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Maybauer MO, Reaves ZR, Brewer JM. Feasibility of using the ProtekDuo cannula in V-P ECMO and PROpella configurations during ground and air transport. Perfusion 2024; 39:620-623. [PMID: 36562322 DOI: 10.1177/02676591221148606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Use of the ProtekDuo cannula has been described for right ventricular assist devices (RVADs) and extracorporeal membrane oxygenation (ECMO) systems. CASE REPORT We describe remote cannulation and transport of two patients with ProtekDuo cannula. One patient had isolated acute right ventricular failure (aRVF), was cannulated with ProtekDuo cannula in venopulmonary (V-P) configuration and transported by ambulance. Another patient had biventricular failure after myocardial infarction, was supported with ProtekDuo and Impella CP in PROpella configuration, and transported by helicopter. DISCUSSION We appear to be the first group to report remote cannulation using the ProtekDuo cannula followed by ambulance and helicopter transport, which were performed without complication. We describe the pros and cons of these configurations in comparison to the gold standard of shock management with venoarterial ECMO, as well as important considerations for transport. CONCLUSION Use of the ProtekDuo cannula for remote cannulations and transport is feasible and appears safe.
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Affiliation(s)
- Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, FL, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, Prince Charles Hospital, University of Queensland, Brisbane, Australia
| | - Zachary R Reaves
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Specialty Critical Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Specialty Critical Care, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
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Santonocito C, Cassisi C, Chiarenza F, Caruso A, Murabito P, Maybauer MO, George S, Sanfilippo F. Morning or Afternoon Scheduling for Elective Coronary Artery Bypass Surgery: Influence of Longer Fasting Periods from Metabolic and Hemodynamic Perspectives. Ann Card Anaesth 2024; 27:136-143. [PMID: 38607877 DOI: 10.4103/aca.aca_204_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Prolonged preoperative fasting may worsen postoperative outcomes. Cardiac surgery has higher perioperative risk, and longer fasting periods may be not well-tolerated. We analysed the postoperative metabolic and hemodynamic variables in patients undergoing elective coronary artery bypass grafting (CABG) according to their morning or afternoon schedule. METHODS Single-centre retrospective study at University teaching hospital (1-year data collection from electronic medical records). Using a mixed-effects linear regression model adjusted for several covariates, we compared metabolic (lactatemia, pH, and base deficit [BD]) and haemodynamic values (patients on vasoactive support, and vasoactive inotropic score [VIS]) at 7 prespecified time-points (admission to intensive care, and 1st, 3rd, 6th, 12th, 18th, and 24th postoperative hours). RESULTS 339 patients (n = 176 morning, n = 163 afternoon) were included. Arterial lactatemia and BD were similar (overall P = 0.11 and P = 0.84, respectively), while pH was significantly lower in the morning group (overall P < 0.05; mean difference -0.01). Postoperative urine output, fluid balance, mean arterial pressure, and central venous pressure were similar (P = 0.59, P = 0.96, P = 0.58 and P = 0.53, respectively). A subgroup analysis of patients with diabetes (n = 54 morning, n = 45 afternoon) confirmed the same findings. The VIS values and the proportion of patients on vasoactive support was higher in the morning cases at the 18th (P = 0.002 and p=0.04, respectively) and 24th postoperative hours (P = 0.003 and P = 0.04, respectively). Mean intensive care length of stay was 1.94 ± 1.36 days versus 2.48 ± 2.72 days for the afternoon and morning cases, respectively (P = 0.02). CONCLUSIONS Patients undergoing elective CABG showed similar or better metabolic and hemodynamic profiles when scheduled for afternoon surgery.
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Affiliation(s)
- Cristina Santonocito
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Cesare Cassisi
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Federica Chiarenza
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Alessandro Caruso
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Paolo Murabito
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Marc O Maybauer
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, United States
- Department of Anesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Shane George
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
| | - Filippo Sanfilippo
- Cardiothoracic Intensive Care Unit, Oxford Heart Centre, John Radcliffe Hospital-Oxford University Hospitals, Oxford, United Kingdom
- Department of Anaesthesia and Intensive Care, A.O.U. "Policlinico-San Marco,", Catania, Italy
- School of Anesthesia and Intensive Care, University of Catania, Catania, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Becker TK, Bruno J, Carr CT, Maybauer MO. Arterial graft cannulation for extracorporeal cardiopulmonary resuscitation. Intensive Care Med 2024; 50:467-468. [PMID: 38372745 DOI: 10.1007/s00134-024-07342-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Torben K Becker
- Division of Critical Care Medicine, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, USA.
| | - John Bruno
- Division of Critical Care Medicine, Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, USA
| | - Casey T Carr
- Department of Emergency Medicine, College of Medicine, University of Florida, Jacksonville, USA
| | - Marc O Maybauer
- Division of Critical Care Medicine, Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, USA
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, Australia
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
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Landolt L, Janelle GM, Ricks W, Rackauskas M, Maybauer MO. Transesophageal Echocardiography Guided Veno-Pulmonary Extracorporeal Membrane Oxygenation Cannula Insertion Technique. ASAIO J 2024:00002480-990000000-00410. [PMID: 38324699 DOI: 10.1097/mat.0000000000002147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Affiliation(s)
- Luke Landolt
- From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - Gregory M Janelle
- From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
| | - William Ricks
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Mindaugas Rackauskas
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida
| | - Marc O Maybauer
- From the Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, Australia
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Gonzalez FA, Santonocito C, Maybauer MO, Lopes LR, Almeida AG, Sanfilippo F. Diastology in the intensive care unit: Challenges for the assessment and future directions. Echocardiography 2024; 41:e15773. [PMID: 38380688 DOI: 10.1111/echo.15773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Myocardial dysfunction is common in patients admitted to the intensive care unit (ICU). Septic disease frequently results in cardiac dysfunction, and sepsis represents the most common cause of admission and death in the ICU. The association between left ventricular (LV) systolic dysfunction and mortality is not clear for critically ill patients. Conversely, LV diastolic dysfunction (DD) seems increasingly recognized as a factor associated with poor outcomes, not only in sepsis but also more generally in critically ill patients. Despite recent attempts to simplify the diagnosis and grading of DD, this remains relatively complex, with the need to use several echocardiographic parameters. Furthermore, the current guidelines have several intrinsic limitations when applied to the ICU setting. In this manuscript, we discuss the challenges in DD classification when applied to critically ill patients, the importance of left atrial pressure estimates for the management of patients in ICU, and whether the study of cardiac dysfunction spectrum during critical illness may benefit from the integration of left ventricular and left atrial strain data to improve diagnostic accuracy and implications for the treatment and prognosis.
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Affiliation(s)
- Filipe A Gonzalez
- Intensive Care Department of Hospital Garcia de Orta, Almada, Portugal
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
| | - Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Luís Rocha Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre St Bartholomew's Hospital London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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Brewer JM, Broman LM, Maybauer MO. A Plea for Adoption of the Common ECLS Nomenclature. ASAIO J 2024; 70:e16. [PMID: 37651629 DOI: 10.1097/mat.0000000000002040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
- J Michael Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma
| | - L Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - 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, Division of Critical Care Medicine, Department of Anesthesiology, University of Florida, Gainesville, Florida
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Sharif A, Brewer JM, El Banayosy A, Mihu MR, Reaves Z, Swant LV, Schoaps RS, Benson C, Khalid MI, Maybauer MO. Extracorporeal membrane oxygenation in diabetic ketoacidosis-related cardiac and respiratory failure. Int J Artif Organs 2024; 47:35-40. [PMID: 38053302 DOI: 10.1177/03913988231214448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Diabetic ketoacidosis (DKA) is a common clinical problem. When patients develop severe shock and/or respiratory failure, extracorporeal membrane oxygenation (ECMO) may be considered. This case series describes the clinical presentation and outcomes of patients with DKA supported with ECMO. METHODS We conducted a retrospective and anonymized review of 15 patients with DKA who required ECMO at our institution. Demographic and ECMO-specific data were collected. Additional variables include ICU length of stay (LOS), acute kidney injury and use of continuous renal replacement therapy, disposition, and mortality. RESULTS All ECMO cannulations were performed by an intensivist using peripheral vascular access. The majority of patients were female (73%) with a median age of 27 (IQR = 21.5-45) years. A diagnosis of diabetes mellitus (DM) prior to ECMO was present in 11 (73%) patients. Venoarterial ECMO was the initial mode used in 11 (73%) patients. The median duration of ECMO support was 7 (IQR = 6-14) days. The median ICU LOS was 12 (IQR = 8.5-20.5) days, and the median hospital LOS was 21 (IQR = 11-36.5) days. Eight patients had cardiac arrest and underwent extracorporeal cardiopulmonary resuscitation (ECPR) of which 4 (50%) patients survived to discharge. Overall, 10 (66.7%) patients were successfully weaned from ECMO and survived to discharge. CONCLUSION This is the largest case series regarding the use of ECMO for patients with refractory shock, cardiac arrest, or respiratory failure related to DKA. The findings suggest that ECMO is a viable support option for managing these patients and has excellent outcomes, including patients with cardiac arrest.
