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Malfertheiner SF, Brodie D, Burrell A, Taccone FS, Broman LM, Shekar K, Agerstrand CL, Serra AL, Fraser J, Malfertheiner MV. Extracorporeal membrane oxygenation during pregnancy and peripartal. An international retrospective multicenter study. Perfusion 2022:2676591221090668. [PMID: 35549557 DOI: 10.1177/02676591221090668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/15/2022]
Abstract
INTRODUCTION Extracorporeal Membrane Oxygenation (ECMO) may be used in the setting of pregnancy or the peripartal period, however its utility has not been well-characterized. This study aims to give an overview on the prevalence of peripartel ECMO cases and further assess the indications and outcomes of ECMO in this setting across multiple centers and countries. METHODS A retrospective, multicenter, international cohort study of pregnant and peripartum ECMO cases was performed. Data were collected from six ECMO centers across three continents over a 10-year period. RESULTS A total of 60 pregnany/peripartal ECMO cases have been identified. Most frequent indications are acute respiratory distress syndrome (n = 30) and pulmonary embolism (n = 5). Veno-venous ECMO mode was applied more often (77%). ECMO treatment during pregnancy was performed in 17 cases. Maternal and fetal survival was high with 87% (n = 52), respectively 73% (n = 44). CONCLUSIONS Various emergency scenarios during pregnancy and at time of delivery may require ECMO treatment. Peripartal mortality in a well-resourced setting is rare, however emergencies in the labor room occur and knowledge of available rescue therapy is essential to improve outcome. Obstetricians and obstetric anesthesiologists should be aware of the availability of ECMO resource at their hospital or region to ensure immediate contact when needed.
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Affiliation(s)
- S Fill Malfertheiner
- Department of Obstetrics and Gynecology, Hospital St. Hedwig of the Order of St. John, Regensburg University, Regensburg, Germany
| | - D Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, 12294Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York.,Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York
| | - A Burrell
- Department of Intensive Care, The Alfred Hospital, Melbourne, Australia
| | - F S Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, ULB, Brussels, Belgium
| | - L M Broman
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - K Shekar
- Critical Care Research Group, 67567The Prince Charles Hospital, Brisbane, Australia
| | - C L Agerstrand
- Division of Pulmonary, Allergy, and Critical Care Medicine, 12294Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York.,Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York
| | - A L Serra
- Division of Pulmonary, Allergy, and Critical Care Medicine, 12294Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York.,Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York
| | - J Fraser
- Critical Care Research Group, 67567The Prince Charles Hospital, Brisbane, Australia
| | - M V Malfertheiner
- Department of Internal Medicine II, Cardiology and Pneumology, University Hospital Regensburg, Regensburg, Germany
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Zipfel S, Biancari F, Mariscalco G, Dalén M, Settembre N, Welp H, Perrotti A, Wiebe K, Leo E, Loforte A, Chocron S, Pacini D, Juvonen T, Broman LM, Di Perna D, Yusuff H, Harvey C, Mongardon N, Maureira JP, Levy B, Falk L, Ruggieri VG, Kluge S, Reichenspurner H, Folliguet T, Fiore A. Extracorporeal Membrane Oxygenation for Patients with Severe COVID-19-Related ARDS: A European Multicenter Analysis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725648] [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: 10/21/2022]
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Fuchs G, Berg N, Broman LM, Prahl Wittberg L. P2791Method for detection of blood clots in ventricular assist devices. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The technical development of modern ventricular assist devices (VAD) shows continued improvement in patient outcome. VADs continue to gain increased use not only as bridge to transplant but also as a destination therapy. However, VAD therapy is associated with complications, among which thromboembolic complications are common. Better management for early detection is paramount to improve patient outcome.
Purpose
The aims of this study were to determine if the VADs under consideration may retain clots, and to assess the feasibility of early clot detection using a non-invasive technique.
