Use Of Extracorporeal Membrane Oxygenation Research Articles

Effects of Intraoperative Support Strategies on Endothelial Injury and Clinical Lung Transplant Outcomes

In lung transplantation, postoperative outcomes favor intraoperative use of extracorporeal membrane oxygenation (ECMO) over cardiopulmonary bypass (CBP). We investigated the effect of intraoperative support strategies on endothelial injury biomarkers and short-term posttransplant outcomes. Adults undergoing bilateral lung transplantation with No-Support, venoarterial (V-A) ECMO, or CPB were included. Plasma samples pre- and post-transplant were collected for Luminex assay to measure endothelial injury biomarkers including syndecan-1 (SYN-1), intercellular adhesion molecule-1 (ICAM-1), and matrix metalloprotease-9. Fifty five patients were included for analysis. The plasma level of SYN-1 at arrival in the intensive care unit was significantly higher with CPB compared to V-A ECMO and No-Support (P < 0.01). The rate of primary graft dysfunction grade 3 (PGD3) at 72 hours was 60.0% in CPB, 40.1% in V-A ECMO, and 15% in No-Support (P = 0.01). Postoperative plasma levels of SYN-1 and ICAM-1 were significantly higher in recipients who developed PGD3 at 72 hours. SYN-1 levels were also significantly higher in patients who developed acute kidney injury and hepatic dysfunction after transplant. Postoperative, SYN-1 upon intensive care arrival was found to be a significant predictive biomarker of PGD3, acute kidney injury, and hepatic dysfunction following lung transplantation. CPB is associated with higher plasma concentrations of SYN-1, a marker of endothelial glycocalyx degradation, upon arrival to the intensive care unit. Higher levels of SYN-1 are predictive of end-organ dysfunction following lung transplantation. Our data suggests that intraoperative strategies aimed at modulating endothelial injury will help improve lung transplantation outcomes.

The Utility of Risk Scores in Postcardiotomy Extracorporeal Membrane Oxygenation.

The use of a venoarterial extracorporeal membrane oxygenation (ECMO) in the postcardiotomy shock setting (PC-ECMO) can be life-saving. Risk stratification for patients under PC-ECMO is currently challenging. The aim of this study was to assess the discriminatory ability of the different available risk scores for mortality in PC-ECMO patients. Patients aged >18years undergoing coronary artery bypass, valve surgery, or a combination of these procedures and implanted an ECMO for postcardiotomy shock between January 2017 and June 2022 in a single ELSO registered center were retrospectively included. The STS, Euroscore II, SAVE, modified SAVE, APACHE II, and VIS scores were compared for their discriminatory ability concerning weaning and 30-day survival. During the study period, 7342 patients underwent coronary bypass or valve surgery, of whom 109 patients with PC-ECMO were included in the analysis. The Euroscore II and STS scores were not associated significantly with 30-day mortality, whereas the SAVE, the modified SAVE, APACHE II, and VIS scores significantly predicted 30-day mortality. The SAVE and the modified SAVE scores showed moderate discrimination ability with AUCs of 0.672 and 0.695, while the APACHE and VIS scores had a satisfactory discriminatory ability with AUCs of 0.727 and 0.844, respectively. Currently used risk scores for PC-ECMO patients do not provide satisfactory predictions for weaning and survival. VIS at the 24th hour can be a valuable parameter for risk analysis and prospective studies can investigate novel PC-ECMO risk scoring systems.

Extracorporeal Membrane Oxygenation use on Liver Transplantation: An Integrative Review

Objective: To review the applicability of extracorporeal membrane oxygenation (ECMO) during the pre, intra and postoperative periods of patients undergoing liver transplantation. Methods: This is an integrative review that seeks to evaluate the indications for the use of ECMO in liver transplantation. As databases, were used: MEDLINE, Web of Science and Scopus, with articles published in the last ten years in English and Portuguese. Results: In this review, 24 papers were included, of which 3 were original articles and 21 were case reports. The studies were divided according to the ECMO application period concerning the liver transplant: one for the preoperative, eight intraoperative and 15 postoperative. It was identified that ECMO use is mainly related to hepatopulmonary syndrome complications. The limited number of studies regarding using ECMO in the preoperative period reflects the importance of hepatic transplant as the main measure to manage liver disease complications. In the intraoperative phase, ECMO usage is expressive in managing cardiopulmonary complications refractory to previous interventions. The use of this mechanism in the postoperative period is the most reported. The main indication is severe hypoxemia secondary to hepatopulmonary syndrome, in which other treatments have been ineffective. The main complications related to this mechanism were sepsis, renal failure and bleeding. Conclusion: ECMO is an important therapeutic modality for managing complications resulting from liver transplantation. However, only some studies in the literature have an adequate sample number to assess its actual efficacy and level of safety.