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Affiliation(s)
- Ammar Sharif
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - J Michael Brewer
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - Aly El Banayosy
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - Mircea R Mihu
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
- Department of Medicine, Division of Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, USA
| | - Zachary Reaves
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - Laura V Swant
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - Robert S Schoaps
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - Clayne Benson
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - Malik Ibithaj Khalid
- INTEGRIS Health Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support, Oklahoma City, OK, USA
| | - Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, USA
- Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
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Setiadi H, El-Banayosy AM, Long JW, Maybauer MO, Mihu MR, El Banayosy A. Oncostatin M for characterizing the inflammatory burden and outcome of V-V ECMO in ARDS patients. Artif Organs 2023; 47:1885-1892. [PMID: 37476931 DOI: 10.1111/aor.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Assessing the outcome of Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) support remains challenging as plasma lactate (pLA), the widely used tool for this purpose, has been shown unreliable. We hypothesized that plasma oncostatin M (pOSM), a sensitive marker of leukocyte activation in infection and inflammation, could address this deficiency. METHODS Plasma OSM levels were measured by ELISA in 30 Acute Respiratory Distress Syndrome (ARDS) patients, prior to cannulation (baseline) and decannulation. RESULTS Based on the absolute pOSM levels at presentation, patients were separated into two groups, A and B. Patients in group A had low pOSM levels (Mean ± SD; Median, 1.1 ± 3.8; 0 pg/mL), whereas group B had high pOSM levels (1548 ± 1999; 767 pg/mL) [t-test: p < 0.01]. The percentage of pOSM levels at decannulation relative to baseline OSM levels was significantly higher in those who died (116.8 ± 68.0; 85.3%) than those who survived (47.6 ± 25.5; 48.9%) [t-test: p = 0.02; Mann-Whitney U Test: p = 0.01]. Conversely, no significant difference was observed in the percentage of pLA levels between those who died (142.9 ± 179.9; 89.8%) and those who survived (79.3 ± 34.3; 81.8%) [t-test: p = 0.31; Mann-Whitney U Test: p = 0.63]. CONCLUSION These early findings suggested critical value of absolute and relative pOSM to characterize the inflammatory burden of ARDS patients and the outcome of their V-V ECMO support.
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Affiliation(s)
- Hendra Setiadi
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Ahmed M El-Banayosy
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - James W Long
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Marc O Maybauer
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mircea R Mihu
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Aly El Banayosy
- Advanced Cardiac Care, INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Maybauer MO, Brewer JM. The protekduo cannula for acute right ventricular support in thyrotoxicosis. Ann Card Anaesth 2023; 26:464-467. [PMID: 37861588 PMCID: PMC10691564 DOI: 10.4103/aca.aca_26_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 10/21/2023] Open
Abstract
A 25-year-old female was presented with acute right heart failure (aRHF) and cardiogenic shock secondary to thyrotoxicosis with concomitant acute respiratory failure. A ProtekDuo cannula was placed to provide temporary percutaneous right ventricular assistance and extracorporeal membrane oxygenation (ECMO) in venopulmonary (V-P) configuration, which provided both decompression of the right ventricle (RV) and oxygenation. With treatment of the underlying thyrotoxicosis, the RV function improved and respiratory failure resolved. She was discharged home in good condition. This case details alternative ECMO management with ProtekDuo compared to the gold standard of venoarterial (V-A) ECMO.
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Affiliation(s)
- Marc O. Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, College of Medicine, Gainesville, FL, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Australia
| | - Joseph M. Brewer
- INTEGRIS Baptist Medical Center, Nazih Zuhdi Transplant Institute, Specialty Critical Care and Acute Circulatory Support Service, Oklahoma City, OK, USA
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Mihu MR, Maybauer MO, Cain K, Swant LV, Harper MD, Schoaps RS, Brewer JM, Sharif A, Benson C, El Banayosy AM, El Banayosy A. Bridging the gap: safety and outcomes of intensivist-led ECMO retrievals. Front Med (Lausanne) 2023; 10:1239006. [PMID: 37680617 PMCID: PMC10481738 DOI: 10.3389/fmed.2023.1239006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Purpose Most extracorporeal membrane oxygenation (ECMO) cannulations are performed by cardiothoracic surgeons (CTS). Due to an increase in utilization of ECMO and limited availability of CTS, there is a mismatch between ECMO demand and CTS accessibility for remote cannulations. We report our intensivist-led program's experience in remote ECMO cannulations, retrievals, complications, and outcomes. Materials and methods A prospective, single-center, observational study was performed on patients that required ECMO cannulation at the referring facilities and were transported to our institution between program initiation, on October 1, 2014 to September 30, 2022. Results were presented as mean ± SD, median (min - max) or number (%). Results Since program commencement, 305 patients were accepted for ECMO retrieval. Three hundred and three patients were placed on ECMO at the 47 referring hospitals among 5 states. In our study, 185 (61%) patients required veno-arterial ECMO and 115 (38%) were placed on veno-venous ECMO. Three patients (1%) were cannulated for veno-arteriovenous ECMO. Twenty patients were cannulated under cardio-pulmonary resuscitation. Most of the patients were transported by ambulance (79%), 14% by helicopter, and 7% by airplane. Six out of the 303 patients did not leave the referring facility. All patients that left the referring hospitals arrived safely to our institution. No major complications occurred in route. Conclusion Our study's findings indicate that non-CTS physicians can successfully cannulate and retrieve patients with a low complication profile.
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Affiliation(s)
- Mircea R. Mihu
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
- Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, United States
| | - Marc O. Maybauer
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, QLD, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL, United States
- Department of Anesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
| | - Kaitlyn Cain
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
| | - Laura V. Swant
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
| | - Michael D. Harper
- MedStar Heart and Vascular Institute, MedStar Washington Medical Center, Washington, DC, United States
| | - Robert S. Schoaps
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
| | - Joseph M. Brewer
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
| | - Ammar Sharif
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
| | - Clayne Benson
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
| | - Ahmed M. El Banayosy
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
| | - Aly El Banayosy
- Specialty Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Baptist Medical Center, Oklahoma City, OK, United States
- Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, United States
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12
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Maybauer MO, Swol J, Sharif A, Benson C, Brewer JM. The ProtekDuo in percutaneous peripheral venopulmonary-arterial ECMO and PROpella configuration for cardiogenic shock with biventricular failure. Ann Card Anaesth 2023; 26:339-342. [PMID: 37470537 PMCID: PMC10451139 DOI: 10.4103/aca.aca_150_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/04/2022] [Accepted: 10/09/2022] [Indexed: 07/21/2023] Open
Abstract
This article describes a case study where a patient with ProtekDuo + oxygenator and Impella CP (PROpella) in biventricular failure and cardiogenic shock was reconfigured to venopulmonary-arterial (VP-A) extracorporeal membrane oxygenation (ECMO), secondary to leg ischemia. The ProtekDuo was subsequently used as double-lumen drainage cannula, returning blood into a newly percutaneously placed femoral arterial cannula, mimicking venoarterial (V-A) ECMO in VP-A configuration. The following day, an Impella 5.5 could be placed and the ProtekDuo was reconfigured back to its default venopulmonary (V-P) ECMO configuration, now again as PROpella with minimally invasive biventricular groin-free full mechanical circulatory support. However, while in VP-A, good drainage blood flows of up to 4.5 LPM could be achieved similar to the ProtekDuo forward flow. None of the lumens collapsed secondary to negative pressure in the system. Drainage through the ProtekDuo for VP-A ECMO is feasible and without complications for a 24-hour period. This new method extends the ProtekDuo's spectrum of use.
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Affiliation(s)
- Marc O. Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, FL, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Australia
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Ammar Sharif
- Nazih Zuhdi Transplant Institute, Advanced Cardiac and Critical Care, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
| | - Clayne Benson
- 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
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13
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Abstract
We sought to review the role of extracorporeal membrane oxygenation (ECMO) for the management of burn and smoke inhalation injury in the adult patient population. Therefore, we conducted a systematic search of the literature according to specific combination of key words to ascertain the effectiveness of this support strategy. A total of 26 articles were filtered out of 269 and considered suitable for this study. The PICOS approach and PRISMA flow chart were followed for the purposes of our review. Although there is growing evidence supporting the role of ECMO as an option for burn injury in the adult patient population, this strategy should be considered if a likely successful outcome is expected.
