1
|
Pitts B, Vaughan M, Roney JK. Implementing an Adult Extracorporeal Membrane Oxygenation Program During the COVID-19 Pandemic. Am J Nurs 2023; 123:46-53. [PMID: 37988024 DOI: 10.1097/01.naj.0000997232.94091.ba] [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: 11/22/2023]
Abstract
BACKGROUND In response to the needs of patients infected with COVID-19, an interdisciplinary team was assembled to implement an adult extracorporeal membrane oxygenation (ECMO) program in the surgical ICU of a West Texas tertiary care hospital. Use of Extracorporeal Life Support Organization (ELSO) guidelines was essential to the development of this effort. AIM The aim of this project was to develop, implement, and evaluate an adult ECMO program. METHODS A logic model was used in designing and evaluating the adult ECMO program. A 35-hour ECMO specialist training course was developed, and training began in August 2020, a month before implementation of the project began. Patient outcomes were measured between September 2020 and December 2021. Descriptive statistics were used to measure the clinical outcomes of interest. RESULTS Seventeen newly trained ECMO specialists included experienced critical care nurses and respiratory therapists. Protocols were developed for the initiation of ECMO, and tracked patient outcomes included survival off ECMO, survival to discharge, major and minor complications, and length of stay. Nine patients had COVID-19 and demonstrated an 11.11% mortality rate after adult ECMO program implementation. CONCLUSIONS Use of the ELSO professional guidelines to design and develop this project led to the achievement of a sustainable ECMO program. Hospital leaders can now implement adult ECMO programs amid other demands for resources that may be created by future pandemics.
Collapse
Affiliation(s)
- Brandy Pitts
- Brandy Pitts is an RN and Midge Vaughan is ECMO program coordinator at Providence Covenant Children's Hospital, Lubbock, TX. Jamie Kay Roney was Texas regional research coordinator at Providence Covenant Health, Lubbock, TX, during implementation of the adult ECMO program and is currently director of nursing professional development at the Texas Nurses Association, Austin. Contact author: Jamie Kay Roney, . The authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | |
Collapse
|
2
|
Seoane LA, Burgos L, Vila RB, Furmento JF, Costabel JP, Vrancic M, Villagra M, Ramírez-Hoyos OD, Navia D, Diez M. [Impact of a multidisciplinary team "ECMO Team" on the prognosis of patients undergoing veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock and cardiac arrest]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:132-140. [PMID: 38298412 PMCID: PMC10824746 DOI: 10.47487/apcyccv.v4i4.325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
Objectives Veno-arterial Extracorporeal membrane oxygenation (VA ECMO) is a salvage intervention in patients with cardiogenic shock (CS), and cardiac arrest (CA) refractory to standard therapies. The design of ECMO Teams has achieved the standardization of processes, although its impact on survival and prognosis is unknown. Objective We aimed to analyze whether the creation of an ECMO Team has modified the prognosis of patients undergoing VA ECMO for refractory CS or CA. Materials and methods . We conducted a single-center retrospective cohort study. Patients with refractory CS or CA who underwent VA ECMO were divided in two consecutive periods: from 2014 to April 2019 (pre-ECMO T) and from May 2019 to December 2022 (Post ECMO T). The main outcomes were survival on ECMO, in-hospital survival, complications, and annual ECMO volume. Results Eighty-three patients were included (36 pre-ECMO T and 47 post-ECMO T). The mean age was 53 +/-13 years. The most common reason for device indication was different: postcardiotomy shock (47.2%) pre-ECMO T and refractory cardiogenic shock (29.7%) post-ECMO T. The rate of extracorporeal cardiopulmonary resuscitation was 14.5%. The median duration of VA ECMO was longer after ECMO team implementation: 8 days (IQR 5-12.5) vs. five days (IQR 2-9, p=0.04). Global in-hospital survival was 45.8% (38.9% pre-ECMO T vs. 51.1% post-ECMO T; p=0.37), and the survival rate from VA ECMO was 60.2% (55.6% pre-ECMO T vs 63.8% post-ECMO T; p= 0.50). The volume of VA ECMO implantation was significantly higher in the post-ECMO team period (13.2 +/3.5 per year vs. 6.5 +/-3.5 per year, p: 0.02). The rate of complications was similar in both groups. Conclusions After the implementation of an ECMO team, there was no statistical difference in the survival rate of patients treated with VA ECMO. However, a significant increase in the number of patients supported per year was observed after the implementation of this multidisciplinary team. Post-ECMO T, the most common reason for device indication was cardiogenic shock, with longer run times and a higher rate of extracorporeal cardiopulmonary resuscitation.
