F Sertic, C Bermudez, J E Rame
PURPOSE OF THE REVIEW: The purpose of this review is to describe the outcomes following refractory cardiogenic shock (CS) requiring mechanical circulatory support and factors associated with successful and unsuccessful weaning from VA-ECMO. Based on the presented data, we will propose a weaning and bridging algorithm with the aim of facilitating this complex process. RECENT FINDINGS: Refractory CS requiring VA-ECMO support is associated with high early mortality...
October 24, 2020: Current Heart Failure Reports
Nicholas R Hess, Gavin W Hickey, Ibrahim Sultan, Arman Kilic
BACKGROUND: This study compared outcomes of patients bridged with extracorporeal membrane oxygenation (ECMO) to orthotopic heart transplantation (OHT) following the recent heart allocation policy change. METHODS: The United Network of Organ Sharing Registry (UNOS) database was queried to examine OHT patients between 2010 and 2020 that were bridged with ECMO. Waitlist outcomes and 1-year posttransplant survival were compared between patients waitlisted and/or transplanted before and after the heart allocation policy change...
October 14, 2020: Journal of Cardiac Surgery
Noah Weingarten, Dean Schraufnagel, Gilman Plitt, Anthony Zaki, Kamal Ayyat, Haytham Elgharably
Introduction Lung transplantation outcomes are influenced by the intraoperative mechanical cardiopulmonary support strategy used. This surgery was historically done either on cardiopulmonary bypass (CPB) or off pump. Recently, there has been increased interest in intraoperative support with veno-arterial (VA) or veno-venous (VV) extracorporeal membrane oxygenation (ECMO). However, there is a lack of consensus on the relative risks, benefits and indications for each intraoperative support strategy. Areas covered This review includes information from cohort studies, case-control studies, and case series that compare morbidity and/or mortality of two or more intraoperative cardiopulmonary support strategies during lung transplantation...
October 22, 2020: Expert Review of Medical Devices
M Zimmermann, S Vallier, B G Sanchez, M Agossou, N Venissac
Tracheal tumour is rare but can lead to upper airway obstruction and acute respiratory distress. Its management includes surgical resection, radiotherapy or interventional bronchoscopy. Ventilation or difficulties with tracheal intubation can occur during the peri-operative course resulting in serious adverse consequences. We report the case of an 83-year-old man with an obstructive tracheal chondrosarcoma resected by rigid bronchoscopy undergoing veno-venous extracorporeal membrane oxygenation. Such support should be considered when the patient's airway patency cannot be ensured by conventional methods...
July 2020: Anaesthesia reports
Mohammed A Shamsah, Zouheir Ibrahim Bitar, Huda Alfoudri
Background: Significant coagulopathy and hyperinflammation are found in patients with coronavirus disease 2019 (COVID-19). Expert consensus has recommended prophylactic anticoagulation in COVID-19 patients due to the risk of thrombo-embolism. However, the use of therapeutic anticoagulation in these patients is still a matter of debate. Case summary: We describe a patient with COVID-19 pneumonia and a clinical hyperinflammatory state. He developed early respiratory depression and required ventilation, and he subsequently developed haemodynamic instability...
October 2020: European Heart Journal. Case Reports
Hai Zou, Shengqing Li
No abstract text is available yet for this article.
October 2020: European Heart Journal. Case Reports
Cheryl Godcharles, Melody Safarzadeh, Emily A Oliver, Amanda Roman, Huda B Al-Kouatly
Extracorporeal membrane oxygenation (ECMO) is used to provide acute respiratory and/or hemodynamic support to patients with severe, refractory respiratory failure. Phrenic nerve injury with subsequent hemidiaphragm paralysis should be included in the differential diagnosis of pregnant women with persistent hypoxia after ECMO cannulation.
October 2020: Clinical Case Reports
Jianrong Wang, Jinyu Huang, Wei Hu, Xueying Cai, Weihang Hu, Ying Zhu
OBJECTIVE: We aimed to examine the risk factors and prognosis of nosocomial pneumonia (NP) during extracorporeal membrane oxygenation (ECMO). METHODS: We retrospectively analyzed data of patients who received ECMO at the Affiliated Hangzhou Hospital of Nanjing Medical University between January 2013 and August 2019. The primary outcome was the survival-to-discharge rate. RESULTS: Sixty-nine patients who received ECMO were enrolled, median age 42 years and 26 (37...