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Affiliation(s)
- Massimo Capoccia
- South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany
- The University of Queensland, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, Integris Baptist Medical Center, Oklahoma, OK, USA
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany
- The University of Queensland, Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida, Gainesville, FL, USA
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Usman AA, Cevasco M, Maybauer MO, Spelde AE, Olia S, Bermudez C, Ibrahim M, Szeto W, Vernick WJ, Gutsche JT. Oxygenated right ventricular assist device as part of veno-venopulmonary extracorporeal membrane oxygenation to support the right ventricle and pulmonary vasculature. J Cardiothorac Surg 2023; 18:134. [PMID: 37041646 PMCID: PMC10088623 DOI: 10.1186/s13019-023-02264-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
COVID-19 infection can lead to severe acute respiratory distress syndrome (ARDS), right ventricular (RV) failure and pulmonary hypertension. Venovenous extracorporeal membrane oxygenation (V-V ECMO) has been used for patients with refractory hypoxemia. More recently dual-lumen right atrium to pulmonary artery oxygenated right ventricular assist devices (Oxy-RVAD) have been utilized in the severe medical refractory COVID ARDS setting. Historically, animal data has demonstrated that high continuous non-pulsatile RVAD flows, leading to unregulated and unprotected circulation through the pulmonary vessels is associated with an increased risk of pulmonary hemorrhage and increased amount of extravascular lung water. These risks are heightened in the setting of ARDS with fragile capillaries, left ventricular (LV) diastolic failure, COVID cardiomyopathy, and anticoagulation. Concurrently, due to infection, tachycardia, and refractory hypoxemia, high V-V ECMO flows to match high cardiac output are often necessary to maintain systemic oxygenation. Increase in cardiac output without a concurrent increase in VV ECMO flow will result in a higher fraction of deoxygenated blood returning to the right heart and therefore resulting in hypoxemia. Several groups have suggested using a RVAD only strategy in COVID ARDS; however, this exposes the patients to the risk of pulmonary hemorrhage. We present one of the first known cases using an RV mechanical support, partial flow pulmonary circulation, oxygenated Veno-venopulmonary (V-VP) strategy resulting in RV recovery, total renal recovery, awake rehabilitation, and recovery.
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Affiliation(s)
- Asad Ali Usman
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA, USA.
| | - Marisa Cevasco
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Marc O Maybauer
- Advanced Cardiac and Critical Care, Nazih Zuhdi Transplant Institute, 24/7 Shock Service, Intergris Baptist Medical Center, Oklahoma City, OK, USA
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Hospital cardiac Arrest, Brisbane, Australia
| | - Audrey Elizabeth Spelde
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA, USA
| | - Salim Olia
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Christian Bermudez
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Ibrahim
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Wilson Szeto
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - William J Vernick
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA, USA
| | - Jacob T Gutsche
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Hospital of the University of Pennsylvania, 3400 Spruce St, 6 Silverstein Pavilion, Philadelphia, PA, USA
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16
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Brewer JM, Sparling J, Maybauer MO. Venoarterial extracorporeal membrane oxygenation for "protected" catheter-based embolectomy in high-risk/massive pulmonary embolism. Perfusion 2023:2676591231167713. [PMID: 36998160 DOI: 10.1177/02676591231167713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
High-risk/massive pulmonary embolism (PE) has a high mortality rate, especially when cardiac arrest occurs. Venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) can rapidly restore and maintain circulation while a decision regarding further care or performance of other interventions takes place. Catheter-based embolectomy (CBE) is a technology that allows for percutaneous access, clot removal, and potential resolution of shock while avoiding sternotomy required for traditional pulmonary embolectomy. Rapid placement of V-A ECMO in patients with high-risk/massive PE prior to CBE may confer circulatory protection before, during, and after the procedure.
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Affiliation(s)
- Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Jeffrey Sparling
- INTEGRIS Cardiovascular Physicians, INTEGRIS Heart Hospital, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, INTEGRIS Baptist Medical Center, 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, Australia
- Division of Critical Care Medicine, Department of Anesthesiology, University of Florida, Gainesville, FL, USA
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17
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Maybauer MO, Maybauer DM, Capoccia M. Extracorporeal life support in pediatric burn care: A systematic review. Int J Artif Organs 2023; 46:182-187. [PMID: 36800906 DOI: 10.1177/03913988231155508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
A systematic review of the role of extracorporeal life support (ECLS) in pediatric patients with burn and smoke inhalation injury was undertaken. A systematic search of the literature according to a specific combination of keywords to ascertain the effectiveness of this treatment strategy was conducted. A total of 14 articles out of 266 were considered suitable for the analysis in pediatric patients. The PICOS approach and PRISMA flow chart were followed for the purpose of this review. Despite the limited number of studies on the subject, ECMO in burn and smoke inhalation injury provides an additional level of support in pediatric patients leading to positive outcomes. V-V ECMO demonstrated the best overall survival of all configurations, with similar outcomes to non-burned patients. Prolonged mechanical ventilation prior to ECMO decreases survival and increases mortality by 12% with each additional day off ECMO. Good outcomes have been described for scald burns, dressing changes, and pre-ECMO cardiac arrest.
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Affiliation(s)
- Marc O Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany.,Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Australia.,Division of Critical Care Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany.,Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Australia
| | - Massimo Capoccia
- Yorkshire Heart Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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18
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Brewer JM, Capoccia M, Maybauer DM, Lorusso R, Swol J, Maybauer MO. The ProtekDuo dual-lumen cannula for temporary acute mechanical circulatory support in right heart failure: A systematic review. Perfusion 2023; 38:59-67. [PMID: 36597024 DOI: 10.1177/02676591221149859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Acute right ventricular failure (aRVF) is associated with high mortality and morbidity. Mechanical circulatory support (MCS) may be considered as an advanced treatment option. The ProtekDuo is a cannula that can be used to provide acute right ventricular support as part of a temporary percutaneous (tp) right ventricular assist device (RVAD) system. The primary objective of this systematic review is to describe patient survival and complications when the ProtekDuo cannula was used as part of an tpRVAD system. METHODS MEDLINE, Embase, and Scopus were searched from database inception to August 26, 2022. Reference sections of studies were reviewed to screen for database omissions. RESULTS Seven studies with 127 patients were eligible for inclusion. The studies included patients with aRVF from a variety of causes. Mean duration of support was between 10 and 58 days in five studies. Patient survival to discharge was between 60% and 85.2% in two studies. Four authors reported 30-day survival between 60% and 85.2%. Devicerelated and non-device related complications were low. CONCLUSIONS Patients treated with RVAD using the ProtekDuo cannula have comparable survival rates and complications to other tpRVAD systems. Several advantages exist compared to other RVAD systems.
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Affiliation(s)
- Joseph M Brewer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, 23171Integris Baptist Medical Center, Oklahoma, OK, USA
| | - Massimo Capoccia
- Department of Cardiac Surgery, 4472Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, 9377Philipps University, Marburg, Germany
| | - Roberto Lorusso
- Department of Cardio Thoracic Surgery, 82246Maastricht University Medical Center, Maastricht, Netherlands
| | - Justyna Swol
- Department of Respiratory Medicine, 470426Paracelsus Medical University, Nuremberg, Germany
| | - Marc O Maybauer
- Nazih Zuhdi Transplant Institute, Advanced Cardiac Care, Specialty Critical Care and Acute Circulatory Support Service, 23171Integris Baptist Medical Center, Oklahoma, OK, USA.,Department of Anaesthesiology and Intensive Care Medicine, 9377Philipps 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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19
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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 2022; 46:93-98. [PMID: 36495090 PMCID: PMC9747364 DOI: 10.1177/03913988221142904] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [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,Marc O Maybauer, Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL 32610, 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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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Abstract
Introduction: Anaphylaxis is a rare but serious and potentially fatal complication of anesthesia. Little is known about the incidence and outcome of anaphylaxis in cardiac surgical patients, which we aimed to investigate. Methods: This was a 21-year retrospective study of cardiac surgical patients at Manchester Royal Infirmary, Manchester Foundation Trust, Manchester, UK. Results: A total of 19 cases of anaphylaxis were reported among 17,589 patients (0.108%) undergoing cardiac surgery. The majority (15/19) occurred before cardiopulmonary bypass (CPB), mostly during or within 30 min after the induction of anesthesia (10/19). Two occurred within 15 min of going onto CPB. Of these 17 cases, 11 were abandoned, and 6 proceeded. The severity of reactions in the patients who proceeded ranged from grade II to grade IV of the Ring and Messmer classification. Two cases occurred after the completion of surgery. All patients survived to 90 days. However, this did not appear to be related to CPB or protamine as most of the reactions occurred before CPB. Instead, the most common causative agents were gelofusine, antibiotics, muscle relaxants, and chlorhexidine. In 6 cases, surgery proceeded despite the anaphylaxis, in 11 cases the surgery was postponed, and in 2 cases the procedure had already been completed. Conclusion: As all patients survived, our results provide preliminary support for proceeding with surgery although we cannot speculate on the likely outcomes of patients who were postponed, had their surgery proceeded. Based on our data, the incidence of anaphylaxis in cardiac surgical patients may be 10–20 times higher than in the general surgical population.