Collapse
Affiliation(s)
- Leonardo A. Seoane
- Servicio de Cardiología Crítica, Departamento de Cardiología, ICBA Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Servicio de Cardiología CríticaDepartamento de CardiologíaICBA Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Lucrecia Burgos
- Sección de Insuficiencia Cardíaca, Departamento de Cardiología, ICBA Instituto Cardiovascular, Buenos Aires, Argentina.Sección de Insuficiencia CardíacaDepartamento de CardiologíaICBA Instituto CardiovascularBuenos AiresArgentina
| | - Rocío Baro Vila
- Sección de Insuficiencia Cardíaca, Departamento de Cardiología, ICBA Instituto Cardiovascular, Buenos Aires, Argentina.Sección de Insuficiencia CardíacaDepartamento de CardiologíaICBA Instituto CardiovascularBuenos AiresArgentina
| | - Juan F. Furmento
- Servicio de Cardiología Crítica, Departamento de Cardiología, ICBA Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Servicio de Cardiología CríticaDepartamento de CardiologíaICBA Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Juan P. Costabel
- Servicio de Cardiología Crítica, Departamento de Cardiología, ICBA Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Servicio de Cardiología CríticaDepartamento de CardiologíaICBA Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Mariano Vrancic
- Servicio de Cirugía cardiovascular, ICBA Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Servicio de Cirugía cardiovascularICBA Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Maximiliano Villagra
- Servicio de Ultrasonido, Departamento de Diagnóstico por Imagen. ICBA Instituto Cardiovascular de Buenos Aires Buenos AiresArgentina.Servicio de UltrasonidoDepartamento de Diagnóstico por ImagenICBA Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Olga D Ramírez-Hoyos
- Sección de Perfusión, Servicio de Cirugía Cardiovascular, ICBA Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Sección de PerfusiónServicio de Cirugía CardiovascularICBA Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Daniel Navia
- Servicio de Cirugía cardiovascular, ICBA Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.Servicio de Cirugía cardiovascularICBA Instituto Cardiovascular de Buenos AiresBuenos AiresArgentina
| | - Mirta Diez
- Sección de Insuficiencia Cardíaca, Departamento de Cardiología, ICBA Instituto Cardiovascular, Buenos Aires, Argentina.Sección de Insuficiencia CardíacaDepartamento de CardiologíaICBA Instituto CardiovascularBuenos AiresArgentina
| |
Collapse
|
3
|
Ciullo AL, Wall N, Taleb I, Koliopoulou A, Stoddard K, Drakos SG, Welt FG, Goodwin M, Van Dyk N, Kagawa H, McKellar SH, Selzman CH, Tonna JE. Effect of Portable, In-Hospital Extracorporeal Membrane Oxygenation on Clinical Outcomes. J Clin Med 2022; 11:6802. [PMID: 36431279 PMCID: PMC9693180 DOI: 10.3390/jcm11226802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
The time between onset of cardiogenic shock and initiation of mechanical circulatory support is inversely related to patient survival as delays in transporting patients to the operating room (OR) for venoarterial extracorporeal membrane oxygenation (VA ECMO) could prove fatal. A primed and portable VA ECMO system may allow faster initiation of ECMO in various hospital locations and subsequently improve outcomes for patients in cardiogenic shock. We reviewed our institutional experience with VA ECMO based on two time periods: beginning of our VA ECMO program and from initiation of our primed and portable in-hospital ECMO system. The primary endpoint was patient survival to discharge. A total of 137 patients were placed on VA ECMO during the study period; n = 66 (48%) before and n = 71 (52%) after program initiation. In the second era, the proportion of OR ECMO initiation decreased significantly (from 92% to 49%, p < 0.01) as more patients received ECMO in other hospital units, including the emergency department (p < 0.01) and during cardiac arrest (12% vs. 38%, p < 0.01). Survival to hospital discharge was equivalent between the two groups (30% vs. 42%, p = 0.1) despite more patients being placed on ECMO during ongoing cardiac arrest. Finally, we observed increased clinical volume since initiation of the in-hospital, portable ECMO system. Developing an in-hospital, primed and portable VA ECMO program resulted in increased clinical volume with equivalent patient survival despite a sicker cohort of patients. We conclude that more rapid deployment of VA ECMO may extend the treatment eligibility to more patients and improve patient outcomes.
