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Farmakis D, Polyzogopoulou E, Parissis J. Extracorporeal life support at the emergency department: new insights into the management of acute cardiac care patients. Hellenic J Cardiol 2021; 62:46-47. [PMID: 33753233 DOI: 10.1016/j.hjc.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
| | - Eftihia Polyzogopoulou
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - John Parissis
- University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
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Kosmopoulos M, Bartos JA, Kalra R, Goslar T, Carlson C, Shaffer A, John R, Kelly R, Raveendran G, Brunsvold M, Chipman J, Beilman G, Yannopoulos D. Patients treated with venoarterial extracorporeal membrane oxygenation have different baseline risk and outcomes dependent on indication and route of cannulation. Hellenic J Cardiol 2020; 62:38-45. [PMID: 32387591 DOI: 10.1016/j.hjc.2020.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate the baseline risk of patients treated with Extracorporeal Cardiopulmonary Membrane Oxygenation (ECMO) in relation to cannulation strategy and indication for ECMO as well as the relation of cannulation strategy with survival and secondary hospitalization outcomes. METHODS Severity of illness and predicted mortality risk were assessed in 317 patients. Central cannulation was used in 52 patients unable to wean off cardiopulmonary bypass after cardiac surgery. Peripheral cannulation was used in 179 patients for extracorporeal cardiopulmonary resuscitation (eCPR) and in 86 patients who received ECMO for refractory cardiogenic shock (RCS). RESULTS Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were significantly worse (P < 0.01) for peripheral ECMO eCPR (23.2) vs central ECMO (14.6) and vs peripheral ECMO for RCS (18.9). Survival After Venoarterial ECMO (SAVE) scores were significantly worse for peripheral ECMO for eCPR (-7.85) and RCS (-10.38) vs central ECMO (-3.97), and P < 0.01. Peripherally cannulated patients had significantly worse renal function. No significant difference existed for survival to discharge (peripheral ECMO for eCPR, 31%; central ECMO, 44%; peripheral ECMO for refractory cardiac shock, 39.5%; and P = 0.176), although centrally cannulated patients had significantly longer treatment durations compared with peripheral ECMO for eCPR. CONCLUSIONS Peripherally cannulated patients with eCPR had significantly worse APACHE II and SAVE scores compared to peripherally cannulated RCS or patients with central ECMO, despite having similar mortality.
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Affiliation(s)
| | - Jason A Bartos
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Tomaz Goslar
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA; Department of Intensive Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Slovenia
| | - Claire Carlson
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Ranjit John
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Rose Kelly
- Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Ganesh Raveendran
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Brunsvold
- Intensive Care and Surgical Critical Service Line, University of Minnesota, Minneapolis, MN, USA
| | - Jeffrey Chipman
- Intensive Care and Surgical Critical Service Line, University of Minnesota, Minneapolis, MN, USA
| | - Gregory Beilman
- Intensive Care and Surgical Critical Service Line, University of Minnesota, Minneapolis, MN, USA
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3
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Vargas-Camacho G, Contreras-Cepeda V, Gómez-Gutierrez R, Quezada-Valenzuela G, Nieto-Sanjuanero A, Santos-Guzmán J, González-Salazar F. Venoarterial extracorporeal membrane oxygenation in heart surgery post-operative pediatric patients: A retrospective study at Christus Muguerza Hospital, Monterrey, Mexico. SAGE Open Med 2020; 8:2050312120910353. [PMID: 32166028 PMCID: PMC7052455 DOI: 10.1177/2050312120910353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 02/04/2020] [Indexed: 01/13/2023] Open
Abstract
Objectives Extracorporeal membrane oxygenation is a life support procedure developed to offer cardiorespiratory support when conventional therapies have failed. The purpose of this study is to describe the findings during the first years using venoarterial extracorporeal membrane oxygenation in pediatric patients after cardiovascular surgery at Christus Muguerza High Specialty Hospital in Monterrey, Mexico. Methods This is a retrospective, observational, and descriptive study. The files of congenital heart surgery post-operative pediatric patients, who were treated with venoarterial extracorporeal membrane oxygenation from January 2013 to December 2015, were reviewed. Results A total of 11 patients were reviewed, of which 7 (63.8%) were neonates and 4 (36.7%) were in pediatric age. The most common diagnoses were transposition of great vessels, pulmonary stenosis, and tetralogy of Fallot. Survival rate was 54.5% and average life span was 6.3 days; the main complications were sepsis (36.3%), acute renal failure (36.3%), and severe cerebral hemorrhage (9.1%). The main causes of death were multi-organ dysfunction syndrome (27.3%) and cerebral hemorrhage (18.2%). Conclusion The mortality rates found are very similar to those found in a meta-analysis report published in 2013 and the main complication and causes of death are also very similar to the majority of extracorporeal membrane oxygenation reports for these kinds of patients. Although the results are encouraging, early sepsis detection, prevention of cerebral hemorrhage, and renal function monitoring must be improved.
