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Calhoun A, Szabo C, Convissar D, Pisano DV, Ortoleva J. Beyond Venoarterial and Venovenous Extracorporeal Membrane Oxygenation: Novel Cannulation Strategies. J Cardiothorac Vasc Anesth 2024; 38:1830-1835. [PMID: 38890087 DOI: 10.1053/j.jvca.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 06/20/2024]
Affiliation(s)
| | - Christopher Szabo
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT
| | - David Convissar
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | - Jamel Ortoleva
- Department of Anesthesiology, Boston Medical Center, Boston, MA
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2
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Brewer JM, Lorusso R, Broman LM, Conrad SA, Swol J, Maybauer MO. Central Venopulmonary Extracorporeal Membrane Oxygenation: Background and Standardized Nomenclature. ASAIO J 2024; 70:e123-e128. [PMID: 38768563 PMCID: PMC11356689 DOI: 10.1097/mat.0000000000002239] [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: 05/22/2024] Open
Abstract
This review highlights advancements in extracorporeal life support (ECLS), emphasizing the critical role of standardized terminology, particularly for extracorporeal membrane oxygenation (ECMO) in treating right ventricular and respiratory failure. Advocating for the adoption of the Extracorporeal Life Support Organization (ELSO) Maastricht Treaty for ECLS Nomenclature guidelines, it aims to resolve communication barriers in the ECMO field. Focusing on venopulmonary (VP) ECMO utilizing central pulmonary artery (PA) access, this review details surgical approaches and introduces a terminology guide to support effective knowledge exchange and advancements in patient care.
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Affiliation(s)
- J. Michael Brewer
- From the Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
- Queen’s University Health Quality Programs, Kingston, ON, Canada
| | - Roberto Lorusso
- Extracorporeal Life Support (ECLS) Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - L. Mikael Broman
- Extracorporeal Membrane Oxygenation (ECMO) Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Steven A. Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Marc O. Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, Florida
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3
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Capoccia M, Brewer JM, Rackauskas M, Becker TK, Maybauer DM, Stukov Y, Lorusso R, Maybauer MO. Outcome of Veno-Pulmonary Extracorporeal Life Support in Lung Transplantation Using ProtekDuo Cannula: A Systematic Review and Description of Configurations. J Clin Med 2024; 13:4111. [PMID: 39064150 PMCID: PMC11277848 DOI: 10.3390/jcm13144111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 06/29/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Refractory end-stage pulmonary failure may benefit from extracorporeal life support (ECLS) as a bridge to lung transplantation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) has been recommended for patients who have failed conventional medical therapy and mechanical ventilation. Veno-arterial (VA) ECMO may be used in patients with acute right ventricular (RV) failure, haemodynamic instability, or refractory respiratory failure. Peripheral percutaneous approaches, either dual-site single-lumen cannulation for veno-pulmonary (VP) ECMO or single-site dual-lumen (dl)VP ECMO, using the ProtekDuo right ventricular assist device (RVAD) cannula, has made this configuration a desirable option as a bridge to transplantation. These configurations support the right ventricle, prevent recirculation by placing the tricuspid and pulmonary valve between the drainage and return cannulas, provide the direct introduction of oxygenated blood into the pulmonary artery, and have been shown to decrease the incidence of acute kidney injury (AKI), requiring continuous renal replacement therapy (CRRT) in certain disease states. This promotes haemodynamic stability, potential sedation-weaning trials, extubation, mobilisation, and pre-transplant rehabilitation. Methods: A web-based literature search in PubMed and EMBASE was undertaken based on a combination of keywords. The PICOS and PRISMA approaches were used. Results: Four case series were identified out of 323 articles, with a total of 34 patients placed on VP ECMO as a bridge to lung transplantation. All relevant data are reviewed and integrated into the Discussion. Conclusions: Despite the limited available evidence, the use of ProtekDuo has become very promising for the management of end-stage lung disease as a bridge to lung transplantation.
