cardiovascular Surgery , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey
| | - Yakup Ergül
- a Department of Pediatric Cardiology , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey and
| | - Alper Güzeltaş
- a Department of Pediatric Cardiology , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey and
| | - Sertaç Haydin
- b Department of Pediatric Cardiovascular Surgery , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey
| | - Mehmet Yeniterzi
- b Department of Pediatric Cardiovascular Surgery , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey
| | - İhsan Bakır
- b Department of Pediatric Cardiovascular Surgery , Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery, Research and Training Hospital , Istanbul , Turkey
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Squiers JJ, Lima B, DiMaio JM. Contemporary extracorporeal membrane oxygenation therapy in adults: Fundamental principles and systematic review of the evidence. J Thorac Cardiovasc Surg 2016; 152:20-32. [DOI: 10.1016/j.jtcvs.2016.02.067] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/30/2016] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
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Nicolas F, Daniel J, Fournier J, Bruniaux J, Binet J. Circulatory assistance by way of long-term cardiopulmonary bypass. Perfusion 2016. [DOI: 10.1177/026765918900400108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
From 1978 to 1986, 46 patients underwent prolonged circulatory support of 5-39 hours duration, at the Centre Chirurgical Marie Lannelongue. Indication for circulatory support was decided in the immediate postoperative stage, or later in patients with major, intractable heart failure, not responsive to standard resuscitative treatment. Patient details and equipment used are described, together with the details of monitoring. Outcome was favourable in 20 to 35% of cases, depending on the severity of the underlying cardiac pathology. Circulatory support by way of cardiopulmonary bypass (CPB) proved a readily feasible and reliable procedure. The method is an effective resuscitative technique, applicable in cases of reversible underlying pathology. In extreme cases, it may constitute an intermediate step before proceeding to cardiac transplantation or total circulatory support using a mechanical device such as an artificial heart.
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Affiliation(s)
- F. Nicolas
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
| | - J.P. Daniel
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
| | - J.F. Fournier
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
| | - J. Bruniaux
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
| | - J.P. Binet
- Centre Chirurgical Marie Lannelongue, Le Plessis Robinson
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Broman LM, Frenckner B. Transportation of Critically Ill Patients on Extracorporeal Membrane Oxygenation. Front Pediatr 2016; 4:63. [PMID: 27379221 PMCID: PMC4904149 DOI: 10.3389/fped.2016.00063] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 05/30/2016] [Indexed: 11/13/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) may be a life-saving procedure for patients with severe reversible pulmonary or cardiac failure or for patients in need for a bridge to transplantation. ECMO is provided by specialized centers, but patients in need of ECMO are frequently taken care of at other centers. Conventional transports to an ECMO center can be hazardous and deaths have been described. For this reason, many ECMO centers have developed transport programs with mobile ECMO. After request, the mobile team including all necessary equipment to initiate ECMO is sent to the referring hospital, where the patient is cannulated and ECMO commenced. The patient is then transported on ECMO to the ECMO facility by road, helicopter, or fixed-wing aircraft depending on distance, weather conditions, etc. Eight publications have reported series of more than 50 transports on ECMO of which the largest included over 700. Together, these papers report on more than 1400 patient transports on ECMO. Two deaths during transport have occurred. A number of other adverse events are described, but without effect on patient outcome. Survival of patients transported on ECMO is equivalent to that of non-transported ECMO patients. It is concluded that long-, short-distance interhospital transports on ECMO can be performed safely. The staff should be experienced and highly competent in intensive care, ECMO cannulation, ECMO treatment, intensive care transport, and air transport medicine.
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Affiliation(s)
| | - Björn Frenckner
- ECMO Center, Karolinska University Hospital, Stockholm, Sweden
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Kapur NK, Zisa DC. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) fails to solve the haemodynamic support equation in cardiogenic shock. EUROINTERVENTION 2016; 11:1337-9. [DOI: 10.4244/eijv11i12a261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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