October 2020: Journal of International Medical Research
Tomasz Mroczek, Marcin Gladki, Janusz Skalski
We present the case of a 27-month-old boy who underwent accidental hypothermia to 11.8°C and was resuscitated with prolonged rewarming with extracorporeal membrane oxygenation without significant neurological impairments. This is probably the lowest temperature ever documented, at which a human being has been successfully resuscitated from accidental hypothermia after the long period of circulatory arrest.
November 1, 2020: European Journal of Cardio-thoracic Surgery
Min Jiang, Jun Wang, Fei He
Acute poisoning induced cardiac arrest (APCA) is an acute circulatory failure caused by severe poisoning, which is characterized by complicated mechanisms, limited treatment methods and poor prognosis. Recently, emerging evidence has demonstrated that extracorporeal membrane oxygenation (ECMO) could be a promising tool that may benefit the patients with APCA refractory to conventional resuscitation methods. However, further well-designed studies are needed to evaluate and resolve the emerged problems during the process of ECMO therapy in patients with APCA, such as population indications, optimal conditions, cost-effectiveness, etc...
September 2020: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Wei Li, Xufeng Chen, Yong Mei, Jinru Lyu, Deliang Hu, Feng Sun, Gang Zhang, Huazhong Zhang, Jinsong Zhang
OBJECTIVE: To explore the changing trend of cardiac troponin T (cTnT) in patients with cardiogenic shock (CS) receiving veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and its predictive value. METHODS: A retrospective study was conducted. The data of patients with CS receiving V-A ECMO admitted to the First Affiliated Hospital of Nanjing Medical University from March 2015 to May 2020 were enrolled. The baseline data, ECMO related parameters, serum cTnT levels at 1, 2, 3 days after ECMO and intensive care unit (ICU) prognosis were recorded...
September 2020: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Klaus Görlinger, Daniel Dirkmann, Ajay Gandhi, Paolo Simioni
Patients with coronavirus disease 2019 (COVID-19) frequently experience a coagulopathy associated with a high incidence of thrombotic events leading to poor outcomes. Here, biomarkers of coagulation (such as D-dimer, fibrinogen, platelet count), inflammation (such as interleukin-6), and immunity (such as lymphocyte count) as well as clinical scoring systems (such as sequential organ failure assessment [SOFA], International Society on Thrombosis and Hemostasis disseminated intravascular coagulation [ISTH DIC], and sepsis-induced coagulopathy [SIC] score) can be helpful in predicting clinical course, need for hospital resources (such as intensive care unit [ICU] beds, intubation and ventilator therapy, and extracorporeal membrane oxygenation [ECMO]) and patient's outcome in patients with COVID-19...
November 2020: Anesthesia and Analgesia
Marco Giani, Clarissa Forlini, Benedetta Fumagalli, Roberto Rona, Antonio Pesenti, Giuseppe Foti
No abstract text is available yet for this article.
October 19, 2020: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Robert C Davis, Lucian A Durham, Laszlo Kiraly, Jayshil J Patel
Extracorporeal membrane oxygenation (ECMO) is a supportive care system for patients with respiratory or cardiac failure. Patients requiring ECMO are at risk for significant inflammation, prolonged hospitalization, and acquired malnutrition and sarcopenia. Societal guidelines recommend early enteral nutrition in critically ill patients; however, in this population, optimal timing and dose of nutrition remains unknown and fear of reduced splanchnic perfusion, delayed gastric emptying, and bowel ischemia poses a barrier to appropriate energy and protein intake...
October 19, 2020: Nutrition in Clinical Practice
Nikolaos A Diakos, Katherine Thayer, Lija Swain, Maithri Goud, Pankaj Jain, Navin K Kapur
In-hospital mortality associated with cardiogenic shock (CS) remains high despite introduction of mechanical circulatory support. In this study, we aimed to investigate whether systemic inflammation is associated with clinical outcomes in CS. We retrospectively analyzed systemic cytokine levels and the neutrophil-to-lymphocyte ratio (NLR), a marker of low-grade inflammation, among 134 patients with CS supported by VA-ECMO or Impella. Sixty-one percent of patients survived CS and either underwent device explantation or were bridged to LVAD or cardiac transplant...