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Affiliation(s)
- Massimo Capoccia
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - Joseph M. Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK 73112, USA;
- Queen’s University Health Quality Programs, Kingston, ON K7L 3N6, Canada
| | - Mindaugas Rackauskas
- Department of Surgery, Division of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.R.); (Y.S.)
| | - Torben K. Becker
- Department of Emergency Medicine, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Dirk M. Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35032 Marburg, Germany;
| | - Yuriy Stukov
- Department of Surgery, Division of Thoracic Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA; (M.R.); (Y.S.)
| | - Roberto Lorusso
- Extracorporeal Life Support (ECLS) Centrum, Cardio-Thoracic Surgery and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), 6229 ER Maastricht, The Netherlands;
- Cardiovascular Research Institute (CARIM), 6229 ER Maastricht, The Netherlands
| | - Marc O. Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35032 Marburg, Germany;
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane 4032, Australia
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Brewer JM, Maybauer MO. The ProtekDuo Cannula: A Comprehensive Review of Efficacy and Clinical Applications in Right Ventricular Failure. J Clin Med 2024; 13:4077. [PMID: 39064117 PMCID: PMC11278424 DOI: 10.3390/jcm13144077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Right ventricular failure (RVF) is a clinical challenge associated with various underlying acute and chronic medical conditions, necessitating diverse management strategies including mechanical circulatory support (MCS). The ProtekDuo cannula represents an important advancement in medical devices for MCS in the setting of RVF. When combined with an extracorporeal blood pump, the dual-lumen design allows for direct bypass of the RV using simultaneous drainage and return of blood using percutaneous, single-site access. Studies have reported favorable outcomes with the ProtekDuo cannula and low device-related complications, but comparative studies with other MCS devices are limited. Still, the ProtekDuo cannula has numerous advantages; however, it is not without challenges, and opportunities for further research exist. The ProtekDuo cannula holds significant potential for future advancements in the field of MCS, offering promising solutions for RVF management.
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Affiliation(s)
- Joseph M. Brewer
- Specialty Critical Care and Acute Circulatory Support Service, Nazih Zuhdi Transplant Institute, INTEGRIS Health Baptist Medical Center, Oklahoma City, OK 73112, USA
| | - Marc O. Maybauer
- Division of Critical Care Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL 32610, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, 35037 Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD 4072, Australia
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Crawford B, Rawal S, Rackauskas M, Maybauer MO. Transesophageal Echocardiography-Guided ProtekDuo Percutaneous Temporary Right Ventricular Assist Device Cannulation Technique. Ann Card Anaesth 2024; 27:280-281. [PMID: 38963370 PMCID: PMC11315245 DOI: 10.4103/aca.aca_58_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/15/2024] [Accepted: 04/05/2024] [Indexed: 07/05/2024] Open
Affiliation(s)
- Bronson Crawford
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Shiv Rawal
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Mindaugas Rackauskas
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Marc O. Maybauer
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Anaesthesia and Intensive Care, Philipps University, Marburg, Germany
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, Australia
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Maybauer MO, Rackauskas M, Brewer JM, Becker TK. Concurrent veno-pulmonary extracorporeal membrane oxygenation cannulation with ProtekDuo parallel to an in situ veno-pulmonary single-lumen cannula. Perfusion 2024:2676591241264119. [PMID: 38900997 DOI: 10.1177/02676591241264119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
This technical report describes the successful transition from dual lumen, single site veno-venous extracorporeal membrane oxygenation ((dl)V-V ECMO) to single lumen, dual site veno-pulmonary (V-P) ECMO, and subsequently to dual lumen, single site (dl)V-P ECMO involving temporary placement of two cannulas in the main pulmonary artery. No complications were observed during these transitions. This technique could address concerns related to cannula exchanges in VP ECMO. However, caution is warranted and constant monitoring of cannula position using real-time imaging is required when using this technique due to the risk profile.