Collapse
Affiliation(s)
- Anna L. Ciullo
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Natalie Wall
- Department of Surgery, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Iosif Taleb
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Antigone Koliopoulou
- Division of Cardiothoracic Surgery, Evangelismos Hospital, Athens, AL 35611, USA
| | - Kathleen Stoddard
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Stavros G. Drakos
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Fred G. Welt
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Matthew Goodwin
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Nate Van Dyk
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Hiroshi Kagawa
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Stephen H. McKellar
- Division of Cardiothoracic Surgery, Department of Surgery, Intermountain Healthcare, Salt Lake City, UT 84132, USA
| | - Craig H. Selzman
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| | - Joseph E. Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Department of Emergency Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
| |
Collapse
|
4
|
Establishing a New ECMO Referral Center Using an ICU-Based Approach: A Feasibility and Safety Study. Healthcare (Basel) 2022; 10:healthcare10030414. [PMID: 35326892 PMCID: PMC8948761 DOI: 10.3390/healthcare10030414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/13/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care unit (ICU). Methods: A model was created for setting up a new ECMO referral center within the structure of an existing mixed ICU in a tertiary hospital. A retrospective analysis was carried out of the first 33 patients treated in the initial period of the center’s activity, from mid 2018 to the end of 2020. Results: An ECMO center was established and developed entirely based on the resources of an existing mixed ICU. Thirty-three patients were treated. They had an overall survival rate at 90 days of 60.6%. In veno-venous (VV) mode ECMO duration, ICU length of stay, and SOFA score were significantly higher than in veno-arterial mode. No significant differences in clinical characteristics were observed between survivors and non-survivors on VV-ECMO. Conclusions: A regional ECMO center can be set up as an integral part of a mixed ICU in a tertiary hospital. Extracorporeal therapy, such as continuous renal replacement therapy and mechanical ventilation can be managed entirely by intensivists. Further studies are needed to show that the ICU-based approach to setting up a new ECMO center is no less effective than the multidisciplinary approach.
Collapse
|
5
|
Lee JJ, Kim YS, Chung S, Jeong DS, Yang JH, Sung K, Kim WS, Jun TG, Cho YH. Impact of a Multidisciplinary Team Approach on Extracorporeal Circulatory Life Support-Bridged Heart Transplantation. J Chest Surg 2021; 54:99-105. [PMID: 33767029 PMCID: PMC8038881 DOI: 10.5090/jcs.20.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
Background The number of heart transplantations (HTx) is increasing annually. Due to advances in medical and surgical support, the outcomes of HTx are also improving. Extracorporeal circulatory life support (ECLS) provides patients with decompensated heart failure a chance to undergo HTx. A medical approach involving collaboration among experienced experts in different fields should improve the outcomes and prognosis of ECLS-bridged HTx. Methods From December 2003 to December 2018, 1,465 patients received ECLS at Samsung Medical Center. We excluded patients who had not undergone HTx or underwent repeated transplantations. Patients younger than 18 years were excluded. We also excluded patients who received an implantable durable left ventricular assist device before HTx. In total, 91 patients were included in this study. A multidisciplinary team approach began in March 2013 at our hospital. We divided the patients into 2 groups depending on whether they were treated before or after implementation of the team approach. Results The 30-day mortality rate was significantly higher in the pre-ECLS team group than in the post-ECLS team group (n=5, 18.5% vs. n=2, 3.1%; p=0.023). The 1-year survival rate was better in the post-ECLS team group than in the pre-ECLS team group (n=57, 89.1% vs. n=19, 70.4%; p=0.023). Conclusion We found that implementing a multidisciplinary team approach improved the outcomes of ECLS-bridged HTx. Team-based care should be adapted at HTx centers that perform high-risk HTx.