October 19, 2020: Journal of Cardiovascular Translational Research
Elvis Brscic, Gabriella Rovero, Pierpaolo Sori, Katiuscia Testa, Sebastiano Marra
Extracorporeal membrane oxygenation (ECMO) has been developed to provide hemodynamic support in patients with severe cardiac or respiratory failure. In the last few years, its use has become increasingly common in interventional cardiology rooms for high-risk coronary interventions and for transcatheter therapies for valvular disease, which are increasingly complex in subsets of fragile patients at high surgical risk and with multiple comorbidities.Here, we describe the treatment of an extremely critical patient for severe dual valvulopathy, severe impairment of post-infarct systolic function, advanced heart failure with prohibitive operative risk...
November 2020: Giornale Italiano di Cardiologia
Paolo Biban, Giorgio Conti, Andrea Michele Wolfler, Silvia Carlassara, Eloisa Gitto, Immacolata Rulli, Andrea Moscatelli, Camilla Micalizzi, Fabio Savron, Raffaella Sagredini, Giulia Genoni, Marco Binotti, Fabio Caramelli, Monica Fae, Andrea Pettenazzo, Valentina Stritoni, Luigia D'Amato, Geremia Zito Marinosci, Edoardo Calderini, Stefano Scalia Catenacci, Alberto Berardi, Francesco Torcetta, Ezio Bonanomi, Daniele Bonacina, Giorgio Ivani, Pierantonio Santuz
INTRODUCTION: Some evidence indicates that exogenous surfactant therapy may be effective in infants with acute viral bronchiolitis, even though more confirmatory data are needed. To date, no large multicentre trials have evaluated the effectiveness and safety of exogenous surfactant in severe cases of bronchiolitis requiring invasive mechanical ventilation (IMV). METHODS AND ANALYSIS: This is a multicentre randomised, placebo-controlled, double-blind study, performed in 19 Italian paediatric intensive care units (PICUs)...
October 19, 2020: BMJ Open
Samuel Heuts, Johannes F Ubben, Vanessa Banks-Gonzales, Jan-Willem Sels, Roberto Lorusso, Walther N K A van Mook, Thijs S R Delnoij
Patients with coronavirus disease 2019 (COVID-19) are prone to pulmonary artery hypertension (PAH) and right ventricular pressure overload due to severe bilateral infiltrates, high ventilation pressures, persistent hypoxemia, pulmonary fibrosis, and/or pulmonary embolism. In patients on extracorporeal membrane oxygenation (ECMO), this potentially leads to increased recirculation. In the current report, the authors present a case in which continuous inhaled nitric oxide (iNO)-enriched ventilation was effective in terms of PAH and recirculation reduction in a COVID-19 patient on veno-venous ECMO...
October 5, 2020: Journal of Cardiothoracic and Vascular Anesthesia
Jennifer Conway, Ryan Cantor, Devin Koehl, Robert Spicer, Dipankar Gupta, Michael McCulloch, Alfred Asante-Korang, Dean T Eulrich, James K Kirklin, Elfriede Pahl
Background Infants with heart failure remain at significant risk for wait list mortality, despite mechanical circulatory support (MCS). It is unclear if the outcomes are influenced by modality of support or underlying diagnosis. We sought to compare the outcomes of infants <10 kg, focusing on modality of support and underlying diagnosis. Methods and Results Using the Pediatric Heart Transplant Society database, we evaluated survival following first MCS device in children <10 kg who were listed for heart transplant between 2010 and 2018...
October 20, 2020: Journal of the American Heart Association
Mirko Belliato, Luca Cremascoli, Francesco Epis, Fiorenza Ferrari, Maria G Quattrone, Maximilian V Malfertheiner, Lars M Broman, Anna Aliberti, Fabio S Taccone, Giorgio A Iotti, Roberto Lorusso
Veno-venous extracorporeal membrane oxygenation (V-V ECMO) represents a component of the treatment strategy for severe respiratory failure. Clinical evidence on the management of the lung during V-V ECMO are limited just as the consensus regarding timing of weaning. The monitoring of the carbon dioxide (CO2) removal (V'CO2TOT) is subdivided into two components: the membrane lung (ML) and the native lung (NL) are both taken into consideration to evaluate the improvement of the function of the lung and to predict the time to wean off ECMO...
October 15, 2020: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
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