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Affiliation(s)
- Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of FloridaCollege of Medicine, Gainesville, FL, USA
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, AUS
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
| | - Mindaugas Rackauskas
- Department of Surgery, Division of Thoracic Surgery, University of FloridaCollege of Medicine, Gainesville, FL, USA
| | - J Michael Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Torben K Becker
- Department of Emergency Medicine, Division of Critical Care Medicine, University of FloridaCollege of Medicine, Gainesville, FL, USA
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Saha BK, Brewer JM, Maybauer MO. Venopulmonary Extracorporeal Membrane Oxygenation and the Importance of Nomenclature Adherence for an Emerging Mode. Crit Care Med 2024; 52:e323-e324. [PMID: 38752822 DOI: 10.1097/ccm.0000000000006154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Affiliation(s)
- Biplab K Saha
- Lung Transplantation and ECMO Program, Department of Pulmonary, Critical Care and Sleep Medicine, University of Florida College of Medicine, Gainesville, FL
| | - J Michael Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Health Baptist Medical Center, Oklahoma City, OK
| | - Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
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Salazar-Rojas LA, García Gómez DI, Pinzon Martinez YV, Lasso Perdomo JP, Soto Ramirez JC, Gorgadze T, Mendoza Monsalve MA, Vasquez Rincon RF, Castillo Blanco MA, Pizarro Gomez CE, Bermon Angarita A. Venopulmonary Artery Extracorporeal Life Support (VPa ECMO): A Novel Strategy for Refractory Hypoxemia Complicating VV ECMO. ASAIO J 2024; 70:365-370. [PMID: 38261534 DOI: 10.1097/mat.0000000000002125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Refractory hypoxemia (RH) during venovenous extracorporeal membrane oxygenation (VV ECMO) support is a complex problem that limits the benefit of this therapy. The need for sustained deep sedation and delays in active rehabilitation are considered as a direct consequence of RH. Changing from VV ECMO to a configuration that returns the flow to pulmonary artery, such as venopulmonary extracorporeal membrane oxygenation (VPa ECMO) may decrease recirculation and improve systemic oxygen delivery. We present a retrospective report that describes the impact of VPa ECMO on oxygenation during sedation withdrawal in 41 patients who received VV ECMO for coronavirus disease 2019 (COVID-19). We evidenced that arterial oxygen pressure (PaO 2 ) increased from 68 to 112.3 mm Hg ( p = 0.001) with a reduction of ECMO flow (5.7-4.8 L/m; p = 0.001). Other findings included lower rates of depth sedation (Richmond Agitation Sedation Scale [RASS] ≤3, 37-63%; p = 0.007) and lower requirement inotropic support assessed by LVIS score (4.7-1.1; p = 0.005). Discharge survival was 54% with a sustained benefit until day 79. This cannulation strategy improved effectively PaO 2 in this cohort, it may be an alternative in patients with RH in VV ECMO.
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Affiliation(s)
| | | | | | | | - Juan Carlos Soto Ramirez
- From the ECMO and VAD program, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia
| | - Tamar Gorgadze
- Catheterization laboratory, Chief medical officer IC-HIC, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia
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Bagate F, Masi P, Boukantar M, Radu C, Saiydoun G, Fiore A, Chiaroni PM, Teiger E, Folliguet T, Gallet R, Mekontso Dessap A. Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: the role of conversion to veno-pulmonary arterial assist-a case series. Front Med (Lausanne) 2024; 11:1348077. [PMID: 38725464 PMCID: PMC11079173 DOI: 10.3389/fmed.2024.1348077] [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: 12/01/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Pulmonary vascular dysfunction during severe acute respiratory distress syndrome (ARDS) may lead to right ventricle (RV) dysfunction and acute cor pulmonale (ACP). The occurrence/persistence of ACP despite conventional extracorporeal membrane oxygenation (ECMO) is a challenging situation. We explored the usefulness of a specific dual-lumen cannula that bypasses the RV, and on which a veno-pulmonary arterial assist (V-P ECMO) was mounted, in ARDS patients. Methods We report a case-series of ARDS patients put on conventional veno-arterial or veno-venous ECMO and presented refractory ACP as an indication for a reconfiguration to V-P ECMO using the ProtekDuo cannula. The primary endpoint was the mitigation of RV and pulmonary vascular dysfunction as assessed by the change in end-diastolic RV/left ventricle (LV) surface ratio. Results Six patients had their conventional ECMO reconfigured to V-P ECMO to treat refractory ACP. There was a decrease in end-diastolic RV/LV surface ratio, as well as end-systolic LV eccentricity index, and lactatemia immediately after V-P ECMO initiation. The resolution of refractory ACP was immediately achieved in four of our six (66%) patients. The V-P ECMO was weaned after a median of 26 [8-93] days after implantation. All but one patient were discharged home. We detected one case of severe hemolysis with V-P ECMO and two suspected cases of right-sided infective endocarditis. Conclusion V-P ECMO is useful to mitigate RV overload and to improve hemodynamics in case of refractory ACP despite conventional ECMO.