Collapse
Affiliation(s)
- Jae Jun Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Su Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hyuk Yang
- 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
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, 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
| |
Collapse
|
6
|
Impact of an Extracorporeal Membrane Oxygenation Intensivist-Led Multidisciplinary Team on Venovenous Extracorporeal Membrane Oxygenation Outcomes. Crit Care Explor 2020; 2:e0297. [PMID: 33251521 PMCID: PMC7688254 DOI: 10.1097/cce.0000000000000297] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives: Venovenous extracorporeal membrane oxygenation is increasingly being established as a treatment option for severe acute respiratory failure. We sought to evaluate the impact of a dedicated specialist team-based approach on patient outcomes. Design: Retrospective cohort study. Setting: Single-center medical ICU in an academic tertiary hospital. Patients: Adult patients initiated on venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. Interventions: Initiation of an extracorporeal membrane oxygenation intensivist-led multidisciplinary team; critical decisions on extracorporeal membrane oxygenation management were jointly made by a dedicated team of extracorporeal membrane oxygenation intensivists, together with the multidisciplinary team. Measurements and Main Results: Eighty-one patients (75%) and 27 patients (35%) were initiated on venovenous extracorporeal membrane oxygenation in the preextracorporeal membrane oxygenation intensivist-led multidisciplinary team (before January 2018) and postextracorporeal membrane oxygenation intensivist-led multidisciplinary team period (after January 2018), respectively. Inhospital (14.8% vs 44.4%, p = 0.006) and ICU mortality (11.1% vs 40.7%, p = 0.005) were significantly lower in the postextracorporeal membrane oxygenation intensivist-led multidisciplinary team period. On multivariate analysis correcting for possible confounding factors (ICU severity and extracorporeal membrane oxygenation-specific mortality prediction scores, body mass index, preextracorporeal membrane oxygenation vasopressor support, preextracorporeal membrane oxygenation cardiac arrest, and days on mechanical ventilation before extracorporeal membrane oxygenation initiation), management by an extracorporeal membrane oxygenation intensivist-led multidisciplinary team remained associated with improved hospital survival (odds ratio, 5.06; 95% CI, 1.20–21.28). Patients in the postextracorporeal membrane oxygenation intensivist-led multidisciplinary team period had less nosocomial infections (18.5% vs 46.9%, p = 0.009), a shorter ICU stay (12 days [interquartile range, 6–16 d] vs 15 days [interquartile range, 10–24 d]; p = 0.049), and none suffered an intracranial hemorrhage or nonhemorrhagic stroke. Conclusions: An extracorporeal membrane oxygenation intensivist-led multidisciplinary team approach is associated with improved outcomes in patients initiated on venovenous extracorporeal membrane oxygenation for severe acute respiratory failure.
Collapse
|
7
|
Linke NJ, Fulcher BJ, Engeler DM, Anderson S, Bailey MJ, Bernard S, Board JV, Brodie D, Buhr H, Burrell AJC, Cooper DJ, Fan E, Fraser JF, Gattas DJ, Higgins AM, Hopper IK, Huckson S, Litton E, McGuinness SP, Nair P, Orford N, Parke RL, Pellegrino VA, Pilcher DV, Sheldrake J, Reddi BAJ, Stub D, Trapani TV, Udy AA, Hodgson CL. A survey of extracorporeal membrane oxygenation practice in 23 Australian adult intensive care units. CRIT CARE RESUSC 2020; 22:166-170. [PMID: 32389109 PMCID: PMC10692478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Natalie J Linke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Bentley J Fulcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Daniel M Engeler
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | | | - Michael J Bailey
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Stephen Bernard
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Jasmin V Board
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Daniel Brodie
- Department of Medicine and Center for Acute Respiratory Failure, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY, USA
| | - Heidi Buhr
- Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Aidan J C Burrell
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - David J Cooper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - David J Gattas
- Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Ingrid K Hopper
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Sue Huckson
- Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia
| | - Edward Litton
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia
| | - Shay P McGuinness
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Priya Nair
- Intensive Care Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Neil Orford
- Intensive Care Unit, University Hospital Geelong, Geelong, VIC, Australia
| | - Rachael L Parke
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | | | - David V Pilcher
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Jayne Sheldrake
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | | | - Dion Stub
- Intensive Care Unit, Alfred Hospital, Melbourne, VIC, Australia
| | - Tony V Trapani
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
8
|
Na SJ, Jeon K. Extracorporeal membrane oxygenation support in adult patients with acute respiratory distress syndrome. Expert Rev Respir Med 2020; 14:511-519. [PMID: 32089016 DOI: 10.1080/17476348.2020.1734457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: The global number of patients receiving extracorporeal membrane oxygenation (ECMO) support has been growing after several studies highlighted the favorable results attained in cases of severe respiratory failure. However, evidence-based guidelines for optimal use of ECMO are lacking.Areas covered: This review covers optimal candidates, timing of initiation, strategies for patient management including mechanical ventilation, and decision-making regarding discontinuation of ECMO based on its potential role in treatment of patients with acute respiratory distress syndrome.Expert opinion: Early initiation of ECMO should be considered if hypoxemia and uncompensated hypercapnia do not respond to optimal conventional treatment. Use of a comprehensive management approach for preventing additional lung injury and extrapulmonary organ failure is critical during ECMO support to ensure the best outcome. The possibility of weaning from ECMO should be fully assessed by a multidisciplinary team during ECMO support. Futility should not be determined solely by duration of ECMO, and use of prolonged ECMO for lung recovery may be worthwhile.
Collapse
Affiliation(s)
- Soo Jin Na
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|