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Affiliation(s)
- Rahul Norawat
- Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK
| | - Akbar Vohra
- Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK
| | - Andrew Parkes
- Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK
| | - Niall J O'Keeffe
- Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK
| | - Sujata Anipindi
- Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK
| | - Marc O Maybauer
- Department of Anesthesia and Intensive Care, Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester University and Manchester Academic Health Science Centre, Manchester, UK; Department of Anaesthesia and Critical Care, University of Queensland Critical Care Research Group and The Prince Charles Hospital, Brisbane, Australia; Department of Anesthesiology and Intensive Care, Philipps University, Marburg, Germany; Advanced Cardiac and Critical Care, Nazih Zuhdi Transplant Institute, Integris Health, Oklahoma City, USA
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23
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Maybauer MO, Koerner MM, Swol J, Banayosy AE, Maybauer DM. The novel ProtekDuo ventricular assist device: Configurations, technical aspects, and present evidence. Perfusion 2022:2676591221090607. [PMID: 35619541 DOI: 10.1177/02676591221090607] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The ProtekDuo, single site dual lumen cannula can be used in a multitude of configurations. In the medical literature, the ProtekDuo is described as right ventricular assist device (RVAD), as left ventricular assist device (LVAD), as biventricular assist device (BiVAD) when combined with an Impella device or other LVAD's, as double lumen drainage cannula on cardiopulmonary bypass (CPB), as RVAD with oxygenator, in veno-pulmonary (V-P) ECMO configuration, venovenous-pulmonary (VV-P) ECMO configuration with additional drainage cannula, and in veno-venopulmonary (V-VP) ECMO configuration as double lumen return cannula. Improvements in flow and oxygenation have been recognized in various settings and need further scientific evaluation. We summarized the above-mentioned configurations, technical aspects, and the present literature available for the ProtekDuo.
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Affiliation(s)
- 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,BNE, Australia.,Advanced Cardiac and Critical Care, Intergris Baptist Medical Center, Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, USA
| | - Michael M Koerner
- Advanced Cardiac and Critical Care, Intergris Baptist Medical Center, Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, OK, USA.,Faculty of Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Justyna Swol
- Department of Pneumology, Allergology and Sleep Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Aly El Banayosy
- Advanced Cardiac and Critical Care, Intergris Baptist Medical Center, Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA
| | - 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,BNE, Australia
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24
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Abstract
Extracorporeal membrane oxygenation (ECMO) is a widely used technique to provide circulatory and/or respiratory support in critically ill patients. ECMO treatment usually necessitates systemic anticoagulation. Unfractionated Heparin (UFH) is a commonly used anticoagulant in patients on ECMO support. In situations where UFH is contraindicated, alternative anticoagulation strategies can be applied, such as the use of direct thrombin inhibitors (DTI). Bivalirudin and argatroban are the most widely used DTIs. In this report we give account of the current evidence regarding dosing, monitoring and complications associated with the use of these agents in ECMO dependent patients.
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Affiliation(s)
- Janos Geli
- Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Massimo Capoccia
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dirk M Maybauer
- Department of Anaesthesia and Intensive Care, Philipps University, Marburg, Germany
| | - Marc O Maybauer
- Department of Anaesthesia and Intensive Care, Philipps University, Marburg, Germany.,Critical Care Research Group, The Prince Charles Hospital, University of Queensland, Brisbane, Australia.,Advanced Critical Care and Acute Circulatory Support, Nazih Zuhdi Transplant Institute, Integris Health, Oklahoma City, OK, USA.,Department of Medicine, Oklahoma State University Health Science Center, Tulsa, OK, USA
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25
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Mihu MR, Mageka D, Swant LV, El Banayosy A, Maybauer MO, Harper MD, Koerner MM, El Banayosy A. Veno-arteriovenous extracorporeal membrane oxygenation-A single center experience. Artif Organs 2021; 45:1554-1561. [PMID: 34519067 DOI: 10.1111/aor.14070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/07/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with combined circulatory shock and respiratory failure may benefit from veno-arteriovenous (V-AV) extracorporeal membrane oxygenation support (ECMO). We report our center's experience with V-AV ECMO and propose an algorithm to help identify patients that may benefit from early V-AV ECMO support. METHODS Clinical data were extracted from electronic medical records between November 1, 2016 and November 1, 2019. RESULTS Out of a total of 369 patients placed on extracorporeal life support (ECLS), we identified a total of 26 patients who underwent hybrid ECMO placement. Three patients were excluded from our analysis due to veno-venoarterial extracorporeal membrane oxygenation (V-VA ECMO) configuration, therefore 23 patients were included in our analysis. The median age was 53 (range 25-73) years. Hybrid ECMO support was instituted most commonly for differential hypoxemia in patients on venoarterial (V-A) ECMO support, and cardiogenic shock in patients who were initially started on venovenous (V-V) ECMO. The initial ECMO cannulation was V-A in 12 patients, V-V in 8 patients, and directly V-AV in 3 patients. Nine out of 23 patients were successfully decannulated (39.1%) and survived until hospital discharge. The main ECMO-related complications included bleeding (n = 10), circuit exchange either due to hemolysis or oxygenator failure (n = 4), ECMO cannula site infection (n = 2), deep venous thrombosis (n = 2), and death during ECMO cannula exchange (n = 1). CONCLUSIONS V-AV ECMO represents a rescue strategy in critically ill patients with combined respiratory failure and cardio-circulatory shock.
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Affiliation(s)
- Mircea R Mihu
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, Oklahoma, USA
| | - Dennis Mageka
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Laura V Swant
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Ahmed El Banayosy
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA
| | - Marc O Maybauer
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, Oklahoma, USA.,Department of Anesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany.,Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia.,Department of Anaesthesia, Manchester University NHS Foundation Trust, University of Manchester, Manchester Health Science Center, Manchester, UK
| | - Michael D Harper
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, Oklahoma, USA
| | - Michael M Koerner
- Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, Oklahoma, USA.,Faculty of Medicine, Ruhr-University, Bochum, Germany.,Department of Medicine/Cardiology, Baylor, Scott & White Health and College of Medicine, Texas A&M, Temple, Texas, USA
| | - Aly El Banayosy
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA
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26
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Abstract
Myasthenia gravis (MG) is an autoimmune disease affecting the neuromuscular junction causing weakness and fatigability of muscles. Careful perioperative management is required because of the unpredictable susceptibility to muscle relaxants. In this case report, we describe the successful management of a MG patient for normothermic coronary artery bypass graft (CABG) surgery with titrated doses of rocuronium without prolonged postoperative ventilation. We chose rocuronium because full and rapid recovery of neuromuscular blockade is possible with sugammadex. We conclude that using rocuronium is safe during general anaesthesia in MG patients undergoing on-pump CABG when combined with continuous neuromuscular monitoring and careful perioperative management.
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Affiliation(s)
- Vinayak Vanjari
- Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre and University of Manchester, Manchester, United Kingdom
| | - Marc O Maybauer
- Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre and University of Manchester, Manchester, United Kingdom; Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany; Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Australia
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27
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Geli J, Capoccia M, Maybauer DM, Maybauer MO. Argatroban Anticoagulation for Adult Extracorporeal Membrane Oxygenation: A Systematic Review. J Intensive Care Med 2021; 37:459-471. [PMID: 33653194 DOI: 10.1177/0885066621993739] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Heparin is the widely used anti-coagulation strategy for patients on extracorporeal membrane oxygenation (ECMO). Nevertheless, heparin-induced thrombocytopenia (HIT) and acquired anti-thrombin (AT) deficiency preclude the use of heparin requiring utilization of an alternative anticoagulant agent. Direct thrombin inhibitors are being proposed as potential alternatives with argatroban as one of the main agents. We aimed to review the evidence with regard to safety and efficacy of argatroban as a potential definitive alternative to heparin in the adult patient population undergoing ECMO support. METHODS A web-based systematic literature search was performed in Medline (PubMed) and Embase from inception until June 18, 2020. RESULTS The search identified 13 publications relevant to the target (4 cohort studies and 9 case series). Case reports and case series with less than 3 cases were not included in the qualitative synthesis. The aggregate number of argatroban treated patients on ECMO was n = 307. In the majority of studies argatroban was used as a continuous infusion without loading dose. Starting doses on ECMO varied between 0.05 and 2 μg/kg/min and were titrated to achieve the chosen therapeutic target range. The activated partial thormboplastin time (aPTT) was the anticoagulation parameter used for monitoring purposes in most studies, whereas some utilized the activated clotting time (ACT). Optimal therapeutic targets varied between 43-70 and 60-100 seconds for aPTT and between 150-210 and 180-230 seconds for ACT. Bleeding and thromboembolic complication rates were comparable to patients treated with unfractionated heparin (UFH). CONCLUSIONS Argatroban infusion rates and anticoagulation target ranges showed substantial variations. The rational for divergent dosing and monitoring approaches are discussed in this paper. Argatroban appears to be a potential alternative to UFH in patients requiring ECMO. To definitively establish its safety, efficacy and ideal dosing strategy, larger prospective studies on well-defined patient populations are warranted.
