Extracoporeal Membrane Oxygenation Research Articles

Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation from a De novo ECMO Center During Resource Limited Settings of SARS-nCOV2 Pandemic: A Retrospective Case Series

Abstract Background: Outcomes of Veno-Venous extracoporeal membrane oxygenation during resource limited settings of SARS-nCOV2 pandemic from a denovo ECMO centre. Methods: Adult patients with age more than 18 years on VV-ECMO were evaluated on the duration of the onset of symptoms to hospital admissions (direct or referred); mechanical ventilation; time to initiate ECMO, Murray score, PaCO2, and PaO2/FiO2 ratio; associated organ injury; duration of intensive care unit; hospital stay; and mortality. Results: From 01 Jun 2020 to 30 May 2022, eight patients were placed on VV-ECMO. The mean age of cannulation was 46 years. Two (25%) patients were health-care workers. The mean Murray score, PaCO2, and the PaO2/FiO2 ratio were 3.375, 72.5 mmHg, and 65.98, respectively. The average time to initiate ECMO was 8.375 days from the time of admission, with an average duration of ECMO of 16.375 days. One (12.5%) survived the intervention and was discharged uneventfully. Conclusions: Delayed initiation of VV-ECMO in severe SARS-nCoV2 acute respiratory distress syndrome may result in higher mortality and worse outcomes.

Reperfusion therapy for ST-elevation myocardial infarction complicated by cardiogenic shock: the European Society of Cardiology EurObservational programme acute cardiovascular care-European association of PCI ST-elevation myocardial infarction registry.

To determine the current state of the use of reperfusion and adjunctive therapies and in-hospital outcomes in European Society of Cardiology (ESC) member and affiliated countries for patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). ESC EurObservational Research Programme prospective international cohort study of admissions with STEMI within 24 h of symptom onset (196 centres; 26 ESC member and 3 affiliated countries). Of 11 462 patients enrolled, 448 (3.9%) had CS. Patients with compared to patients without CS, less frequently received primary percutaneous coronary intervention (PCI) (65.5% vs. 72.2%) and fibrinolysis (15.9% vs. 19.0), and more often had no reperfusion therapy (19.0% vs. 8.5%). Mechanical support devices (intraaortic ballon pump 11.2%, extracoporeal membrane oxygenation 0.7%, other 1.1%) were used infrequently in CS. Bleeding definition academic research consortium 2-5 bleeding complications (10.1% vs. 3.0%, P < 0.01) and stroke (4.2% vs. 0.9%, P < 0.01) occurred more frequently in patients with CS. In-hospital mortality was 10-fold higher (35.5% vs. 3.1%) in patients with CS. Mortality in patients with CS in the groups with PCI, fibrinolysis, and no reperfusion therapy were 27.4%, 36.6%, and 62.4%, respectively. In this multi-national registry, patients with STEMI complicated by CS less frequently receive reperfusion therapy than patients with STEMI without CS. Early mortality in patients with CS not treated with primary PCI is very high. Therefore, strategies to improve clinical outcome in STEMI with CS are needed.

Coronavirus-induced myocarditis: A meta-summary of cases

BackgroundMyocarditis caused by SARS-CoV-2 infection was proposed to account for a proportion of cardiac injury in patients with COVID-19. However, reports of coronavirus-induced myocarditis were scarce. The aim of this review was to summarise the published cases of myocarditis and describe their presentations, diagnostic processes, clinical characteristics and outcomes. MethodsA literature search of MEDLINE, EMBASE, Scopus, Web of Science, CENTRAL and OpenGrey on was performed on 3 June 2020. Studies of myocarditis in patients with COVID-19 were included, and those only reporting cardiac injury or heart failure were excluded. Cases were “confirmed” myocarditis if diagnosed on cardiac magnetic resonance imaging (CMR) or histopathology. Those without were grouped as “possible” myocarditis. ResultsA total of 31 studies on 51 patients were included; 12 cases were confirmed myocarditis while 39 had possible myocarditis. The median age was 55 and 69% were male. The most common presenting symptoms were fever, shortness of breath, cough and chest pain. Electrocardiogram changes included non-specific ST-segment and T-wave changes and ventricular tachycardia. Most patients had elevated cardiac and inflammatory biomarkers. Left ventricular dysfunction and hypokinesis was common. CMR established the diagnosis in 10 patients, with features of cardiac oedema and cardiac injury. Five patients had histopathological examination. Some cases required mechanical ventilation and extracoporeal membrane oxygenation, and 30% of patients recovered but 27% died. ConclusionsCOVID-19 myocarditis was associated with ECG, cardiac biomarker and echocardiographic changes, and the manifestation could be severe leading to mortality. Endomyocardial biopsy was not available in most cases but CMR was valuable.