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Affiliation(s)
- François Bagate
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Médecine Intensive Réanimation, Créteil, France
- Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, France
| | - Paul Masi
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Médecine Intensive Réanimation, Créteil, France
- Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, France
| | - Madjid Boukantar
- APHP, Hôpitaux Universitaires Henri Mondor, Service de Cardiologie, Créteil, France
| | - Costin Radu
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | - Gabriel Saiydoun
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | - Antonio Fiore
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | | | - Emmanuel Teiger
- APHP, Hôpitaux Universitaires Henri Mondor, Service de Cardiologie, Créteil, France
| | - Thierry Folliguet
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | - Romain Gallet
- APHP, Hôpitaux Universitaires Henri Mondor, Service de Cardiologie, Créteil, France
- U955-IMRB, Equipe 03, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), Maisons-Alfort, France
| | - Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Médecine Intensive Réanimation, Créteil, France
- Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, France
- INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
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Tomarchio E, Momigliano F, Giosa L, Collins PD, Barrett NA, Camporota L. The intricate physiology of veno-venous extracorporeal membrane oxygenation: an overview for clinicians. Perfusion 2024; 39:49S-65S. [PMID: 38654449 DOI: 10.1177/02676591241238156] [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: 04/26/2024]
Abstract
During veno-venous extracorporeal membrane oxygenation (V-V ECMO), blood is drained from the central venous circulation to be oxygenated and decarbonated by an artificial lung. It is then reinfused into the right heart and pulmonary circulation where further gas-exchange occurs. Each of these steps is characterized by a peculiar physiology that this manuscript analyses, with the aim of providing bedside tools for clinical care: we begin by describing the factors that affect the efficiency of blood drainage, such as patient and cannulae position, fluid status, cardiac output and ventilatory strategies. We then dig into the complexity of extracorporeal gas-exchange, with particular reference to the effects of extracorporeal blood-flow (ECBF), fraction of delivered oxygen (FdO2) and sweep gas-flow (SGF) on oxygenation and decarbonation. Subsequently, we focus on the reinfusion of arterialized blood into the right heart, highlighting the effects on recirculation and, more importantly, on right ventricular function. The importance and challenges of haemodynamic monitoring during V-V ECMO are also analysed. Finally, we detail the interdependence between extracorporeal circulation, native lung function and mechanical ventilation in providing adequate arterial blood gases while allowing lung rest. In the absence of evidence-based strategies to care for this particular group of patients, clinical practice is underpinned by a sound knowledge of the intricate physiology of V-V ECMO.
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Affiliation(s)
- Emilia Tomarchio
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Francesca Momigliano
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Lorenzo Giosa
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Patrick Duncan Collins
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Nicholas A Barrett
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Luigi Camporota
- Department of Critical Care Medicine, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
- Centre for Human and Applied Physiological Sciences, School of Basic and Medical Biosciences, King's College London, London, UK
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Brewer JM, Broman LM, Swol J, Lorusso R, Conrad SA, Maybauer MO. Standardized nomenclature for peripheral percutaneous cannulation of the pulmonary artery in extracorporeal membrane oxygenation: Current uptake and recommendations for improvement. Perfusion 2023:2676591231210457. [PMID: 37930875 DOI: 10.1177/02676591231210457] [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: 11/08/2023]
Abstract
The rising application of extracorporeal membrane oxygenation (ECMO) has emphasized the need for consistent and standardized terminology, especially concerning peripheral percutaneous cannulation of the pulmonary artery (PPC-PA). The Extracorporeal Life Support Organization (ELSO) Nomenclature Task Force produced the ELSO Maastricht Treaty for extracorporeal life support (ECLS) Nomenclature to address this challenge. However, adherence to nomenclature recommendations has been poor in publications describing PPC-PA. We aim to describe common nomenclature errors and provide a user-guide for abbreviations that can be used by authors, reviewers, and journal staff to ensure properadherence to standardized nomenclature in publications describing PPC-PA.