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Affiliation(s)
- Janos Geli
- Department of Cardiothoracic Anaesthesia and Critical Care, 59562Karolinska University Hospital, Stockholm, Sweden
| | - Massimo Capoccia
- Department of Aortic and Cardiac Surgery, 156726Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany.,Department of Anaesthesia, 105551Manchester Royal Infirmary, Manchester University NHS Foundation Trust, The University of Manchester and Manchester Academic Health Science Centre, Manchester, United Kingdom.,Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia.,Nazih Zuhdi Transplant Institute, Advanced Critical Care, Integris Baptist Medical Centre, Oklahoma City, and Oklahoma State University, Tulsa, Oklahoma, USA
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28
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Maybauer MO, El Banayosy A, Koerner MM, Hooker RL, Swant LV, Mihu MR, Harper MD. Mechanical cardiopulmonary resuscitation for venoarterial ECMO implantation in pulmonary embolism complicated by type B aortic dissection and retroperitoneal hemorrhage. J Card Surg 2020; 35:2821-2824. [PMID: 33043655 DOI: 10.1111/jocs.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient with acute pulmonary embolism suffered cardiac arrest, received manual and mechanical cardiopulmonary resuscitation and tissue plasminogen activator before extracorporeal cardiopulmonary resuscitation was initiated. She suffered a type B aortic dissection and retroperitoneal hemorrhage secondary to resuscitation measures. This case report describes high-risk anticoagulation management for contradicting treatment goals in preparation for pulmonary embolectomy on cardiopulmonary bypass.
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Affiliation(s)
- Marc O Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany.,Critical Care Research Group, The Prince Charles Hospital, and The University of Queensland, Brisbane, Australia.,Department of Anaesthesia, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center and University of Manchester, Manchester, UK.,Advanced Critical Care, INTEGRIS Nazih Zuhdi Transplant Institute, Oklahoma City, Oklahoma.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, Oklahoma
| | - Aly El Banayosy
- Advanced Critical Care, INTEGRIS Nazih Zuhdi Transplant Institute, Oklahoma City, Oklahoma
| | - Michael M Koerner
- Advanced Critical Care, INTEGRIS Nazih Zuhdi Transplant Institute, Oklahoma City, Oklahoma.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, Oklahoma.,Faculty of Medicine, Ruhr-University, Bochum, Germany
| | - Robert L Hooker
- Advanced Critical Care, INTEGRIS Nazih Zuhdi Transplant Institute, Oklahoma City, Oklahoma
| | - Laura V Swant
- Advanced Critical Care, INTEGRIS Nazih Zuhdi Transplant Institute, Oklahoma City, Oklahoma
| | - Mircea R Mihu
- Advanced Critical Care, INTEGRIS Nazih Zuhdi Transplant Institute, Oklahoma City, Oklahoma
| | - Michael D Harper
- Advanced Critical Care, INTEGRIS Nazih Zuhdi Transplant Institute, Oklahoma City, Oklahoma.,Department of Medicine/Cardiology, Oklahoma State University Health Science Center, Tulsa, Oklahoma
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29
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Capoccia M, Maybauer MO. Extra-corporeal membrane oxygenation in aortic surgery and dissection: A systematic review. World J Crit Care Med 2019; 8:135-147. [PMID: 31942440 PMCID: PMC6957356 DOI: 10.5492/wjccm.v8.i8.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Very little is known about the role of extracorporeal membrane oxygenation (ECMO) for the management of patients undergoing major aortic surgery with particular reference to aortic dissection.
AIM To review the available literature to determine if there was any evidence.
METHODS A systematic literature search through PubMed and EMBASE was undertaken according to specific key words.
RESULTS The search resulted in 29 publications relevant to the subject: 1 brief communication, 1 surgical technique report, 1 invited commentary, 1 retrospective case review, 1 observational study, 4 retrospective reviews, 13 case reports and 7 conference abstracts. A total of 194 patients were included in these publications of whom 77 survived.
CONCLUSION Although there is no compelling evidence for or against the use of ECMO in major aortic surgery or dissection, it is enough to justify its use in this patient population despite current adverse attitude.
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Affiliation(s)
- Massimo Capoccia
- Department of Aortic and Cardiac Surgery, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, United Kingdom
| | - Marc O Maybauer
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, United Kingdom
- Department of Anaesthesiology and Intensive Care Medicine, Phillips University, Marburg 35037, Germany
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane QLD 4032, Queensland, Australia
- Advanced Critical Care and Transplant Institute, Integris Baptist Medical Centre, Oklahoma City, OK 73112, United States
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30
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Maybauer MO, El Banayosy A, Hooker RL, Vanhooser DW, Harper MD, Mihu MR, Swant LV, Horstmanshof DA, Koerner MM. Percutaneous venoarterial extracorporeal membrane oxygenation as a bridge to double valve implantation in acute biventricular heart failure with profound cardiogenic shock. J Card Surg 2019; 34:1664-1666. [PMID: 31508845 DOI: 10.1111/jocs.14255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 71-year-old woman was admitted with acute hypoxic and hypercapnic respiratory failure and cardiogenic shock, secondary to acute on chronic biventricular systolic and diastolic congestive heart failure and severe aortic and mitral valve stenosis. She further presented with pulmonary hypertension and moderate-to-severe tricuspid regurgitation requiring high and increasing doses of vasopressors. The patient was percutaneously cannulated for venoarterial extracorporeal membrane oxygenation (VA-ECMO) and stabilized on ECMO, with a urine output of 17.3 L within the following 8 days. Balloon valvuloplasty and/or transcatheter aortic valve replacement were discussed but ruled out by the multidisciplinary team considering the mitral valve could not be fully addressed. Though lung function was not fully optimized, a window of opportunity was identified and used for double valve replacement on day 8 of VA-ECMO support. After a 24-hour vasoplegic period, the patient was extubated to continuous positive airway pressure and further transitioned to nasal cannula, following which she recovered well.
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Affiliation(s)
- Marc O Maybauer
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma.,Cardio-Thoracic Surgery, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Aly El Banayosy
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Robert L Hooker
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - David W Vanhooser
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Michael D Harper
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Mircea R Mihu
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Laura V Swant
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Douglas A Horstmanshof
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma
| | - Michael M Koerner
- Advanced Critical Care, Nazih Zuhdi Transplant Institute, Advanced Cardiac Care and 24/7 Shock Service, Integris Baptist Medical Center, Oklahoma City, Oklahoma
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31
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Abstract
Rhabdomyoma is the most common cardiac tumor in infancy and commonly located in the ventricles causing outflow obstruction or arrhythmias. We report a rare pediatric (7 month old) case of a right atrial rhabdomyoma presenting with severe cyanosis and low cardiac output from significant tricuspid inflow obstruction with right to left shunt across a stretched patent foramen ovale. We present an emergency cardiac surgery for right atrial tumor resection, and the management of separating the patient with failing right ventricle from cardiopulmonary bypass using a Glenn shunt, since extracorporeal membrane oxygenation (ECMO) or nitric oxide was not available.
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Affiliation(s)
- Rahul Norawat
- Manchester Academic Health Science Centre, Cardiothoracic Anaesthesia and Intensive Care, Manchester University, Manchester University NHS Foundation Trust, Manchester, UK; Department of Cardiac Anaesthesia, Apollo Hospital, New Delhi, India
| | - Deepa Sarkar
- Department of Cardiac Anaesthesia, Apollo Hospital, New Delhi, India
| | - Marc O Maybauer
- Manchester Academic Health Science Centre, Cardiothoracic Anaesthesia and Intensive Care, Manchester University, Manchester University NHS Foundation Trust, Manchester, UK; Department of Anaesthesiology and Intensive Care, The Prince Charles Hospital, The University of Queensland, Critical Care Research Group, Brisbane, Australia; Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany
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32
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Maybauer MO, Koerner MM, Maybauer DM. Perspectives on adjunctive use of ketamine for analgosedation during extracorporeal membrane oxygenation. Expert Opin Drug Metab Toxicol 2019; 15:349-351. [PMID: 30913933 DOI: 10.1080/17425255.2019.1593963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Analgosedation on ECMO is more than the choice of any drug, it has to be context specific. Ketamine may be considered as an adjunctive therapy in patients requiring high-dose opioids and sedatives during ECMO support with difficulty to achieve a target RASS. Considering ketamine provides analgesia while maintaining airway reflexes, it could be useful for early ECMO weaning and use of ECMO in awake, non-intubated, spontaneously breathing patients with respiratory failure ('awake' ECMO), especially for patients having considerable waiting periods while being bridged to transplant. The hemodynamic effects of ketamine may provide the benefit of decreasing vasopressor requirements, thereby potentially improving microcirculation. In this context, the effects on end-organ function and the need for renal replacement therapy should be investigated. Pharmacokinetic and pharmacodynamic studies on ketamine ex- and in vivo are of utmost importance to delineate its pharmacological profile and effectiveness during ECMO therapy and to create admissible future study hypothesis.