Current Anesthesia Management of Congenital Diaphragmatic Hernia: A Narrative Literature Review

Congenital diaphragmatic hernia (CDH) is a congenital disorder characterized by a defect in the diaphragm, which causes the contents of the stomach to protrude into the chest cavity. Increased survival of CDH patients related to initial management in the form of a ventilator strategy, management of pulmonary hypertension, improvement of surgical and anesthetic techniques, and use of extracorporeal membrane oxygenation (ECMO) when indicated. Early stabilization of the patient is a priority before performing a surgical intervention for the hernia organ. This narrative literature review aimed to explain the current management, especially in the field of anesthesia in a congenital diaphragmatic hernia. In conclusion, the current management aims to improve survival rates and reduce the morphology of CDH patients.

Extracorporeal Membrane Oxygenation in Acute Respiratory Failure.

Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a form of mechanical life support that provides full respiratory bypass in patients with severe respiratory failure as a bridge to recovery or lung transplantation. The use of ECMO for respiratory failure and capable centers offering ECMO has expanded over the years, increasing its availability. As VV-ECMO provides an artificial mechanism for oxygenation and decarboxylation of native blood, it allows for an environment in which safer mechanical ventilatory care may be provided, allowing for treatment and resolution of underlying respiratory pathologies. Landmark clinical trials have provided a framework for better understanding patient selection criteria, resource utilization, and outcomes associated with ECMO when applied in settings of refractory respiratory failure. Maintaining close vigilance and management of complications during ECMO as well as identifying strategies post-ECMO (e.g., recovery, transplantation, etc.), are critical to successful ECMO support. In this review, we examine considerations for candidate selection for VV-ECMO, review the evidence of utilizing VV-ECMO in respiratory failure, and provide practical considerations for managing respiratory ECMO patients, including complication identification and management, as well as assessing for the ability to separate from ECMO support and the procedures for decannulation.

Outcomes with use of extra-corporeal membrane oxygenation in high-risk pulmonary embolism: a national database perspective.

High-risk pulmonary embolism (PE) patients can be managed with systemic lysis, catheter-based therapies, or surgical embolectomy. Despite the advent of newer therapies, patients with high-risk PE remain with a 50-60% short-term mortality risk. In such patients, extracorporeal membrane oxygenation (ECMO) is increasingly utilized for hemodynamic support. To evaluate the outcomes of the use of ECMO in patients with high-risk PE. Using the National Inpatient Sample (NIS) database, we identified patients with high-risk PE using ICD 10 codes and compared in-hospital outcomes of patients with and without ECMO support. We identified 38,035 patients with high-risk PE, of whom 820 had undergone ECMO placement. Most patients who underwent ECMO were male (54%), white (65%), and with a mean age of 53.7years. ECMO use was not associated with a meaningful difference in patient mortality when comparing treatment groups (OR, 1.32 ± 0.39; 0.74-2.35; p = 0.35). Rather, ECMO use was associated with a higher frequency of inpatient complications. ECMO use was not associated with a significant difference in patient mortality in patients with high-risk PE.

Severe Pulmonary Hemorrhage in Herpangina.