Early Positive Fluid Balance is Associated with Mortality in Patients Treated with Veno-Arterial Extra Corporeal Membrane Oxygenation For Cardiogenic Shock: a Retrospective Cohort Study.

Veno-arterial Extracoporeal Membrane Oxygenation (VA-ECMO) provides circulatory assistance for patients in cardiogenic shock. Large quantities of fluids are often required, especially during the early stages, but can result in a potentially harmful fluid-overload. The objective was to determine the association of early fluid-balance and mortality. Retrospective single-center study in 101 VA-ECMO patients between 2013 and 2016. Daily fluid-balance and weight changes over the 5 first days were observed. Analyses between survivors and non-survivors were conducted using Mann-Whitney tests and logistic regression multivariable and Cox hazard-proportional analyses to determine any association with 28-days mortality. Mortality was 47.5%. The fluid-balance was higher in non-survivors at day-1 (47.3[18.1-71.9] vs. 19.3[1.5-36.2] mL/kg, P < 0.0001) and day-2 (30.6[14.8-71.0] vs. 10.1[-9.8 to 34.7] mL/kg, P = 0.025), as was the cumulative fluid-balance over the first 5 days (107.3[40.5-146.2] vs. 53.0[7.5-74.3] mL/kg, P = 0.04). The administration of unintentional fluids (used for preparation and infusion of drugs) represented an important part of the administrated fluids (15 mL/kg/d-23 mL/kg/d). A significant but moderate correlation was observed between fluid-balance and weight variations over the 5 days (r values ranging from 0.36 to 0.54). Among other parameters, day-1 fluid-balance was independently associated with mortality (OR = 14.34 [1.58-129.79], P = 0.02) and day-1 and day-2 with time to death (HR = 8.26 [1.12-60.98], P = 0.04 and 2.89 [1.26-6.65], P = 0.01). A threshold of 38.8 mL/kg predicted mortality with a sensitivity of 60% and specificity of 83% (area under the curve: 0.749). Early positive fluid-balance is associated with mortality in VA-ECMO patients.

Oxy Right Ventricular Assist Device Using Extracoporeal Membrane Oxygenation as a Bridge to Lung Transplant for Right Ventricular Failure

Patients with IPF and cardiopulmonary failure caused by secondary pulmonary hypertension have poor prognoses. If lung oxygen exchange capacity is completely lost and secondary heart failure caused by pulmonary exacerbation was appeared, it is difficult to maintain survival via conventional peripheral ECMO alone. We used Oxy-RVAD(RA-PA ECMO) as novel configuration delivered via anterior thoracotomy to treat end-stage IPF patients with RHF. Patients with RHF caused by secondary pulmonary hypertension, who had a bridge to LT, were indicated for Oxy-RVAD placement. After ECMO initiation, echoic findings were used to diagnose RHF, and Oxy-RVAD was inserted when the hemodynamic status was unstable or laboratory data on other organs were abnormal. We chose the cannulation and Oxy-RVAD incision sites (left fourth anterior thoracotomy) considering the fact that LT was planned. Two purse-string sutures were placed more than 1 cm above the pulmonary valve to allow return cannula insertion using the Seldinger technique. After MPA cannulation, the inflow cannula in the jugular vein was converted into a drainage cannula. To decompress the right heart, double drainage was enforced. A total of eleven patients underwent conversion from peripheral ECMO to Oxy-RVAD between September 2018 and September 2019. Eight patients successfully underwent LT. The remaining three patients survived for 9, 14 and 23 days under Oxy-RVAD, respectively. Hospital stay of all patients was 73.0 ± 55.4. 30 days mortality and In hospital mortality in LT group was 0 and 2 (25%). In conclusion, Oxy-RVAD can be reduced the signs of multiple organ failures that can be caused by RVF by decompressing the right ventricle. In the successful lung transplant group that waited for lung transplant under RVAD, they had satisfactory survival result. Oxy-RVAD is useful option in Patients with RHF caused by secondary pulmonary hypertension, who were on ECMO support as a bridge to LT.