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Affiliation(s)
- Marc O Maybauer
- a Cardiothoracic Anesthesia and Intensive Care, Manchester Royal Infirmary , Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre and University of Manchester , Manchester , UK.,b Critical Care Research Group, The Prince Charles Hospital , University of Queensland , Brisbane , Queensland , Australia.,c Anesthesia and Intensive Care Medicine , Philipps-University Marburg , Marburg , Germany
| | - Michael M Koerner
- d Integris Baptist Medical Center, Advanced Critical Care and Transplant Institute , Oklahoma State University , Oklahoma City , OK , USA
| | - Dirk M Maybauer
- c Anesthesia and Intensive Care Medicine , Philipps-University Marburg , Marburg , Germany
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33
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Maybauer DM, Talke PO, Westphal M, Maybauer MO, Traber LD, Enkhbaatar P, Morita N, Traber DL. Positive End-expiratory Pressure Ventilation Increases Extravascular Lung Water Due to a Decrease in Lung Lymph Flow. Anaesth Intensive Care 2019; 34:329-33. [PMID: 16802485 DOI: 10.1177/0310057x0603400307] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Positive end-expiratory pressure (PEEP) is used to improve gas exchange, increase functional residual capacity, recruit air spaces, and decrease pulmonary shunt in patients suffering from respiratory failure. The effect of PEEP on extravascular lung water (EVLW), however, is still not fully understood. This study was designed as a prospective laboratory experiment to evaluate the effects of PEEP on EVLW and pulmonary lymph flow (QL) under physiologic conditions. Twelve adult sheep were operatively prepared to measure haemodynamics of the systemic and pulmonary circulation, and to assess EVLW. In addition, the lung lymphatic duct was cannulated and a tracheostomy performed. The animals were then mechanically ventilated in the awake-state without end-expiratory pressure (PEEP 0). After a two-hour baseline period, PEEP was increased to 10 cmH2O for the duration of two hours, and then reduced back to 0 cmH2O. Cardiopulmonary variables, QL, and arterial blood gases were recorded intermittently; EVLW was determined two hours after each change in PEEP. The increase in PEEP resulted in a decrease in QL (7±1 vs 5±1 ml/h) and an increase in EVLW (498±40 vs 630±58 ml; P<0.05 each) without affecting cardiac output. As PEEP was decreased back to baseline, QL increased significantly (5±1 vs 10±2 ml/h), whereas EVLW returned back to baseline. This study suggests that institution of PEEP produces a reversible increase in EVLW that is linked to a decrease in QL.
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Affiliation(s)
- D M Maybauer
- Department of Anaesthesiology, Investigational Intensive Care Unit, The University of Texas Medical Branch, and Shriners Burns Hospital for Children at Galveston, USA
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34
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Maybauer MO, Vohra A, O'Keeffe NJ, Prodromou OE, Maher W, Haravi H, Mountney K, Hoschtitzky JA. Extracorporeal membrane oxygenation in adult congenital heart disease: a case series and literature review. CRIT CARE RESUSC 2017; 19:15-20. [PMID: 29084497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) can be used as rescue intervention for cardiac and/or respiratory failure. High-risk adult patients with adult congenital heart disease (ACHD) may require pre- and post-operative ECMO support. DESIGN, SETTING AND PARTICIPANTS Retrospective data collection within a five-year time period from 2011 to 2016, at a single-centre study at a tertiary university hospital and regional unit for ACHD. Patients with ACHD in cardiogenic shock or failure to be separated from cardio-pulmonary bypass (CPB) were included. INTERVENTION Venoarterial (VA) ECMO. RESULTS Three patients had Ebstein anomaly and one patient had a double-outlet right ventricle transposition type and severe atrioventricular valve insufficiency. Three male patients and one female patient were aged ranging from 19 to 52 years. All received VA ECMO, two each with central or peripheral cannulation. The mean duration of ECMO support was 7 days (range, 3-13 days) and bleeding complications were the main complications observed, with a range of 12 to 104 blood products used. One patient required renal replacement therapy for acute kidney injury and also had leg ischaemia. MAIN OUTCOME MEASURES Two of four patients (50%) were successfully weaned off ECMO and survived to hospital discharge in this high-risk group of patients in severe heart failure. The patients are currently at 3 and 4 years follow-up, with improved mobility and exercise tolerance compared with pre-operatively. CONCLUSION ECMO is a promising temporary rescue intervention for patients with ACHD and cardiogenic shock. The extracorporeal cardiac support is a useful bridge to recovery.
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Affiliation(s)
- Marc O Maybauer
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany.
| | - Akbar Vohra
- Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust; Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Niall J O'Keeffe
- Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust; Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Ourania E Prodromou
- Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust; Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Wael Maher
- Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust; Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Hoeda Haravi
- Manchester Perfusion Practice, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust, Manchester, United Kingdom
| | - Katrina Mountney
- Manchester Perfusion Practice, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust, Manchester, United Kingdom
| | - Johann A Hoschtitzky
- Department of Cardiac Surgery, Regional Adult Congenital Heart Disease Unit, Manchester Royal Infirmary, Central Manchester University Hospitals, NHS Foundation Trust; Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Asmussen S, Przkora R, Maybauer DM, Fraser JF, Sanfilippo F, Jennings K, Adamzik M, Maybauer MO. Meta-Analysis of Electroacupuncture in Cardiac Anesthesia and Intensive Care. J Intensive Care Med 2017; 34:652-661. [PMID: 28569130 DOI: 10.1177/0885066617708558] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acupuncture treatment has been employed in China for over 2500 years and it is used worldwide as analgesia in acute and chronic pain. Acupuncture is also used in general anesthesia (GA). The aim of this systematic review and meta-analysis was to assess the efficacy of electroacupuncture (EA) in addition to GA in patients undergoing cardiac surgery. METHODS We searched 3 databases (Pubmed, Cochrane Library, and Web of Science-from 1965 until January 31, 2017) for randomized controlled trials (RCTs) including patients undergoing cardiac surgery and receiving GA alone or GA + EA. As primary outcomes, we investigated the association between GA + EA approach and the dosage of intraoperative anesthetic drugs administered, the duration of mechanical ventilation (MV), the postoperative dose of vasoactive drugs, the length of intensive care unit (ICU) and hospital stay, and the levels of troponin I and cytokines. RESULTS The initial search yielded 477 citations, but only 7 prospective RCTs enrolling a total of 321 patients were included. The use of GA + EA reduced the dosage of intraoperative anesthetic drugs (P < .05), leading to shorter MV time (P < .01) and ICU stay (P < .05) as well as reduced postoperative dose of vasoactive drugs (P < .001). In addition, significantly lower levels of troponin I (P < .01) and tumor necrosis factor α (P < .01) were observed. CONCLUSION The complementary use of EA for open-heart surgery reduces the duration of MV and ICU stay, blunts the inflammatory response, and might have protective effects on the heart. Our findings stimulate future RCT to provide definitive recommendations.