To the Editors: Herpangina is a common infectious disease of childhood caused by enteroviruses (EV): Coxsackievirus A2, 4, 5, 6, 8, 10, 16 and Enterovirus A71 (EV-A71).1 The clinical manifestations of herpangina include fever, sore throat and herpes in the pharynx and isthmus. The minority have serious complications, such as encephalitis, meningitis, pulmonary hemorrhage, pulmonary edema and cardiopulmonary failure.1,2 Although coxsackievirus A6 (CV-A6) has become the dominant pathogen of herpangina in some regions of China,2,3 severe cases caused by CV-A6 are rare. We present an extremely rare case of CV-A6 severe herpangina complicated with pulmonary hemorrhage. A 4-years and 7-months old boy was admitted to our hospital with a history of fever and vomiting for 1 day, cough and dyspnea for half a day, mechanical ventilation for 8 hours, and extracorporeal membrane oxygenation (ECMO) support for 3.5 hours. One day before admission, the child presented to a local hospital with high fever, vomiting, herpes in the isthmus and no rash on the hands, feet or hips. Thirteen hours before admission, the child developed a cough, pink frothy sputum and dyspnea. Nasal catheter oxygen, gamma globulin and methylprednisolone treatments did not work. Eight hours before admission, he developed severe dyspnea, pale complexion, unconsciousness, rapid heart rate, low blood pressure and poor peripheral circulation. Three hours before admission, the boy was placed on ECMO and transferred to our hospital. The patient received the EV71 vaccine. Blood tests revealed blood lactate (7.5 mmol/L), B-type natriuretic peptide precursor (21,768 pg/mL), creatine kinase isoenzyme (16.130 ng/mL) and troponin T (0.515 ng/mL). Echocardiography showed a large left ventricle, left ventricular ejection fraction 24%. Head magnetic resonance imaging and computed tomography, electroencephalogram and the cerebrospinal fluid examinations were normal. The CV-A6 nucleic acid test was positive. The diagnosis was CV-A6 severe herpangina, cardiopulmonary failure and pulmonary hemorrhage. After comprehensive treatment with ECMO, mechanically assisted ventilation, methylprednisolone anti-inflammatory agent, intravenous immunoglobulin shock therapy, anti-infection therapy, vasoactive drugs and other agents, cardiopulmonary function was restored, and the boy was discharged 14 days later. The specific mechanism of severe herpangina complicated with pulmonary hemorrhage is unclear, pulmonary hemorrhage is preceded by and closely associated with the central nervous system involvement. Severe herpangina with pulmonary hemorrhage may be related to neurogenic pulmonary edema, cardiac dysfunction, increased vascular permeability and cytokine storms.4 As an important part of modern pediatric intensive care, ECMO has been used to support gas exchange in children with severe acute respiratory failure who fail mechanical ventilation.5 ECMO for severe cardiopulmonary failure provides gas exchange and systemic circulation. In this case, when the patient developed severe pulmonary hemorrhage and routine mechanical ventilation could not maintain vital signs, the use of ECMO effectively avoided irreversible organ damage and saved the patient’s life.

Extracorporeal Life Support for Cardiogenic Shock in Octogenarians: Single Center Experience.

The age limit for the use of extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiac failure is not defined. The aim of the study was to evaluate the outcomes of octogenarians supported with ECMO due to cardiogenic shock. A retrospective review of consecutive elderly patients supported with ECMO during a 13-year period in a tertiary care center. Patient's demographic variables, comorbidities, perioperative data and outcomes were collected from patient medical records. Data of octogenarian patients were compared with the septuagenarian group. The main outcomes of the study was in hospital mortality, 6-month survival and 1-year survival after hospital discharge and discharge options. Multivariate logistic regression analysis was performed to identify the factors associated with hospital survival. Eleven patients (18.3%) in the elderly group were octogenarians (aged 80 years or above), and forty-nine (81.7%) were septuagenarians (aged 70-79 years). There were no differences except age in demographic and preoperative variables between groups. Pre ECMO SAVE, SOFA, SAPS-II and inotropic scores were significantly higher in septuagenarians than octogenarians. There was no statistically significant difference in hospital mortality, 6-month survival, 1 year survival or discharge options between groups. ECMO could be successfully used in selected octogenarian patients undergoing cardiac surgery to support a failing heart. An early decision to initiate ECMO therapy in elderly post-cardiotomy shock patients is associated with favorable outcomes.

Soluble ST2 as a Useful Biomarker for Predicting Clinical Outcomes in Hospitalized COVID-19 Patients.