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Affiliation(s)
- J Michael Brewer
- Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - L Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Roberto Lorusso
- ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center, Maastricht (MUMC), The Netherlands
- Cardiovascular Research Institute (CARIM), Maastricht, the Netherlands
| | - Steven A Conrad
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, FL, USA
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Ritter LA, Haj Bakri M, Fahey HC, Sanghavi KK, Kallur A, Bien-Aime F, Sallam T, Alassar A, Balsara K, Kitahara H, MacGillivray TE, Zaaqoq AM. Pulmonary Artery Dual-Lumen Cannulation Versus Two Cannula Percutaneous Extracorporeal Membrane Oxygenation Configuration in Right Ventricular Failure. ASAIO J 2023; 69:766-773. [PMID: 37145800 DOI: 10.1097/mat.0000000000001950] [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: 05/06/2023] Open
Abstract
Refractory right ventricular failure has significant morbidity and mortality. Extracorporeal membrane oxygenation is indicated when medical interventions are deemed ineffective. However, it is still being determined if one configuration is better. We conducted a retrospective analysis of our institutional experience comparing the peripheral veno-pulmonary artery (V-PA) configuration versus the dual-lumen cannula with the tip in the pulmonary artery (C-PA). The analysis of a cohort of 24 patients (12 patients in each group). There was no difference in survival after hospital discharge (58.3% in the C-PA group compared to 41.7% in the V-PA group, p = 0.4). Among the C-PA group, there was a statistically significant shorter ICU length of stay (23.5 days [interquartile range {IQR} = 19-38.5] vs. 43 days [IQR = 30-50], p = 0.043) and duration of mechanical ventilation (7.5 days [IQR = 4.5-9.5] compared to (16.5 days [IQR = 9.5-22.5], p = 0.006) in the V-PA group. In the C-PA group, there were lower incidents of bleeding (33.33% vs. 83.33%, p =0.036) and combined ischemic events (0 vs. 41.67%, p = 0.037). In our single-center experience, the C-PA configuration might have a better outcome than the V-PA one. Further studies are needed to confirm our findings.
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Affiliation(s)
- Lindsay A Ritter
- From the Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Mouaz Haj Bakri
- From the Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Heather C Fahey
- Department of Cardiology, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | | | - Akhil Kallur
- Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Fred Bien-Aime
- Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Tariq Sallam
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, Rhode Island
| | - Aiman Alassar
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Keki Balsara
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Hiroto Kitahara
- Department of Cardiothoracic Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Thomas E MacGillivray
- Department of Cardiac Surgery, MedStar Washington Hospital Center, Georgetown University, Washington, DC
| | - Akram M Zaaqoq
- From the Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
- Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Washington, DC
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13
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El Banayosy AM, El Banayosy A, Smith JG, Brewer JM, Mihu MR, Swant LV, Schoaps RS, Sharif A, Benson C, Maybauer MO. Extracorporeal life support in pregnant and postpartum women with COVID-19-related acute respiratory distress syndrome. Int J Artif Organs 2023; 46:289-294. [PMID: 37051661 PMCID: PMC10099914 DOI: 10.1177/03913988231168431] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) is an intervention used for patients with acute respiratory distress syndrome (ARDS) from COVID-19 who have failed conventional ventilatory strategies. Very few studies have given insight into the outcomes of pregnant and postpartum patients requiring ECMO support. METHODS Single center, retrospective, observational study of female pregnant and postpartum patients suffering COVID-19 ARDS and requiring ECMO. RESULTS Eight SARS-CoV-2 positive patients were identified. The average age was 31 ± 4 years, with Body Mass Indices (BMI) and SOFA scores ranging between 32-49 and 8-11, respectively. Two patients were pregnant at the time of ECMO initiation, two were peripartum, and four were postpartum. Five patients (63%) had bleeding, and one patient had a hysterectomy. Seven patients (88%) were supported by V-V ECMO and one with V-A ECMO. Patients had between one and three circuit exchanges due to oxygenator failure or clots in the circuit. All patients were in ICU between 7 and 74 days, with hospital length of stay between 8 and 81 days. All patients were weaned off ECMO and were successfully discharged from the hospital. All newborns were born via cesarean section, and all survived to discharge. CONCLUSION Our study shows a 100% neonatal and maternal survival rate demonstrating that ECMO in this patient population is safe. These patients should be transferred to experienced high-volume ECMO centers with the ability to perform emergent cesarean sections. ECMO should be considered a life-saving therapy for pregnant women with severe COVID-19 with an overall excellent maternal and neonatal survival rate.
