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Sundar Krishnan, Gregory A Schmidt
PURPOSE OF REVIEW: Hemodynamic monitoring in ECMO patients requires familiarity with the underlying pathophysiology and circulatory mechanics of extracorporeal flow. This review discusses the various monitoring modalities relevant to the management of patients on venovenous ECMO (VV ECMO) and venoarterial (VA ECMO). We emphasize tools to judge the adequacy of perfusion, predict the response to fluid boluses, measure right ventricular function, assess left ventricular distention (for VA ECMO), and monitor the process of weaning from ECMO...
March 5, 2019: Current Opinion in Critical Care
Samuel Jacob, Brian Lima, Gonzalo V Gonzalez-Stawinski, Magdy M El-Sayed Ahmed, Parag C Patel, Erol V Belli, Ian A Makey, Mathew Thomas, Kevin Landolfo, Carolyn Landolfo, Juan Carlos Leoni Moreno, Daniel S Yip, Si M Pham
BACKGROUND: Severe primary graft dysfunction (PGD) is the leading cause of early death after heart transplant. AIM: To examine the outcomes of heart transplant recipients who received venoarterial extracorporeal membrane oxygenation (VA-ECMO) for severe PGD. METHODS: We reviewed electronic health records of adult patients who underwent heart transplant from November 2005 through June 2015. We defined severe PGD according to International Society for Heart and Lung Transplantation consensus statements...
March 14, 2019: Clinical Transplantation
Eilon Ram, Alexander Kogan, Boris Orlov, Ehud Raanani, Leonid Sternik
The mortality rate after the development of ventricular septal defect (VSD) remains high despite progress in pharmaceutical therapy, invasive cardiology, and surgical techniques. Although early surgical repair of postinfarction VSD is associated with a high mortality rate, in hemodynamic unstable patients surgery cannot always be postponed and surgical repair may be required urgently. We present two cases of patients diagnosed with postinfarction VSD who were in cardiogenic shock with multiorgan failure despite optimal treatment...
February 2019: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Ashley R Wilson-Smith, Yulia Bogdanova, Stephanie Roydhouse, Kevin Phan, David H Tian, Tristan D Yan, Antonio Loforte
Background: Despite advances in management techniques and medical therapy, refractory cardiogenic shock remains a life-threatening condition with high mortality rates. The present systematic review and meta-analysis aims to explore the outcomes associated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in the setting of refractory cardiogenic shock, stratified per survivorship. Methods: A literature search was performed using three electronic databases from the date of their inception up to June 2018...
January 2019: Annals of Cardiothoracic Surgery
Ashleigh Xie, Paul Forrest, Antonio Loforte
Background: Despite the survival benefit of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for treatment of refractory cardiogenic shock, it can also have potentially deleterious effects of left ventricular overload and pulmonary edema. The objective of this review was to investigate the current evidence on the incidence, diagnosis, risk factors, prevention, and interventions for left ventricular overload in adult and pediatric VA-ECMO patients. Methods: Five electronic databases, including MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Database of Systematic Reviews, were searched for original published studies from their dates of inception to January 2018...
January 2019: Annals of Cardiothoracic Surgery
Jae Hwan Choi, Jessica G Y Luc, Matthew P Weber, Haritha G Reddy, Elizabeth J Maynes, Avijit K Deb, Louis E Samuels, Rohinton J Morris, H Todd Massey, Antonio Loforte, Vakhtang Tchantchaleishvili
Background: Heparin-induced thrombocytopenia (HIT) is a severe antibody-mediated reaction leading to transient prothrombosis. However, its incidence in patients on extracorporeal life support (ECLS) is not well described. The aim of this systematic review was to report the incidence of HIT in patients on ECLS, as well as compare the characteristics and outcomes of HIT in patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and veno-venous ECMO (VV-ECMO). Methods: An electronic search was performed to identify all studies in the English literature examining outcomes of patients with HIT on ECLS...
January 2019: Annals of Cardiothoracic Surgery
Howard Todd Massey, Jae Hwan Choi, Elizabeth J Maynes, Vakhtang Tchantchaleishvili
The majority of clinical pathways and paradigms utilized in the treatment and management of cardiogenic shock with temporary mechanical circulatory support (MCS) are largely based on individual physician intuition and ad hoc problem-solving. Substantial mortality gains in the acute myocardial infarction cardiogenic shock (AMI-CS) population were observed with the reported outcomes of the SHOCK trial in 1999 compared to previous populations with AMI-CS. Nonetheless even in the age of percutaneous coronary intervention (PCI) of the infarct related artery, survival rates continue to be only approximately 50%...
January 2019: Annals of Cardiothoracic Surgery
Massimo Boffini, Erika Simonato, Davide Ricci, Fabrizio Scalini, Matteo Marro, Stefano Pidello, Matteo Attisani, Paolo Solidoro, Paolo Olivo Lausi, Vito Fanelli, Cristina Barbero, Luca Brazzi, Mauro Rinaldi
Background: Lung transplantation is the treatment of choice for end-stage pulmonary disease in selected patients. However, severe primary graft dysfunction is a significant complication of transplant and requires the implantation of an extracorporeal support. The aim of the study is to evaluate the impact of extracorporeal membrane oxygenation (ECMO) after transplant in our center. Methods: From January 2008 till June 2018, 195 consecutive unselected patients receiving a lung transplant were considered...
