Is Veno-Venous Extracorporeal Membrane Oxygenation Always the Right Choice for Pediatric Patients With Refractory Respiratory Failure? An Extracorporeal Life Support Organization Registry analysis.

Hybrid and parallel extracorporeal membrane oxygenation circuits

Outcomes and survival prediction in adults with sickle cell disease treated with extracorporeal membrane oxygenation∗

What is New in ECMO for COVID-19?

Long-Term Outcomes Are Important: Extracorporeal Membrane Oxygenation for COVID-19

Venovenous Versus Venoarterial Extracorporeal Membrane Oxygenation for Adult Patients With Acute Respiratory Distress Syndrome Requiring Precannulation Hemodynamic Support: A Review of the ELSO Registry

The Emerging Role of Bivalirudin for Therapeutic Anticoagulation in Patients With Coronavirus Disease 2019 Requiring Extracorporeal Membrane Oxygenation Support: Is It Time to Change the Routine Practice?

Improved survival in venovenous vs venoarterial extracorporeal membrane oxygenation for pediatric noncardiac sepsis patients: a study of the Extracorporeal Life Support Organization registry

The optimal timing for pursuing tracheostomy in patients with prolonged mechanical ventilation with either veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is a discussion of risk versus benefit. Depending on the etiology, cardiothoracic surgical patients carry some of the highest risk for respiratory failure postprocedure.Given that patients with end-stage cardiopulmonary status may be fraught with substantial comorbidities, it is critically important to manage the risk-benefit profile of performing a tracheostomy procedure on a patient requiring ECMO support.These cohorts have risk factors that may depend on each patient's inflammatory state, lung de-recruitment peri-procedure and postprocedure and bleeding requiring transfusions to name a few.We provide a descriptive analysis of ECMO patients on both VA and VV configurations who survived to hospital discharge receiving tracheostomy either during or after their ECMO course. A retrospective single-institutional study collected all consecutive patients age 18 and above who received any form of ECMO between 2016 and 2020. Five hundred forty-fivepatients were screened based on having received ECMO. Patients with mixed EMCO modality were excluded due to heterogeneity of disease process. A total of 521 patients received either VV or VA ECMO. A total of 54 patients received tracheostomy and had sufficiently clean data for analysis. Tracheostomy patients were compared based on survival to discharge, tracheostomy surgical complications, ECMO duration, ECMO configuration, inotrope and vasopressor use, transfusion rates, total ventilator days, total days on intravenoussedation, and history of cardiotomy or heart transplant were assessed. Baseline characteristics of race, age, gender, and body mass index (BMI) were also collected. A total of 54 patients received tracheostomy. Twenty-nineof those patients received tracheostomy during the course of their ECMO, of whom 13 were on VV ECMO, 16 on VA ECMO. Another 25 patients underwent tracheostomy after successful ECMO explant; 8 of those were VV ECMO with the remaining 17 were on VA ECMO before explantation, with mean delay to tracheostomy, 10 and 19 days after explant between both modalities, respectively. A statistically significantly greater proportion of VV ECMO patients received a tracheostomy at any point versusVA ECMO patients (25.93% vs. 8.35%, p ≤ .0001). No statistically significant difference was noted in timing of tracheostomy when stratified by EMCO modality (VA 51.51% after explant vs. VV 38.10% after explant, p = .33).There was a greater frequency of minor tracheostomy complications in patients who were on ECMO at the time of their tracheostomy (p = .014) than in those who received their tracheostomy after being explanted. However, these minor complications did not contribute to a change in survival to hospital discharge (p = .58). Similarly, the small number of major complications (n = 13) did not impair survival to hospital discharge (p = .84).Finally, mean duration of ECMO was longer in those who received tracheostomy during ECMO versus after ECMO. (488.45 vs. 259.72 h, p < .01). Tracheostomy is known to increase patient mobility, clinical participation, and overall decrease in sedation use. Pursuing tracheostomy during ECMO is feasible, does not result in major bleeding, and is associated with only minor complications that overall do not decrease survival. While there is an increased duration of ECMO support in the tracheostomy cohort, this may be due to existing patient conditions, and may not be causal. Research is needed to further determine the external patient factors and specific timing to optimize both VV and VA ECMO courses. We hope that our analysis will pave the initial pathway for an evidence-based guideline on optimal timing of tracheostomy in ECMO patients, whether initiated during or after ECMO and taking into consideration ECMO configuration, its expected duration, and patient comorbidities.

Background/Aim: The use of extracorporeal life support (ECLS) in children has notably increased over the last two decades, the indications for its use are expanding. According to the Extracorporeal Life Support Organization (ELSO) 2016 report, the rate of pediatric extracorporeal membrane oxygenation (ECMO) runs was 24% among all ECMO patients. A relationship between higher ECMO volume and mortality for neonates and adult patients supported with ECLS was reported. Different mortality rates were reported for different diagnostic and age groups for ECMO patients. The objective of this study was to describe our experience with pediatric ECMO. Methods: A retrospective cohort study was conducted on patients between 1 month and 18 years who underwent ECMO treatment in a pediatric intensive care unit from January 2015 to June 2022. Patients’ characteristics, outcomes, and complications were recorded. Results: A total of 22 children underwent ECMO during the study period. The median age of the patients was 4.5 years (ranging from 2 months to 18 years). Eight (36.4%) patients required venoarterial (VA) ECMO, and 14 patients (63.6%) required venovenous (VV) ECMO. Among the eight children who underwent VA ECMO, central cannulation was performed in 62.5% of cases. Seven children who required VV ECMO were cannulated with a double lumen catheter (42.8%). Thirteen (59.1%) patients were successfully weaned from ECMO. Weaning rates were 25% and 78.5% for VA and VV ECMO, respectively. Among 22 patients, overall hospital mortality was 72.7%. Mortality rates were 87.5% and 64.2% for VA and VV ECMO. Five patients (22.7%) survived to hospital discharge. Conclusion: Extracorporeal life support is one of the life-saving treatment modalities. This study found that the children requiring VA ECMO had a higher mortality rate than children requiring VV ECMO, a result that is consistent with the ELSO registry report. In our study, children requiring VV ECMO had a higher weaning rate than the ELSO registry data. However, they had a lower survival to discharge rate than the ELSO registry data. We feel that by describing this case series, the spread of ECMO practice may be supported in Turkey.

Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.

Increasing Opportunity for Lung Transplant in Interstitial Lung Disease With Pulmonary Hypertension

Invasive Hemodynamic and Physiologic Considerations in Patients Undergoing Extracorporeal Membrane Oxygenation

Venovenous versus venoarterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia

Peripartum use of Extracorporeal Membrane Oxygenation (ECMO) in a Patient Suffering from COVID-19 Severe Acute Respiratory Distress Syndrome (ARDS): A Case Report

Extracorporeal membrane oxygenation in infants with meconium aspiration syndrome: a decade of experience with venovenous ECMO