RETRACTED: Peripheral “Right to Right” Extracoporeal Membrane Oxygenation for Right Heart Failure Following Left Ventricular Assist Device Insertion

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the Authors. This abstract has been published due to a miscommunication in the ANZSCTS ASM conference supplement. It needs to be retracted as we the authors wish to submit a full length paper with updated material.

A Man of Many Devices. A 15 Year Old Boy with Exclusively Myocardial Mitochondrial Disease Received a LVAD, TAH, an Orthotopic Heart Transplant and ECMO in one Inpatient Episode

A 15 year old with mixed restrictive/dilated cardiomyopathy from myocardial mitochondrial disorder but normal skeletal muscle mitochondria, presented to a paediatric hospital with symptoms of cardiac failure in 2015. In March 2017 he decompensated despite medical therapy and a Multi-Disciplinary Team opted to insert a HeartwareR (Heartware Inc, Framingham, USA) left ventricular assist device (LVAD) as a rescue bridge to transplant. Poor right ventricular (RV) function and developing tamponade led to poor LVAD flows and he was transferred to our unit in a state of collapse requiring significant vasopressor and inotropic support. The following day, the LVAD was exchanged for a Total Artificial Heart (TAH) (Syncardia Systems LLC, Tucson, USA). The LVAD inflow was found to have deviated into the septum, distorted by severe ventricular hypertrophy. He was listed for a super urgent heart transplant and transplanted 36 days later. His ICU recovery was complicated by prolonged RV failure and vasoplegia. This required 6 days of central veno-arterial extra-coporeal membrane oxygenation (VA ECMO). The sternum was open for 10 days and there were episodes of tamponade and bleeding with a persistent coagulopathy. Following successful ECMO explantation, he had bilateral pneumothoraces and a spontaneous pneumopericardium, which persisted radiologically for 14 days and was managed conservatively. He has been discharged to the ward for rehab of critical care weakness, but requires on-going renal replacement therapy, and has been hospitalised for 249 days at present. He went to the operating room on 10 occasions at this institute and received a total of 63 units of red cells, 22 platelet pools, 34 fresh frozen plasma and 10 courses of prothrombin complex concentrates. The Paediatric Interagency Registry for Mechanical Circulatory Support published in July 2017 reports 364 patients receiving 432 devices in 42 reporting hospitals in the USA.1 80% received an LVAD and 2% a TAH. None converted a LVAD to TAH and then a transplanted heart. 22% of deaths were attributable to ‘circulatory’ causes and a further 26.6% from Multi-Organ Failure. The choice of device to bridge to transplant in this age group is still an evolving process,2 made more difficult in cases of rescue therapy for acute decompensation. This unique case describes some of the challenges involved.

Individualized real-time clinical decision support to monitor cardiac loading during venoarterial ECMO.

Veno-arterial extracoporeal membrane oxygenation (VA ECMO) is increasingly used for acute and refractory cardiogenic shock. Yet, in clinical practice, monitoring of cardiac loading conditions during VA ECMO can be cumbersome. To this end, we illustrate the validity and clinical applicability of a real-time cardiovascular computer simulation, which allows to integrate hemodynamics, cardiac dimensions and the corresponding degree of VA ECMO support and ventricular loading in individual patients over time.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0760-1) contains supplementary material, which is available to authorized users.