Soluble suppression of tumorigenesis-2 (sST2) is an emerging biomarker for sepsis as well as for heart failure. We investigated the prognostic utility of sST2 for predicting clinical outcomes in hospitalized coronavirus disease 2019 (COVID-19) patients. In a total of 52 hospitalized COVID-19 patients, sST2 levels were measured using the ichroma ST2 assay (Boditech Med Inc., Chuncheon-si, Gang-won-do, Republic of Korea). Clinical outcomes included intensive care unit (ICU) admission, ventilator use, extracorporeal membrane oxygenation (ECMO) use, and 30-day mortality. sST2 was analyzed according to clinical outcomes. sST2, sequential organ failure assessment (SOFA) score, critical disease, and 4C mortality score were compared using the receiver operating characteristic (ROC) curve and Kaplan-Meier methods for clinical outcomes. The sST2 level differed significantly according to ICU admission, ventilator use, ECMO use, and 30-day mortality (all p &lt; 0.05). On ROC curve analysis, sST2 predicted ICU admission, ventilator use, ECMO use, and 30-day mortality comparable to SOFA score but significantly better than critical disease. sST2 predicted ICU admission, ventilator use, and ECMO use significantly better than the 4C mortality score. On Kaplan-Meier survival analysis, hazard ratios (95% confidence interval) were 8.4 (2.7-26.8) for sST2, 14.8 (3.0-71.7) for SOFA score, 1.8 (0.5-6.5) for critical disease, and 11.7 (3.4-40.1) for 4C mortality score. This study demonstrated that sST2 could be a useful biomarker to predict ICU admission, ventilator use, ECMO use, and 30-day mortality in hospitalized COVID-19 patients. sST2 may be implemented as a prognostic COVID-19 biomarker in clinical practice.

Extracorporeal membrane oxygenation and Extracorporeal Membrane Oxygenation Cardiopulmonary Resusciation (ECPR) research priorities in Australia: A clinician survey

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) for cardiorespiratory failure and during cardiopulmonary resuscitation has increased significantly and is resource intensive. High-quality evidence to guide management of patients on ECMO is limited. ObjectivesThe objective of this study was to determine the research priorities of clinicians for ECMO and Extracorporeal Membrane Oxygenation Cardiopulmonary Resusciation (ECPR) in Australia and New Zealand. MethodsA prospective, binational survey of clinicians was conducted in May 2022. ResultsThere were 133 respondents; 110 (84%) worked at an Australian ECMO centre; 28 (21%) were emergency, 45 (34%) were intensive care, and 41 (31%) were nursing clinicians. All aspects of ECMO care were identified by respondents as being important for further research; however, appropriate patient selection and determining long-term outcomes were ranked the highest. While most believed ECMO was efficacious, they felt that there was insufficient evidence to determine cost-effectiveness. There was uncertainty of the best model of ECPR provision. Equipoise exists for randomised studies into anticoagulation, blood product usage, and ECPR. ConclusionsThis survey found strong support amongst clinicians for further research into the optimal use of ECMO and ECPR and provides a frame work for prioritising future clinical trials and research agendas.

Mechanical Assist Device-Assisted Percutaneous Coronary Intervention: The Use of Impella Versus Extracorporeal Membrane Oxygenation as an Emerging Frontier in Revascularization in Cardiogenic Shock.

The extracorporeal membrane oxygenation (ECMO) procedure aids in the provision of prolonged cardiopulmonary support, whereas the Impella device (Abiomed, Danvers, MA) is a ventricular assist device that maintains circulation by pumping blood into the aorta from the left ventricle. Blood is circulated in parallel with the heart by Impella. It draws blood straight into the aorta from the left ventricle, hence preserving the physiological flow. ECMO bypasses the left atrium and the left ventricle, and the end consequence is a non-physiological flow. In this article, we conducted a detailed analysis of various publications in the literatureand examined various modalities pertaining to the use ofECMO and Impella for cardiogenic shocks, such as efficacy, clinical outcomes, cost-effectiveness, device-related complications, and limitations. The Impella completely unloads the left ventricle, thereby significantly reducing the effort of the heart. Comparatively, ECMO only stabilizes a patient with cardiogenic shock for a short stretch of time and does not lessen the efforts of the left ventricle ("unload" it). In the acute setting, both devices reduced left ventricular end-diastolic pressure and provided adequate hemodynamic support. By comparing patients on Impella to those receiving ECMO, it was found that patients on Impella were associated with better clinical results, quicker recovery, limited complications, and reduced healthcare costs; however, there is a lack of conclusive studies performed demonstrating the reduction in long-term mortality rates. Considering the effectiveness of given modalities and taking into account the various studies described in the literature, Impella has reported better clinical outcomes although more clinical trials are needed for establishing the effectiveness of these interventional approaches in revascularization in cardiogenic shock.