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Affiliation(s)
- Sven Asmussen
- 1 Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.,2 Departments of Anesthesiology and Epidemiology and Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA.,3 Critical Care Research Group, Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Rene Przkora
- 2 Departments of Anesthesiology and Epidemiology and Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA.,4 Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Dirk M Maybauer
- 2 Departments of Anesthesiology and Epidemiology and Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA.,5 Department of Cardiothoracic Anaesthesia and Critical Care, St George's Hospital, London, UK
| | - John F Fraser
- 3 Critical Care Research Group, Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Filippo Sanfilippo
- 6 Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy.,7 Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany
| | - Kristofer Jennings
- 2 Departments of Anesthesiology and Epidemiology and Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA
| | - Michael Adamzik
- 1 Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Marc O Maybauer
- 2 Departments of Anesthesiology and Epidemiology and Biostatistics, The University of Texas Medical Branch, Galveston, TX, USA.,3 Critical Care Research Group, Prince Charles Hospital, The University of Queensland, Brisbane, Queensland, Australia.,5 Department of Cardiothoracic Anaesthesia and Critical Care, St George's Hospital, London, UK.,8 Cardiothoracic Anaesthesia and Intensive Care, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, University of Manchester, UK
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Sanfilippo F, Asmussen S, Maybauer DM, Santonocito C, Fraser JF, Erdoes G, Maybauer MO. Bivalirudin for Alternative Anticoagulation in Extracorporeal Membrane Oxygenation: A Systematic Review. J Intensive Care Med 2017; 32:312-319. [DOI: 10.1177/0885066616656333] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background:Extracorporeal membrane oxygenation (ECMO) offers therapeutic options in refractory respiratory and/or cardiac failure. Systemic anticoagulation with heparin is routinely administered. However, in patients with heparin-induced thrombocytopenia or heparin resistance, the direct thrombin inhibitor bivalirudin is a valid option and has been increasingly used for ECMO anticoagulation. We aimed at evaluating its safety and its optimal dosing for ECMO.Methods:Systematic web-based literature search of PubMed and EMBASE performed via National Health Service Library Evidence and manually, updated until January 30, 2016.Results:The search revealed 8 publications relevant to the topic (5 case reports). In total, 58 patients (24 pediatrics) were reported (18 received heparin as control groups). Bivalirudin was used with or without loading dose, followed by infusion at different ranges (lowest 0.1-0.2 mg/kg/h without loading dose; highest 0.5 mg/kg/h after loading dose). The strategies for monitoring anticoagulation and optimal targets were dissimilar (activated partial thromboplastin time 45-60 seconds to 42-88 seconds; activated clotting time 180-200 seconds to 200-220 seconds; thromboelastography in 1 study).Conclusion:Bivalirudin loading dose was not always used; infusion range and anticoagulation targets were different. In this systematic review, we discuss the reasons for this variability. Larger studies are needed to establish the optimal approach with the use of bivalirudin for ECMO.
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Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
- School of Anaesthesia and Intensive Care, University of Catania, Catania, Italy
| | - Sven Asmussen
- Department of Anaesthesiology, Ruhr-University Bochum, University Hospital Knappschaftskrankenhaus, Bochum, Germany
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Dirk M. Maybauer
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia
| | - Gabor Erdoes
- Department of Anaesthesiology and Pain Therapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Marc O. Maybauer
- Critical Care Research Group, The Prince Charles Hospital and The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University, Marburg, Germany
- Cardiothoracic Anaesthesia and Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Sanfilippo F, Chiarenza F, Maybauer DM, Maybauer MO. The Easytube for airway management: a systematic review of clinical and simulation studies. J Clin Anesth 2016; 31:215-22. [PMID: 27185715 DOI: 10.1016/j.jclinane.2016.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE Endotracheal intubation is considered the criterion-standard technique for securing the airway. Supraglottic airway devices (SADs) represent a major advance in airway management and are recommended by the guidelines in difficult situations such as Advanced Life Support and "cannot ventilate-cannot intubate" scenarios. The Easytube (EzT) is an SAD introduced a decade ago but not included yet in the above guidelines. DESIGN Systematic review of MEDLINE and EMBASE according to PRISMA guidelines available up to January 12, 2016. SETTING We collected experimental and clinical evidence regarding EzT positioning performed by medial students, anesthesiologists, paramedics, or nurses. PATIENTS Manikins, cadavers, or patients. INTERVENTIONS EzT positioning in both clinical and simulation studies, both under standard and under difficult scenarios. MEASUREMENTS Time to insertion and time to ventilation, success rate and operator's assessment of the device, change in ventilatory parameters, and major complications. MAIN RESULTS Fifteen manuscripts were found: 6 prospective clinical studies and 9 conducted under experimental conditions (7 with a simulator and 2 on cadavers). The EzT inserted by both inexperienced and experienced personnel in most studies had high success rate, and it showed excellent results also during simulated cardiopulmonary resuscitation and in difficult airway scenarios. The EzT had better ventilatory parameters as compared with the Combitube and showed great airway sealing capacity, comparable to the Combitube and to the laryngeal mask airway and superior to other SADs. EzT allowed the insertion of large nasogastric tubes and has only mild adverse effects like other SADs. No major complications were described. CONCLUSION The EzT appears to be a safe and a good alternative to established SADs. It may be considered among SADs by future guidelines on Advanced Life Support and "cannot ventilate-cannot intubate" scenarios.
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Affiliation(s)
- Filippo Sanfilippo
- Cardiothoracic Intensive Care Unit, Intensive Care Directorate, St Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom; School of Anaesthesia and Intensive Care, Department of Anesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele", Catania 95100, Italy.
| | - Federica Chiarenza
- School of Anaesthesia and Intensive Care, Department of Anesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele", Catania 95100, Italy
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University Marburg, Baldinger Strasse, 35043 Marburg, Germany
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University Marburg, Baldinger Strasse, 35043 Marburg, Germany; University of Queensland, Critical Care Research Group and the Prince Charles Hospital at Brisbane, Rode Rd, Chermside 4032, QLD, Australia; Cardiothoracic Anaesthesia and Intensive Care, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, United Kingdom.
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Sanfilippo F, Serena G, Corredor C, Benedetto U, Maybauer MO, Al-Subaie N, Madden B, Oddo M, Cecconi M. Cerebral oximetry and return of spontaneous circulation after cardiac arrest: A systematic review and meta-analysis. Resuscitation 2015; 94:67-72. [DOI: 10.1016/j.resuscitation.2015.06.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/18/2015] [Accepted: 06/24/2015] [Indexed: 01/23/2023]
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Saad AF, Maybauer DM, Maybauer MO. Do initial tidal volumes impact acute respiratory distress syndrome development in patients intubated in the emergency department? J Crit Care 2015; 30:421-2. [PMID: 25700967 DOI: 10.1016/j.jcrc.2014.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Antonio F Saad
- Department of Anesthesiology, Surgical Critical Care, and Maternal Fetal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Dirk M Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany
| | - Marc O Maybauer
- Department of Anaesthesiology and Intensive Care, Philipps University, Marburg, Germany; Critical Care Research Group, University of Queensland, Brisbane, Australia.
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Abstract
Recent promising findings indicate a possible benefit of β-blockade in septic patients. Ongoing trials on esmolol in septic shock are investigating its hemodynamic effects, focusing on heart rate control and echocardiographic changes, as well as potential anti-inflammatory effects. However, given the complex physiology of sepsis and pharmacological effects on β-blockade, large multi-center trials are essential before such a therapy may be applied safely.
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Affiliation(s)
- Marc O Maybauer
- a a Critical Care Research Group, The University of Queensland and the Prince Charles Hospital , Brisbane , Queensland , Australia
- b b Department of Anaesthesiology and Intensive Care , Philipps University , Marburg , Germany
| | - Dirk M Maybauer
- b b Department of Anaesthesiology and Intensive Care , Philipps University , Marburg , Germany
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Sanfilippo F, Santonocito C, Veenith T, Astuto M, Maybauer MO. The Role of Neuromuscular Blockade in Patients with Traumatic Brain Injury: A Systematic Review. Neurocrit Care 2014; 22:325-34. [DOI: 10.1007/s12028-014-0061-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Maybauer MO, Asmussen S, Platts DG, Fraser JF, Sanfilippo F, Maybauer DM. Transesophageal echocardiography in the management of burn patients. Burns 2014; 40:630-5. [DOI: 10.1016/j.burns.2013.08.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 08/20/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
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Chemonges S, Shekar K, Tung JP, Dunster KR, Diab S, Platts D, Watts RP, Gregory SD, Foley S, Simonova G, McDonald C, Hayes R, Bellpart J, Timms D, Chew M, Fung YL, Toon M, Maybauer MO, Fraser JF. Optimal management of the critically ill: anaesthesia, monitoring, data capture, and point-of-care technological practices in ovine models of critical care. Biomed Res Int 2014; 2014:468309. [PMID: 24783206 PMCID: PMC3982457 DOI: 10.1155/2014/468309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/21/2014] [Accepted: 02/10/2014] [Indexed: 12/18/2022]
Abstract
Animal models of critical illness are vital in biomedical research. They provide possibilities for the investigation of pathophysiological processes that may not otherwise be possible in humans. In order to be clinically applicable, the model should simulate the critical care situation realistically, including anaesthesia, monitoring, sampling, utilising appropriate personnel skill mix, and therapeutic interventions. There are limited data documenting the constitution of ideal technologically advanced large animal critical care practices and all the processes of the animal model. In this paper, we describe the procedure of animal preparation, anaesthesia induction and maintenance, physiologic monitoring, data capture, point-of-care technology, and animal aftercare that has been successfully used to study several novel ovine models of critical illness. The relevant investigations are on respiratory failure due to smoke inhalation, transfusion related acute lung injury, endotoxin-induced proteogenomic alterations, haemorrhagic shock, septic shock, brain death, cerebral microcirculation, and artificial heart studies. We have demonstrated the functionality of monitoring practices during anaesthesia required to provide a platform for undertaking systematic investigations in complex ovine models of critical illness.