Methods
Two different VADs, the HeartMate II (HMII) and HeartMate 3 (HM3) were tested in a mock loop. Clot analogs (2 cm yarn fragments) were introduced into the loop upstream to the pump. Sound and vibration of the pump was measured using two hydrophones and at the inflow and outflow of the VAD (frequency range: 0.1Hz to 180kHz). The acoustic/vibration data was analyzed concerning the spectral content.
Results
The flow at the outflow section contained a low frequency swirling component. This appeared to be the basic flow feature. However, in the presence of clot analogs, the frequency signal was amplified. For the HMII this occurred below 10Hz. Concerning the HM3 this signal was more difficult to analyze due to HM3's non-constant rotational speed. However, by using wavelet filtering, it was possible to detect the low frequency signal in the presence of clot analogs. It was also observed that clot analogs tended to accumulate at certain regions in the respective VAD. In the HM3, clot fragments remained in a stagnation region at the bottom pump. This experimental finding contradicts published washout results based on a passive scalar model.
Conclusions
These mock loop results indicated the feasibility of early detection of blood clots in VADs by analysis of the sound/vibration induced by the clot. The signal “finger-print” needed for detection may also be possible to recover under non-continuous operational rotational speed as in the HM 3.
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Affiliation(s)
- G Fuchs
- Sundsvall Regional Hospital, Department of Cardiology, Sundsvall, Sweden
| | - N Berg
- Royal Institute of Technology, Linné Flow Centre & BioMEx, KTH Mechanics, Stockholm, Sweden
| | - L M Broman
- Karolinska Institute, Department of Physiology and Pharmacology, Stockholm, Sweden
| | - L Prahl Wittberg
- Royal Institute of Technology, Linné Flow Centre & BioMEx, KTH Mechanics, Stockholm, Sweden
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Malfertheiner MV, Broman LM, Belliato M, Venti A, Bader A, Taccone FS, Di Nardo M, Maj G, Pappalardo F. Management strategies in venovenous extracorporeal membrane oxygenation: a retrospective comparison from five European centres. CRIT CARE RESUSC 2017; 19:76-81. [PMID: 29084505] [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 To investigate contemporary clinical practice in the management of venovenous (VV) extracorporeal membrane oxygenation (ECMO) in critically ill patients with bacterial pneumonia. METHODS In this multicentre retrospective study, 48 patients with severe respiratory failure due to bacterial pneumonia receiving VV ECMO therapy in five experienced European ECMO centres were included. Ventilator and ECMO settings were analysed. RESULTS Ventilator settings showed great variability between participating centres, particularly relating to positive end-expiratory pressure, peak inspiratory pressure and driving pressure. Different strategies in cannulation, ECMO setting and weaning procedures were also observed. CONCLUSION There is great diversity in management modalities for ventilator and ECMO settings for patients with bacterial pneumonia. Our study emphasises the lack of clinical consensus in VV ECMO management.
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Affiliation(s)
- M V Malfertheiner
- Department of Internal Medicine II, Cardiology and Pneumology, Center for Sleep Medicine, University Medical Center Regensburg, Regensburg, Germany
| | - L M Broman
- ECMO Centre Karolinska, Department of Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital; and Department of Physiology and Pharamacology, Karolinska Institutet, Stockholm, Sweden
| | - M Belliato
- UOC Anestesia e Rianimazione, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Venti
- UOC Anestesia e Rianimazione, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - A Bader
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Belgium
| | - F S Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Belgium
| | - M Di Nardo
- Pediatric Intensive Care Unit, Children's Hospital Bambino Gesù, Rome, Italy
| | - G Maj
- Department of Cardiothoracic Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
| | - F Pappalardo
- Department of Cardiothoracic Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy
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Palmér O, Hultman J, Broman LM. Recirculation Differences in Veno-Venous Extracorporeal Membrane Oxygenation By Different Types of Cannula Designs. Intensive Care Med Exp 2015. [PMCID: PMC4798041 DOI: 10.1186/2197-425x-3-s1-a504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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