Trends and outcomes of cardiogenic shock in Asian populations compared with non-Asian populations in the US: NIS Analysis (2002-2019)

ABSTRACT Background Current understanding of outcomes of cardiogenic shock (CS) in Asian populations is limited. We aim to study the clinical outcomes of CS in Asian population compared with non-Asians in the US. Methods The National Inpatient Sample (NIS) database was queried between 2002-2019 to identify hospitalizations with CS. Race was classified as Asians and non-Asians. The adjusted odds ratios (aOR) for in-hospital outcomes were calculated using multivariate logistic regression analysis. Results Results Of 1,573,285 CS hospitalizations, 48,398 (3%) were Asians and 1,524,887 (97%) were non-Asians between 2002-2019. Adjusted odds of in-hospital mortality (aOR 1.03, 95% CI 1.01–1.05), and use of intra-aortic balloon pump (IABP) (aOR 1.15, 95% CI 1.12–1.17) were significantly higher among Asians compared with non-Asians. The in-hospital mean cost of hospitalization was higher in Asian population ($63,787±$80,261) with CS compared with non-Asians ($56,207±$76,120, p < 0.001). The use of Impella (aOR 0.90, 95% CI 0.86–0.95) and left ventricular assist devices (LVAD) (aOR 0.71, 95% CI 0.65–0.77) were lower with no difference in the use of extracorporeal membrane oxygenation (ECMO) compared with non-Asians. Conclusion Asian populations with CS have higher in-hospital mortality, increased requirement of IABP and higher mean cost of hospitalization compared with non-Asians.

The Use of Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation: Initial Institutional Experience.

Lung transplantation is the final treatment option for end-stage lung disease, and extracorporeal membrane oxygenation (ECMO) is increasingly being used during lung transplantation. The present study aimed to review our initial experience with patients who underwent lung transplantation with or without ECMO since the implementation of the lung transplantation program at our center. Data were prospectively collected on all patients between December 2016 and December 2018. Patients undergoing ECMO as a bridge to lung transplantation were excluded. A total of 48 lung transplants were performed, and ECMO was used in 29 (60.4%) cases. Twenty (83%) patients were female. The median age was 48.5 (range, 14-64) years. The most common indications were idiopathic interstitial pneumonia in 9 (31%) patients, chronic obstructive pulmonary disease in 7 (24.1%) patients, and bronchiectasis in 6 (20.7%) patients. Sequential bilateral lung transplantation was performed in all patients. The 30-day mortality was 20.6% (6/29) for patients with ECMO, however, it was 10.5 (2/19) for patients without ECMO (P=0.433). The median length of stay in the intensive care unit (ICU) was 5 (range, 2-25) days. The ECMO weaning rate was 82.8% (24/29). One-year survival was 62.1% with ECMO versus 78.9% without ECMO, and the 3-year survival was 54.1% versus 65.8%, respectively (P=0.317). ECMO is indicated for more severe patients who underwent lung transplantation. The use of ECMO provides adjuvant support during surgery and the mortality rate is acceptable. Survival is also as similar as non-ECMO patients. ECMO is appropriate for critically ill patients.

Extracorporeal membrane oxygenation for general thoracic surgery: case series and narrative review.

Extracorporeal membrane oxygenation (ECMO) has historically been utilized as a temporary life support option for patients with severe cardiac and pulmonary dysfunction. Recent advancements have enabled the safe application of ECMO in a wider variety of patients; we present a review of its use in patients undergoing general thoracic procedures supported by a case series at our institution. We review current literature focusing on ECMO applications in thoracic surgery outside of the traditional use. Additionally, we offer three cases of ECMO utilization to illustrate success stories and key lessons learned regarding the use of ECMO in general thoracic surgery. Technologic advancements and enhanced safety profiles have enabled the safe application of ECMO in a wide array of patients far beyond the historic indications of cardiogenic shock and acute respiratory distress syndrome (ARDS). It is now feasible to consider ECMO for management of acute thoracic emergencies, as well as to better facilitate operative safety in complex general thoracic surgical procedures. Both venovenous and venoarterial ECMO can be utilized in carefully selected patients to provide cardiopulmonary support while enabling improved visualization and increased mobilization without concern for respiratory and/or cardiac compromise. Enthusiasm for the use of ECMO has increased in recent years. What was once considered a salvage therapy in cases of life-threatening cardiopulmonary decompensation now plays an increasingly important role in the safe conduct of complex thoracic surgery procedures, provides much needed time for organ recovery, and offers acute resuscitation options. This shift broadens our ability to deliver life-saving care to patients that previously would have otherwise had limited treatment options.