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Affiliation(s)
- Gerardo Vargas-Camacho
- Pediatric Intensive Care Unit, Christus Muguerza High Specialty Hospital, Monterrey, Mexico
| | | | - Rene Gómez-Gutierrez
- Pediatric Intensive Care Unit, Christus Muguerza High Specialty Hospital, Monterrey, Mexico
| | | | | | | | - Francisco González-Salazar
- Northeastern Biomedical Investigation Center, Mexican Social Security Institute, Monterrey, Mexico.,Department of Basic Sciences, University of Monterrey, San Pedro Garza García, Mexico
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Amao R, Imamura T, Sawada Y, Endo S, Ozaki S, Okamura K, Masuzawa A, Takaoka T, Hirata Y, Shindo T, Ono M, Haga N. Experiences With Aggressive Cardiac Rehabilitation in Pediatric Patients Receiving Mechanical Circulatory Supports. Int Heart J 2016; 57:769-772. [DOI: 10.1536/ihj.16-067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Rie Amao
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
| | - Teruhiko Imamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yusuke Sawada
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
| | - Sachiko Endo
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
| | - Shinichi Ozaki
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Kenichi Okamura
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Akihiro Masuzawa
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Tetsuhiro Takaoka
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Yasutaka Hirata
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Takahiro Shindo
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Nobuhiko Haga
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo
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5
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Spontaneous Breathing, Extrapulmonary CO2 Removal, and Ventilator-Induced Lung Injury Risk. Crit Care Med 2014; 42:758-60. [DOI: 10.1097/ccm.0000000000000206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hashimoto S. The need for an organized ECMO-based respiratory program in Japan. J Anesth 2012; 26:647-9. [PMID: 22797879 PMCID: PMC7102221 DOI: 10.1007/s00540-012-1441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 06/14/2012] [Indexed: 12/01/2022]
Affiliation(s)
- Satoru Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
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8
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Suma K, Tsuji T, Takeuchi Y, Inoue K, Shiroma K, Yoshikawa T, Narumi J. Clinical performance of microporous polypropylene hollow-fiber oxygenator. Ann Thorac Surg 1981; 32:558-62. [PMID: 7316590 DOI: 10.1016/s0003-4975(10)61798-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A newly developed polypropylene hollow-fiber oxygenator was used from June 1979, to July, 1980, in 100 patients undergoing open-heart operation. Adequate oxygenation and carbon dioxide elimination were observed throughout perfusion in spite of a relatively low ratio of oxygen flow to blood flow. Plasma hemoglobin level was maintained low after long hours of perfusion. There were no complications related to the oxygenator during or after the operation. Because of its highly efficient performance as well as small size and easy handling, this oxygenator is being used routinely during open-heart procedures in our hospital.
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9
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Gaylor JD, Mockross LF. Novel method for fabricating capillary membrane oxygenators. Med Biol Eng Comput 1978; 16:369-78. [PMID: 308584 DOI: 10.1007/bf02442653] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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Solen KA, Whiffen JD, Lightfoot EN. The effect of shear, specific surface, and air interface on the development of blood emboli and hemolysis. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1978; 12:381-99. [PMID: 670260 DOI: 10.1002/jbm.820120311] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Heparinized dog blood was exposed to shear and foreign surfaces in conicylindrical test cells. The cells were injection molded from polycarbonate and were filled using a technique that avoided contact of the blood with air. Particulate-matter formation was measured and was found to be dominated by the surface-to-blood-volume ratio and to be independent of shear rate. Hemolysis was also measured and was found to vary linearly with shear rate and to increase with increasing surface-to-blood volume ratio. Thus, at low shear rates and high specific surface conditions, the degree of hemolysis was found to be minimal while particulate-matter formation was high. The results suggest that the safety of extracoporeal perfusion procedures cannot be inferred from hemolysis measurements alone. In one series of tests, a gas-blood interface was generated at a rate equivalent to the rate of surface renewal in conventional disc oxygenators. The gas-blood interface failed to contribute significantly to the damage indices, which suggests that the apparent superiority of membrane oxygenators may be a result of factors other than the absence of a blood-gas interface.