(709) - The Feasibility of Extracoporeal Membrane Oxygenation Support for Inter-Hospital Transport and Bridge To Lung Transplantation

PurposeAt regional lung transplantation centers, an inter-hospital transport program using extracorporeal membrane oxygenation (ECMO) is necessary in order to provide patients who develop acute respiratory failure outside the hospital a chance at lung transplantation. The purpose of this study was to evaluate the utility of ECMO for safe transportation of lung transplant candidates who encounter respiratory failure outside a lung transplantation center, and as a bridge to lung transplantation.MethodsWe retrospectively analyzed data from 7 patients for whom inter-hospital transport to the lung transplantation center at our hospital was requested between December 2011 and June 2013 due to acute lung failure during the treatment of end stage lung diseases in other hospitals.ResultsAll 7 patients successfully received ECMO using a Terumo Emergency Bypass System® (EBS®), and all were safely transported to our hospital. There were no adverse incidents related to ECMO, and the vital signs were stable during transport. Four patients received lung transplant within 10.5 ± 2.3 days (range 7 to 12 days) after transport, 1 patient was weaned from ECMO without transplant, and 2 patients died with multi-organ failure while awaiting donor lungs.ConclusionECMO was useful for safe transport of patients who developed acute respiratory failure outside of a lung transplantation center, and as a bridge to lung transplantation. We believe that in a regional lung transplantation center, an inter-hospital transport program using ECMO is essential to increase the likelihood of successful transport and survival for lung transplantation patients. PurposeAt regional lung transplantation centers, an inter-hospital transport program using extracorporeal membrane oxygenation (ECMO) is necessary in order to provide patients who develop acute respiratory failure outside the hospital a chance at lung transplantation. The purpose of this study was to evaluate the utility of ECMO for safe transportation of lung transplant candidates who encounter respiratory failure outside a lung transplantation center, and as a bridge to lung transplantation. At regional lung transplantation centers, an inter-hospital transport program using extracorporeal membrane oxygenation (ECMO) is necessary in order to provide patients who develop acute respiratory failure outside the hospital a chance at lung transplantation. The purpose of this study was to evaluate the utility of ECMO for safe transportation of lung transplant candidates who encounter respiratory failure outside a lung transplantation center, and as a bridge to lung transplantation. MethodsWe retrospectively analyzed data from 7 patients for whom inter-hospital transport to the lung transplantation center at our hospital was requested between December 2011 and June 2013 due to acute lung failure during the treatment of end stage lung diseases in other hospitals. We retrospectively analyzed data from 7 patients for whom inter-hospital transport to the lung transplantation center at our hospital was requested between December 2011 and June 2013 due to acute lung failure during the treatment of end stage lung diseases in other hospitals. ResultsAll 7 patients successfully received ECMO using a Terumo Emergency Bypass System® (EBS®), and all were safely transported to our hospital. There were no adverse incidents related to ECMO, and the vital signs were stable during transport. Four patients received lung transplant within 10.5 ± 2.3 days (range 7 to 12 days) after transport, 1 patient was weaned from ECMO without transplant, and 2 patients died with multi-organ failure while awaiting donor lungs. All 7 patients successfully received ECMO using a Terumo Emergency Bypass System® (EBS®), and all were safely transported to our hospital. There were no adverse incidents related to ECMO, and the vital signs were stable during transport. Four patients received lung transplant within 10.5 ± 2.3 days (range 7 to 12 days) after transport, 1 patient was weaned from ECMO without transplant, and 2 patients died with multi-organ failure while awaiting donor lungs. ConclusionECMO was useful for safe transport of patients who developed acute respiratory failure outside of a lung transplantation center, and as a bridge to lung transplantation. We believe that in a regional lung transplantation center, an inter-hospital transport program using ECMO is essential to increase the likelihood of successful transport and survival for lung transplantation patients. ECMO was useful for safe transport of patients who developed acute respiratory failure outside of a lung transplantation center, and as a bridge to lung transplantation. We believe that in a regional lung transplantation center, an inter-hospital transport program using ECMO is essential to increase the likelihood of successful transport and survival for lung transplantation patients.