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Affiliation(s)
- Ahmed M El Banayosy
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Aly El Banayosy
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Jennifer G Smith
- The Perinatal Center, Maternal Fetal Medicine, Oklahoma City, OK, USA
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Mircea R Mihu
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
- Department of Medicine/Cardiology, Oklahoma State University, Tulsa, OK, USA
| | - Laura V Swant
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Robert S Schoaps
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Ammar Sharif
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Clayne Benson
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
| | - Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock & ECMO Service, Integris Health, Oklahoma City, OK, USA
- Department of Medicine/Cardiology, Oklahoma State University, Tulsa, OK, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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14
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Lee TML, Bianchi P, Kourliouros A, Price LC, Ledot S. Percutaneous oxygenated right ventricular assist device for pulmonary embolism: A case series. Artif Organs 2023; 47:595-603. [PMID: 36265137 DOI: 10.1111/aor.14420] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/20/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
Acute right ventricular (RV) failure following massive pulmonary embolism (PE) can have significant hemodynamic consequences and is the mode of death. Temporary mechanical circulatory support can provide tissue perfusion required while thrombectomy or lysis-aimed therapies act to relieve the thrombotic obstruction. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) has conventionally been the first line MCS. A more selective approach to RV support has been advocated in the form of an extracorporeal right ventricular assist device (RVAD) as it mitigates some of the shortcomings of V-A ECMO. We present the first case series of four patients who received fully percutaneous RVAD, with an integrated oxygenator forming an Oxy-RVAD, for selective right heart support following massive PE, including the application of single-access dual-lumen right atrium to pulmonary artery cannula. All patients achieved RV recovery and were successfully weaned from oxy-RVAD support within 5-10 days demonstrating the feasibility of selective percutaneous right heart support in managing these challenging patients.
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Affiliation(s)
- Teresa M L Lee
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK.,Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paolo Bianchi
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK.,Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, Royal Brompton & Harefield Hospitals (part of Guy's and St Thomas's Foundation Trust), London, UK.,Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Imperial College London, London, UK
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15
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Maybauer MO, Capoccia M, Maybauer DM, Lorusso R, Swol J, Brewer JM. The ProtekDuo in ECMO configuration for ARDS secondary to COVID-19: A systematic review. Int J Artif Organs 2023; 46:93-98. [PMID: 36495090 PMCID: PMC9747364 DOI: 10.1177/03913988221142904] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Assessment of the results of the ProtekDuo cannula applied for dedicated right ventricular support with oxygenator in ARDS secondary to COVID-19. METHODS Systematic literature search in NHS library, Medline (Pubmed) and EMBASE using appropriate keywords as well as PICOS and PRISMA approach. RESULTS Out of 285 publications found, 5 publications met the search criteria and were included in this review. A total of 194 patients with ARDS secondary to COVID-19 underwent ProtekDuo placement to establish a combination of respiratory [veno-venous extracorporeal membrane oxygenation (V-V ECMO)] and right ventricular support. Patients treated using the ProtekDuo cannula had survival rates between 59% and 89% throughout the five studies, and a significant survival benefit when compared to an invasive ventilation group or compared to dual site V-V ECMO or other double lumen ECMO cannulas. One study focused on extubation and discontinuation of ventilator support, which could be achieved in 100% of ProtekDuo patients. An association for reduced incidence of acute kidney injury (AKI) and use of continuous renal replacement therapy (CRRT) could be shown when the ProtekDuo was used. CONCLUSION Only limited literature is available for the ProtekDuo in V-P ECMO configuration in the setting of COVID-19 ARDS and should be interpreted with caution. Data on the ProtekDuo is suggestive for lower rates of mortality, AKI and CRRT as compared to other respiratory support modalities.