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12
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Wickline SA, Soeter JR, McNamara JJ. Oxygenation of the cerebral and coronary circulation with right axillary artery perfusion during venoarterial bypass in primates. Ann Thorac Surg 1977; 24:560-5. [PMID: 413502 DOI: 10.1016/s0003-4975(10)63458-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The effectiveness of right axillary artery perform in delivering oxygenated blood to the cerebral and coronary circulation during venoarterial bypass in primates was studied. Both right and left common carotid flow measurements and arterial gas measurements revealed high flows and elevated PO2 levels. Incomplete mixing in the ascending aorta was observed from cineangiograms taken at various pump oxygenator flows in 1 animal. The results demonstrated that the brain receives excellent oxygenation at all bypass levels. However, the coronary circulation is perfused primarily by blood ejected from the left ventricle and receives only minimal contribution of well-oxygenated blood from the pump oxygenator circuit. Therefore, the heart may suffer prolonged hypoxemia during long-term venoarterial bypass for acute respiratory insufficiency.
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13
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Newland PE. Extracorporeal membrane oxygenation in the treatment of respiratory failure--a review. Anaesth Intensive Care 1977; 5:99-112. [PMID: 405883 DOI: 10.1177/0310057x7700500202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) can be used for the treatment of acute respiratory failure. Based on recent experience in establishing such a method of treatment, this paper reviews those aspects of ECMO that need careful consideration before it can be undertaken. Methods of patient selection for ECMO and the physiological changes associated with it are also discussed.
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Hicks RE, Kinney TR, Raphaely RC, Donaldson MH, Henry Edmunds L, Lawrence Naiman J. Successful treatment of varicella pneumonia with prolonged extracorporeal membrane oxygenation in a child with leukemia. J Thorac Cardiovasc Surg 1977. [DOI: 10.1016/s0022-5223(19)39962-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bowen JC, Miller WC. Pathophysiologic considerations in the diagnosis and treatment of post-traumatic pulmonary insufficiency. Am J Surg 1975; 130:550-4. [PMID: 1106242 DOI: 10.1016/0002-9610(75)90510-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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17
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Heiden D, Mielke C, Rodvien R, Hill JD. Platelets, hemostasis, and thromboembolism during treatment of acute respiratory insufficiency with extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)40293-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Cooper J, Duffin J, Zapol W. Cannulation of ascending aorta for long-term membrane oxygenator support. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)40418-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Gaylor JD, Mockros LF. Artificial-lung design: sheet-membrane units. MEDICAL & BIOLOGICAL ENGINEERING 1975; 13:425-35. [PMID: 1195841 DOI: 10.1007/bf02477115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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20
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Rawlings C, Bisgard G, Dufek J, Buss D, Will J, Birnbaum M, Chopra P, Kahn D. Prolonged perfusion with a membrane oxygenator in awake ponies. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)41533-x] [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: 10/25/2022]
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21
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Donald Hill J, Ratliff JL, Fallat RJ, Tucker HJ, Lamy M, Dietrich HP, Gerbode F. Prognostic factors in the treatment of acute respiratory insufficiency with long-term extracorporeal oxygenation. J Thorac Cardiovasc Surg 1974. [DOI: 10.1016/s0022-5223(19)39686-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Lefrak EA, Stevens PM, Pitha J, Balsinger E, Noon GP, Mayor HD. Extracorporeal membrane oxygenation for fulminant influenza pneumonia. Chest 1974; 66:385-8. [PMID: 4413399 DOI: 10.1378/chest.66.4.385] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
MESH Headings
- Carbon Dioxide/blood
- Extracorporeal Circulation
- Humans
- Hypoxia/etiology
- Hypoxia/therapy
- Influenza, Human/complications
- Influenza, Human/diagnostic imaging
- Influenza, Human/microbiology
- Influenza, Human/pathology
- Influenza, Human/therapy
- Lung/pathology
- Male
- Microscopy, Electron
- Middle Aged
- Orthomyxoviridae/isolation & purification
- Oxygen/blood
- Oxygenators, Membrane
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnostic imaging
- Pneumonia, Viral/microbiology
- Pneumonia, Viral/pathology
- Pneumonia, Viral/therapy
- Radiography
- Trachea/microbiology
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Awad JA, Cloutier R, Paradis B, Dorval J, Martin L, Morin PJ. Prolonged pulmonary assistance with the membrane gas-exchanger: a case report. J Pediatr Surg 1973; 8:871-80. [PMID: 4785560 DOI: 10.1016/0022-3468(73)90003-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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