Extracoporeal Membrane Oxygenation Hybrid With Thoratec Ventricular-Assist Devices as Double Bridge to Heart Transplantation

Ventricular-assist devices (VADs) have benefitted patients with end-stage heart failure as a bridge to heart transplantation (HTx). Herein, we describe our experience with HTx in the presence of extracorporeal membrane oxygenation (ECMO) together with the Thoratec VAD (Thoratec Corp, Pleasanton, California). From May 1996 to June 2009, mechanical circulatory support with the Thoratec VAD was provided in 20 patients. Before implantation of the VAD, circulation in 17 patients was maintained using ECMO. Although 350 patients underwent HTx during that period, only 13 patients (65%) received suitable donor organs for orthotopic HTx. The 20 patients ranged in age from 10 to 80 years; 3 were female, and 17 were male; and 17 (85%) required ECMO before VAD implantation. In 11 of 17 patients (65%), the VAD was implanted as a double bridge to HTx. The demand for mechanical circulatory support in patients with acute hemodynamic collapse has led to major improvements in clinically available systems such as ECMO as a double bridge to VAD implantation. We use ECMO as a rescue procedure in patients with acute hemodynamic deterioration. However, during ECMO support, left ventricular afterload increases. If prolonged support is necessary, a VAD may be required. We observed that 65% of patients who received support from an ECMO hybridized with the Thoratec VAD could wait for a suitable donor for HTx. We recommend use of ECMO for short-term support (<1 week) and the Thoratec VAD for medium- or long-term support as a bridge to HTx.

Temporary ciculatory support with extracoporeal membrane oxygenation in adults with potential refactory cardiogenic shock

Temporary ciculatory support with extracoporeal membrane oxygenation in adults with potential refactory cardiogenic shock

Cardiac arrest that developed during anesthetic induction in a patient with abdominal gas gangrene: A case report.

We report here on a fatal case of abdominal gas gangrene. Two days after gastrectomy, a 56-year-old man presented with intractable abdominal pain and fever of a sudden onset, which quickly progressed over several hours to septic shock. Despite of the unexplained gas collections in the abdominal muscle, fascia, and subcutaneous layers on computed tomography scan, its clinical significance was overlooked. Emergency laparotomy was initially scheduled because of concern that there may have been a perforated viscus. At the time of monitoring for the anesthesia, we noticed marbled skin discoloration and the subcutaneous emphysema had spread on his flank. Shortly after the initial suspicion of gas gangrene, cardiac arrest developed during the arterial line cannulation. Despite prompt resuscitation measures, including the administration of catecholamines and the application of extracoporeal membrane oxygenation, he eventually died. Anesthesiologists need to understand this fulminant disease because extensive debridement under general anesthesia is essential for the treatment of abdominal gas gangrene.

Congenital Diaphragmatic Hernia: Two Case Studies with Atypical Presentations

Congenital diaphragmatic hernia (CDH) affects 1 in every 2,000 to 4,000 live births. Many infants with this condition are diagnosed antenatally through routine ultrasound screening. Nearly 90 percent present at delivery with severe respiratory distress requiring intubation. Many of these infants develop persistent pulmonary hypertension of the newborn due to hypoplasia of the affected lung. The survival of infants with CDH is limited by the degree of pulmonary hypoplasia and requires sophisticated medical technology such as high-frequency ventilation and inhaled nitric oxide. Some infants also require treatment with extracoporeal membrane oxygenation. This article gives details of two cases of CDH in which the presentation was atypical. The more subtle presentation is discussed, as well as the embryology and pathophysiology of CDH and the possibility of associated anomalies. Clinical management and impact on the family are outlined.