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Reid TD, Crespo Regalado R, Carlson R, Schneider A, Boone JS, Hockran S, Butler LR, Perez DL, Holloway AD, Nguyen PG, Gallaher J, Charles AG, Raff L. Outcomes in Obese Adult Veno-Venous Extracorporeal Membrane Oxygenation: A Systematic Review. ASAIO J 2024; 70:86-92. [PMID: 37850988 DOI: 10.1097/mat.0000000000002068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Obesity is associated with an overall increased risk of morbidity and mortality. However, in patients with critical illness, sepsis, and acute respiratory distress syndrome, obesity may be protective, termed "the obesity paradox." This is a systematic literature review of articles published from 2000 to 2022 evaluating complications and mortality in adults with respiratory failure on veno-venous extracorporeal membrane oxygenation (VV ECMO) based on body mass index (BMI). Eighteen studies with 517 patients were included. Common complications included acute renal failure (175/377, 46.4%), venous thrombosis (175/293, 59.7%), and bleeding (28/293, 9.6%). Of the six cohort studies, two showed improved mortality among obese patients, two showed a trend toward improved mortality, and two showed no difference. Comparing all patients in the studies with BMI of less than 30 to those with BMI of greater than or equal to 30, we noted decreased mortality with obesity (92, 37.1% of BMI <30 vs. 30, 11% of BMI ≥30, p ≤ 0.0001). Obesity may be protective against mortality in adult patients undergoing VV ECMO. Morbid and super morbid obesity should not be considered a contraindication to cannulation, with patients with BMI ≥ 80 surviving to discharge. Complications may be high, however, with higher rates of continuous renal replacement therapy and thrombosis among obese patients.
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Affiliation(s)
- Trista D Reid
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ricardo Crespo Regalado
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rebecca Carlson
- Health Sciences Library, University Libraries, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew Schneider
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joshua S Boone
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sophie Hockran
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Logan R Butler
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dakota L Perez
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alexa D Holloway
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Phu G Nguyen
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jared Gallaher
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anthony G Charles
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lauren Raff
- From the Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Augustin KJ, Creel‐Bulos CM, Budhrani GF, Miller CF, Fiza B. Extracorporeal membrane oxygenation as acute rescue therapy for negative pressure pulmonary edema in the post anesthesia care unit: A case report. Clin Case Rep 2023; 11:e7606. [PMID: 37397579 PMCID: PMC10314190 DOI: 10.1002/ccr3.7606] [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: 03/03/2023] [Revised: 05/25/2023] [Accepted: 06/09/2023] [Indexed: 07/04/2023] Open
Abstract
Negative pressure pulmonary edema (NPPE) may result in respiratory failure refractory to conventional management strategies. Venovenous extracorporeal membrane oxygenation (VV ECMO) can serve as a rescue therapy in cases of severe respiratory failure. Rapid initiation of VV ECMO can decrease morbidity and mortality while facilitating early liberation from mechanical ventilation and promoting early rehabilitation. We describe the successful utilization of VV ECMO as rescue therapy for severe NPPE-induced hypoxic respiratory failure and peri-arrest state in the postanesthesia care unit (PACU) in a patient with postextubation airway obstruction after undergoing patellar tendon repair.
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Affiliation(s)
- Katrina J. Augustin
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Christina M. Creel‐Bulos
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Gaurav F. Budhrani
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Casey F. Miller
- Department of Surgery, Division of Cardiothoracic SurgeryEmory UniversityAtlantaGeorgiaUSA
| | - Babar Fiza
- Department of Anesthesiology, Division of Critical Care MedicineEmory UniversityAtlantaGeorgiaUSA
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Wada D, Maruyama S, Yoshihara T, Saito F, Yoshiya K, Nakamori Y. Hybrid emergency room: Installation, establishment, and innovation in the emergency department. Acute Med Surg 2023; 10:e856. [PMID: 37266185 PMCID: PMC10231267 DOI: 10.1002/ams2.856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
A novel trauma workflow system called the hybrid emergency room (Hybrid ER) that combines a sliding computed tomography (CT) scanning system with interventional radiology features was first installed in Osaka General Medical Center in 2011. The Hybrid ER enables CT diagnosis and emergency therapeutic interventions without transferring the patient to another examination room. In this article, the history of CT in trauma care, the world's first installation of the Hybrid ER, clinical experiences, and evidence for the Hybrid ER in trauma workflow and nontrauma fields are summarized, and the future and innovation of the Hybrid ER are reviewed.
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Affiliation(s)
- Daiki Wada
- Department of Emergency and Critical Care MedicineKansai Medical University General Medical CenterMoriguchiJapan
| | - Shuhei Maruyama
- Department of Emergency and Critical Care MedicineKansai Medical University General Medical CenterMoriguchiJapan
| | - Tomoyuki Yoshihara
- Department of Emergency and Critical Care MedicineKansai Medical University General Medical CenterMoriguchiJapan
| | - Fukuki Saito
- Department of Emergency and Critical Care MedicineKansai Medical University General Medical CenterMoriguchiJapan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care MedicineKansai Medical University General Medical CenterMoriguchiJapan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care MedicineKansai Medical University General Medical CenterMoriguchiJapan
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Kojima H, Ebana H, Hikone M, Kobayashi A. Severe re-expansion pulmonary oedema requiring veno-venous extracorporeal membrane oxygenation treatment. BMJ Case Rep 2022; 15:e249664. [PMID: 35580947 PMCID: PMC9115024 DOI: 10.1136/bcr-2022-249664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hiroki Kojima
- Department of Emergency Medicine (Tokyo Emergency Room), Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Japan
| | - Hiroki Ebana
- Department of Thoracic Surgery, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Japan
| | - Mayu Hikone
- Department of Emergency Medicine (Tokyo Emergency Room), Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Japan
| | - Aki Kobayashi
- Department of Thoracic Surgery, Tokyo Metropolitan Bokutoh Hospital, Sumida-ku, Japan
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