Extracorporeal Membrane Oxygenation: Set-up, Indications, and Complications.

Extracorporeal membrane oxygenation (ECMO) occupies an increasingly important position in the clinic for the management of cardiac and/or pulmonary failure. As a rescue therapy, ECMO can support patients following respiratory or cardiac compromise to act as a bridge to recovery, to decision, or to transplant. This chapter reviews briefly the history of ECMO implementation as well as devicemodes, from veno-arterial, veno-venous, veno-arterial-venous, and veno-venous-arterial set-ups. The importance of acknowledging complications that can arise in each of these modes cannot be overlooked. Both bleeding and thrombosis are inherent risks to the use of ECMO and the existing strategies for management are reviewed. The device also elicits an inflammatory response, and the use of extracorporeal approaches can lead to infection, both of which are important to examine when reflecting how ECMO can be successfully implemented in patients. This chapter both discusses the understanding of these various complications and highlights the need for future research.

Bibliometric analysis of pediatric extracorporeal membrane oxygen literature

Aim: Consistent innovation is essential given the crucial necessity of extracorporeal membrane oxygenation (ECMO) in patients with respiratory and cardiovascular illnesses that are life-threatening. In the literature so far no bibliometric analysis on pediatric ECMO has been done. We aim to undertake a bibliometric review of the ECMO literature to inform evidence-based innovation, emphasizing key trends and advancements in pediatric ECMO. Materials and Methods: The Web of Science (WoS) database was used to retrieve articles about pediatric ECMO that were published between 1970 and 2022, and these articles were then examined using statistical and bibliometric techniques. Effective analysis and trending topics were identified using network visualization maps. Results: The search for pediatric ECMO literature turned up 726 documents. The publications received 7984 total citations, with an average of 11 citations per publication. The Hirsch (H)-Index was 45, and articles made up 55.51% of the publications. The pediatric ECMO papers received an average of 18.03 citations per article, for a total of 7267 and with 44 H-index. The highest publishing year was 2020 (n=80). The majority of the articles (67.906%) originated in the United States. The other top 5 nations were Canada (4.132%), Italy (3.581%), Australia (3.168%), China (3.030%), and Germany (2.893%). Conclusion: This article can be a useful resource for investigators concerning global output for pediatric ECMO use. The United States ranked first in the number of publications and citations. With the increasing number of publications and implementation, ECMO needs to become more widespread around the world.

Management of Tricuspid Valve Regurgitation During Surgical Ventricular Restoration for Ischemic Cardiomyopathy.

We studied the effect of tricuspid valve (TV) surgery combined with surgical ventricular restoration (SVR) on operative outcomes, rehospitalization, recurrent tricuspid regurgitation, and survival of patients with ischemic cardiomyopathy. Additionally, surgery was compared to conservative management in patients with mild or moderate tricuspid regurgitation. To the best of our knowledge, the advantage of combining TV surgery with SVR in patients with ischemic cardiomyopathy had not been investigated before. This retrospective cohort study included 137 SVR patients who were recruited from 2009 to 2020. Patients were divided into two groups - those with no concomitant TV surgery (n=74) and those with concomitant TV repair or replacement (n=63). Extracorporeal membrane oxygenation use was higher in SVR patients without TV surgery (P=0.015). Re-exploration and blood transfusion were significantly higher in those with TV surgery (P=0.048 and P=0.037, respectively). Hospital mortality occurred in eight (10.81%) patients with no TV surgery vs. five (7.94%) in the TV surgery group (P=0.771). Neither rehospitalization (log-rank P=0.749) nor survival (log-rank P=0.515) differed in patients with mild and moderate tricuspid regurgitation in both groups. Freedom from recurrent tricuspid regurgitation was non-significantly higher in mild and moderate tricuspid regurgitation patients with no TV surgery (P=0.059). Conservative management predicted the recurrence of tricuspid regurgitation. TV surgery concomitant with SVR could reduce the recurrence of tricuspid regurgitation; however, its effect on the clinical outcomes of rehospitalization and survival was not evident. The same effects were observed in patients with mild and moderate tricuspid regurgitation.