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Affiliation(s)
- Marc O Maybauer
- Nazih Zuhdi Transplant Institute,
Advanced Cardiac and Specialty Critical Care, Oklahoma City, OK, USA
- Department of Anaesthesiology and
Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince
Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Anesthesiology, Division
of Critical Care Medicine, University of Florida College of Medicine, Gainesville,
FL, USA
| | - Massimo Capoccia
- Department of Cardiac Surgery, Leeds
General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dirk M Maybauer
- Department of Anaesthesiology and
Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince
Charles Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Roberto Lorusso
- ECLS Centrum, Cardio -Thoracic Surgery
Department, Heart & Vascular Center, Maastricht University Medical Center,
Maastricht (MUMC), The Netherlands; and Cardiovascular Research Institute (CARIM),
Maastricht, The Netherlands
| | - Justyna Swol
- Department of Pneumology, Allergology
and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute,
Advanced Cardiac and Specialty Critical Care, Oklahoma City, OK, USA
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16
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James L, Smith DE. Supporting the "forgotten" ventricle: The evolution of percutaneous RVADs. Front Cardiovasc Med 2023; 9:1008499. [PMID: 36684567 PMCID: PMC9845717 DOI: 10.3389/fcvm.2022.1008499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/30/2022] [Indexed: 01/06/2023] Open
Abstract
Right heart failure (RHF) can occur as the result of an acute or chronic disease process and is a challenging clinical condition for surgeons and interventionalists to treat. RHF occurs in approximately 0.1% of patients after cardiac surgery, in 2-3% of patients following heart transplantation, and in up to 42% of patients after LVAD implantation. Regardless of the cause, RHF portends high morbidity and mortality and is associated with longer hospital stays and higher healthcare costs. The mainstays of traditional therapy for severe RHF have included pharmacological support, such as inotropes and vasopressors, and surgical right ventricular (RV) assist devices. However, in recent years catheter-based mechanical circulatory support (MCS) strategies have offered novel solutions for addressing RHF without the morbidity of open surgery. This manuscript will review the pathophysiology of RHF, including the molecular underpinnings, gross structural mechanisms, and hemodynamic consequences. The evolution of techniques for supporting the right ventricle will be explored, with a focus on various institutional experiences with percutaneous ventricular assist devices.
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17
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El Banayosy AM, El Banayosy A, Brewer JM, Mihu MR, Chidester JM, Swant LV, Schoaps RS, Sharif A, Maybauer MO. The ProtekDuo for percutaneous V-P and V-VP ECMO in patients with COVID-19 ARDS. Int J Artif Organs 2022; 45:1006-1012. [PMID: 36085584 PMCID: PMC9465053 DOI: 10.1177/03913988221121355] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The ProtekDuo with oxygenator mimics veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) in veno-pulmonary (V-P) configuration. We have recently developed a new configuration by utilizing a 25 Fr multistage femoral venous drainage cannula and by returning oxygenated blood through both lumina of the double lumen ProtekDuo cannula (V-VP configuration), thereby creating partial right ventricular bypass and oxygenated blood flow of up to seven LPM. We investigated our experience with V-P and V-VP ECMO in patients suffering from COVID-19 acute respiratory distress syndrome (ARDS). METHODS Single center, retrospective observational study. RESULTS Of nine patients, one was initiated on V-A, two on V-P, and six on V-V ECMO. All patients were reconfigured to V-P and five patients in addition had V-VP ECMO configuration. All patients had at least one and up to three circuit exchanges. Patients were on ECMO support between 20 and 122 (55 ± 29) days, were in ICU between 46 and 161 (78 ± 40) days with a total hospital length of stay between 35 and 171 (82 ± 42) days. Six of nine (67%) patients could successfully be weaned off ECMO, survived, and were discharged. CONCLUSION The ProtekDuo cannula in V-P configuration provides ECMO blood flow while reducing RV flow, wall-stress and dilatation, as well as oxygen consumption. The V-VP configuration is useful to provide high blood flows of up to seven LPM of oxygenated blood, and partial RV support without over-circulating the pulmonary vascular bed. Our results show that V-P and V-VP ECMO configurations are feasible, have good outcome and are without complications.
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Affiliation(s)
- Ahmed M El Banayosy
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Aly El Banayosy
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Mircea R Mihu
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Jaclyn M Chidester
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Laura V Swant
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Robert S Schoaps
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Ammar Sharif
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA.,Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia.,Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, USA
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18
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Maybauer MO, Lorusso R, Swol J. The ProtekDuo cannula for extracorporeal membrane oxygenation: A game changer in COVID-19! Artif Organs 2022; 46:2107-2108. [PMID: 35929444 PMCID: PMC9538240 DOI: 10.1111/aor.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, Intergris Baptist Medical Center, Oklahoma City, Oklahoma, USA.,Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Queensland, Australia.,Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
| | - Roberto Lorusso
- ECLS Centrum, Cardio-Thoracic Surgery Department, and Cardiology Department, Heart & Vascular Center, Maastricht University Medical Center (MUMC), Maastricht, The Netherlands.,Cardiovascular Research Institute (CARIM), Maastricht, The Netherlands
| | - Justyna Swol
- Department of Pneumology, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
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