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Affiliation(s)
- Saul Chemonges
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Medical Engineering Research Facility (MERF), Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Kiran Shekar
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Bond University, Gold Coast, QLD 4226, Australia
| | - John-Paul Tung
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Brisbane, QLD 4059, Australia
| | - Kimble R Dunster
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Science and Engineering Faculty, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Sara Diab
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - David Platts
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Ryan P Watts
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Department of Emergency Medicine, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia
| | - Shaun D Gregory
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
| | - Samuel Foley
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Gabriela Simonova
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Charles McDonald
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Rylan Hayes
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Judith Bellpart
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Daniel Timms
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
| | - Michelle Chew
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Yoke L Fung
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Michael Toon
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia
| | - Marc O Maybauer
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - John F Fraser
- Critical Care Research Group Laboratory, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, QLD 4032, Australia ; The University of Queensland, St Lucia, Brisbane, QLD 4072, Australia ; Innovative Cardiovascular Engineering and Technology Laboratory, The Prince Charles Hospital, Chermside, Brisbane, QLD 4032, Australia
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Sanfilippo F, Santonocito C, Maybauer MO. Routine screening and anticipation of difficult airways in the critical care setting. Minerva Anestesiol 2013; 79:965-966. [PMID: 23449244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Asmussen S, Maybauer DM, Fraser JF, Jennings K, George S, Maybauer MO. A meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients. Burns 2013; 39:625-31. [DOI: 10.1016/j.burns.2013.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 12/18/2012] [Accepted: 01/04/2013] [Indexed: 11/26/2022]
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Asmussen S, Maybauer DM, Fraser JF, Jennings K, George S, Keiralla A, Maybauer MO. Extracorporeal membrane oxygenation in burn and smoke inhalation injury. Burns 2012; 39:429-35. [PMID: 23062623 DOI: 10.1016/j.burns.2012.08.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 07/31/2012] [Accepted: 08/01/2012] [Indexed: 01/22/2023]
Abstract
A systematic review and meta-analysis was conducted to assess the level of evidence for the use of extracorporeal membrane oxygenation (ECMO) in hypoxemic respiratory failure resulting from burn and smoke inhalation injury. We searched any article published before March 01, 2012. Available studies published in any language were included. Five authors rated each article and assessed the methodological quality of studies using the recommendation of the Oxford Centre for Evidence Based Medicine (OCEBM). Our search yielded 66 total citations but only 29 met the inclusion criteria of burn and/or smoke inhalation injury. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. Only a small number of clinical trials, all with a limited number of patients, were available. The overall data suggests that there is no improvement in survival for burn patients suffering acute hypoxemic respiratory failure, with the use of ECMO. ECMO run times of less than 200 h correlate with higher survival compared to 200 h or more. Scald burns show a tendency of higher survival than flame burns. In conclusion, the presently available literature is based on insufficient patient numbers; the data obtained and level of evidence generated are limited. The role of ECMO in burn and smoke inhalation injury is therefore unclear. However, ECMO technology and expertise have improved over the last decades. Further research on ECMO in burn and smoke inhalation injury is warranted.
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Affiliation(s)
- Sven Asmussen
- Department of Anesthesiology, The University of Texas Medical Branch and Shriners Burns Hospital for Children, Galveston, TX 77555, USA.
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Elijah IE, Børsheim E, Maybauer DM, Finnerty CC, Herndon DN, Maybauer MO. Role of the PPAR-α agonist fenofibrate in severe pediatric burn. Burns 2012; 38:481-6. [PMID: 22226866 DOI: 10.1016/j.burns.2011.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/10/2011] [Indexed: 12/13/2022]
Abstract
Fenofibrate is a peroxisome proliferator activated receptor alpha agonist that contains both pro and anti-inflammatory properties, and has been used in the treatment of dyslipidemia and diabetes for decades. Its receptors are expressed in the liver, skeletal muscle, cardiac, enteric, and renal cells, which allow it to provide systemic regulation of lipoprotein metabolism, fatty acid oxidation, and fatty acid transport. Hyperglycemia is a common complication found in the burn population because hepatic glucose production and catecholamine-mediated hepatic glycogenolysis are augmented. Insulin resistance occurs often in these patients and is associated with poor outcomes. In the pediatric burn population, fenofibrate has been found to ameliorate or decrease the number of hypoglycemic episodes when compared to management with insulin alone. Its mechanism of action is thought to involve an improvement in insulin signaling in skeletal muscle, as well as improvements in mitochondrial function, glucose oxidation, and insulin sensitivity. The long term use of fenofibrate in severely burned patients may improve hyperglycemia and insulin resistance, as well as improve wound healing, and reduce apoptosis, and oxidative stress.
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Affiliation(s)
- Itoro E Elijah
- Department of Surgery, The University of Texas Medical Branch and Shriners Burns Hospital for Children at Galveston, TX 77555-0591, USA
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Abstract
OBJECTIVES To evaluate the frequency of use, placement site, success and misplacement rates, and need for intervention for tube thoracostomies (TTs), and the complications with endotracheal intubation associated with TT in the prehospital setting. METHODS We performed a five-year, retrospective study using the records of 1,065 patients who were admitted to the trauma emergency room at a university hospital and who had received chest radiographs or computed tomography (CT) scans within 30 minutes after admission. RESULTS Seven percent of all patients received a TT (5% unilateral, 2% bilateral). Ninety-seven percent of all patients with a TT were endotracheally intubated. The success rate for correctly placed chest tubes was 78%. Twenty-two percent of the chest tubes were misplaced (i.e., too far in the chest, twisted, or bent); half of those had to be corrected, with one needing to be replaced. There were no statistical differences in the frequency of Monaldi or Bülau positions, or the frequency of left or right chest TT. In addition, the two positions did not differ in misplacement rates or the need for intervention. Helicopter emergency medical services physicians used the Monaldi position significantly more frequently than the Bülau position. In-hospital physicians performing interhospital transfer used the Bülau position significantly more frequently, whereas ground emergency medical physicians had a more balanced relationship between the two positions. Tube thoracostomy had no influence on endotracheal tube misplacement rates, and vice versa. CONCLUSION Tube thoracostomy positioning mostly depends on the discretion of the physician on scene. The Monaldi and Bülau positions do not differ in misplacement or complication rates.
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Affiliation(s)
- Marc O Maybauer
- Department of Anaesthesiology, University Hospital at Ulm, Germany.
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Toon MH, Maybauer DM, Arceneaux LL, Fraser JF, Meyer W, Runge A, Maybauer MO. Children with burn injuries--assessment of trauma, neglect, violence and abuse. J Inj Violence Res 2011; 3:98-110. [PMID: 21498973 PMCID: PMC3134932 DOI: 10.5249/jivr.v3i2.91] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Accepted: 10/13/2010] [Indexed: 11/16/2022] Open
Abstract
Burns are an important cause of injury to young children, being the third most frequent cause of injury resulting in death behind motor vehicle accidents and drowning. Burn injuries account for the greatest length of stay of all hospital admissions for injuries and costs associated with care are substantial. The majority of burn injuries in children are scald injuries resulting from hot liquids, occurring most commonly in children aged 0-4 years. Other types of burns include electrical, chemical and intentional injury. Mechanisms of injury are often unique to children and involve exploratory behavior without the requisite comprehension of the dangers in their environment. Assessment of the burnt child includes airway, breathing and circulation stabilization, followed by assessment of the extent of the burn and head to toe examination. The standard rule of 9s for estimating total body surface area (TBSA) of the burn is inaccurate for the pediatric population and modifications include utilizing the Lund and Browder chart, or the child's palm to represent 1% TBSA. Further monitoring may include cardiac assessment, indwelling catheter insertion and evaluation of inhalation injury with or without intubation depending on the context of the injury. Risk factors and features of intentional injury should be known and sought and vital clues can be found in the history, physical examination and common patterns of presentation. Contemporary burn management is underscored by several decades of advancing medical and surgical care however, common to all injuries, it is in the area of prevention that the greatest potential to reduce the burden of these devastating occurrences exists.
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Affiliation(s)
- Michael H. Toon
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
| | - Dirk M. Maybauer
- Department of Anesthesia and Intensive Care, Philipps University of Marburg, Marburg, Germany
- Department of Anesthesiology, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
| | - Lisa L. Arceneaux
- Department of Surgery, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
| | - John F. Fraser
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
| | - Walter Meyer
- Department of Psychiatry, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
| | - Antoinette Runge
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
| | - Marc O. Maybauer
- Critical Care Research Group and The University of Queensland, The Prince Charles Hospital at Brisbane, Australia
- Department of Anesthesia and Intensive Care, Philipps University of Marburg, Marburg, Germany
- Department of Anesthesiology, The University of Texas Medical Branch and Shriners Burns Hospital at Galveston, USA
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