The Role of Echocardiography in Extracorporeal Membrane Oxygenation.

Extracorporeal membrane oxygenation (ECMO) is increasingly used to temporarily support patients in severe circulatory and/or respiratory failure. Echocardiography is a core component of successful ECMO deployment. Herein, we review the role of echocardiography at different phases on extracorporeal support including candidate identification, cannulation, maintenance, complication vigilance, and decannulation. During cannulation, ultrasound is used to confirm intended vascular access and appropriate inflow cannula positioning.While on ECMO, echocardiographic evaluation of ventricular loading conditions and hemodynamics, cannula positioning, and surveillance for intracardiac or aortic thrombi is needed for complication mitigation. Echocardiography is crucial during all phases of ECMO use. Specific echocardiographic queries depend on the ECMO type, V-V, or V-A, and the specific cannula configuration strategy employed.

Experience of using extracorporeal membrane oxygenation for total abruption of a normally located placenta in severe preeclampsia

INTRODUCTION: Premature abruption of a normally located placenta is a sudden and challenging problem to manage, and is a leading cause of maternal and perinatal mortality. Here, we reviewed the case of a pregnant woman with multiple organ failure and premature placental abruption involving the successful use of extracorporeal membrane oxygenation (ECMO) in the treatment of respiratory distress syndrome.&#x0D; AIM: We aimed at assessing the feasibility of using ECMO in the treatment of severe lung damage in a patient with multiple organ failure.&#x0D; CLINICAL CASE: We reviewed the clinical findings of the course of multiple organ failure and lung damage in a puerpera with severe preeclampsia. Moreover, we analyzed her life history, diseases, and diagnostic and treatment methods were analyzed.&#x0D; The described clinical case shows the possibility of the successful use of ECMO in patients with severe lung damage and respiratory distress syndrome in multiple organ failure resulting from severe obstetric complications. Currently, this is the first case involving ECMO in the treatment of the consequences of acute total abruption of a normally located placenta with favorable outcomes in the Republic of Bashkortostan.

Improving access to extracorporeal membrane oxygenation for out of hospital cardiac arrest: pre-hospital ECPR and alternate delivery strategies

BackgroundThe use of extracorporeal membrane oxygenation (ECPR) in refractory out-of-hospital cardiac arrest (OHCA) patients is usually implemented in-hospital. As survival in ECPR patients is critically time-dependent, alternative models in ECPR delivery could improve equity of access.ObjectivesTo identify the best strategy of ECPR delivery to provide optimal patient access, to examine the time-sensitivity of ECPR on predicted survival and to model potential survival benefits from different delivery strategies of ECPR.MethodsWe used transport accessibility frameworks supported by comprehensive travel time data, population density data and empirical cardiac arrest time points to quantify the patient catchment areas of the existing in-hospital ECPR service and two alternative ECPR strategies: rendezvous strategy and pre-hospital ECPR in Sydney, Australia. Published survival rates at different time points to ECMO flow were applied to predict the potential survival benefit.ResultsWith an in-hospital ECPR strategy for refractory OHCA, five hospitals in Sydney (Australia) had an effective catchment of 811,091 potential patients. This increases to 2,175,096 under a rendezvous strategy and 3,851,727 under the optimal pre-hospital strategy. Assuming earlier provision of ECMO flow, expected survival for eligible arrests will increase by nearly 6% with the rendezvous strategy and approximately 26% with pre-hospital ECPR when compared to the existing in-hospital strategy.ConclusionIn-hospital ECPR provides the least equitable access to ECPR. Rendezvous and pre-hospital ECPR models substantially increased the catchment of eligible OHCA patients. Traffic and spatial modelling may provide a mechanism to design appropriate ECPR service delivery strategies and should be tested through clinical trials.