January 2019: Annals of Cardiothoracic Surgery
Christoph Fisser, Christoph Reichenbächer, Thomas Müller, Roland Schneckenpointner, Maximilian V Malfertheiner, Alois Philipp, Maik Foltan, Dirk Lunz, Florian Zeman, Matthias Lubnow
OBJECTIVES: Venovenous extracorporeal membrane oxygenation is indicated in patients with severe refractory acute respiratory failure. Venous thrombosis due to indwelling catheters is a frequent complication. The aim of this study was to analyze the incidence of cannula-related thrombosis and its risk factors after venovenous extracorporeal membrane oxygenation. DESIGN: Retrospective observational study. SETTING: A medical ICU at the University Hospital Regensburg...
January 11, 2019: Critical Care Medicine
Yuliya Tipograf, Michael Salna, Elizaveta Minko, Eric L Grogan, Cara Agerstrand, Joshua Sonett, Daniel Brodie, Matthew Bacchetta
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation (BTT) has become a critical component of caring for patients with end-stage lung disease. This study aims to examine outcomes of patients who received ECMO as a bridge to lung transplantation. METHODS: Statistical analysis was performed on data gathered retrospectively from the electronic medical records of adult patients who received ECMO as BTT at Columbia University Medical Center from April 2009 through July 2018...
February 18, 2019: Annals of Thoracic Surgery
Tim Kaufeld, Eric Beckmann, Fabio Ius, Nurbol Koigeldiev, Wiebke Sommer, Bakr Mashaqi, Felix N Fleissner, Thierry Siemeni, Jacob Ono Puntigam, Jessica Kaufeld, Axel Haverich, Christian Kuehn
BACKGROUND: Venoarterial extracorporeal membrane oxygenation support is a well-established tool in the care of severe refractory cardiac and respiratory failure. The application of this support may serve as a bridge to transplant, recovery or to implantation of a ventricular assist device. Venoarterial extracorporeal membrane oxygenation support can be administered through an open surgical access via the common femoral or axillary artery or a percutaneous approach using Seldinger technique...
February 8, 2019: Perfusion
Shamir Vally, Cyril Ferdynus, Romain Persichini, Bruno Bouchet, Eric Braunberger, Hugo Lo Pinto, Olivier Martinet, David Vandroux, Thomas Aujoulat, Jérôme Allyn, Nicolas Allou
BACKGROUND: Few data are available on the impact of levosimendan in refractory cardiogenic shock patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). The aim of this study was to evaluate the impact of levosimendan on VA-ECMO weaning in patients hospitalized in intensive care unit (ICU). METHODS: This retrospective cohort study was conducted in a French university hospital from 2010 to 2017. All patients hospitalized in ICU undergoing VA-ECMO were consecutively evaluated...
February 1, 2019: Annals of Intensive Care
Laveena Munshi, Allan Walkey, Ewan Goligher, Tai Pham, Elizabeth M Uleryk, Eddy Fan
BACKGROUND: Use of extracorporeal membrane oxygenation (ECMO) in adults with severe acute respiratory distress syndrome has increased in the past 10 years. However, the efficacy of venovenous ECMO in people with acute respiratory distress syndrome is uncertain according to the most recent data. We aimed to estimate the effect of venovenous ECMO on mortality from acute respiratory distress syndrome. METHODS: In this systematic review and meta-analysis, we searched MEDLINE (including MEDLINE In-Process and Epub Ahead of Print), Embase and the Wiley search platform in the Cochrane database for randomised controlled trials and observational studies with matching of conventional mechanical ventilation with and without venovenous ECMO in adults with acute respiratory distress syndrome...
January 11, 2019: Lancet Respiratory Medicine
Makoto Mori, Gerard McCloskey, Arnar Geirsson, Abeel A Mangi, James J Yun, Daniel Jacoby, Tariq Ahmad, Lavanya Bellumkonda, Forrester Lee, Michael E Chen, Pramod Bonde
Effective strategies to optimize Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS 1) patients are in much need. A novel awake venous-arterial extracorporeal membrane oxygenation (aVA ECMO) allows for clinical assessments while temporarily supporting biventricular function and stabilizing end-organ functions. The aim of the study was to assess outcomes of patients with aVA ECMO support before durable left ventricular assist device (LVAD) implantation. We evaluated 83 patients who received durable LVAD in 2012-2015, of whom 19 received aVA ECMO support before durable LVAD...
January 16, 2019: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ashley N Budd, Katherine Kozarek, Chitaru Kurihara, Ankit Bharat, Aaron Reynolds, Adam Kretzer
No abstract text is available yet for this article.
December 22, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Kai Chen, Jianfeng Hou, Hanwei Tang, Shengshou Hu
BACKGROUND: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in postcardiotomy cardiac shock (PCS). The factors that affect mortality in patients who receive ECMO for PCS remain unclear. In this study, we analyzed the outcomes, predictive factors and complications of ECMO use for PCS. METHODS: A total of 152 adult subjects who received VA-ECMO for PCS in Fuwai Hospital were consecutively included. We retrospectively collected the baseline characteristics, outcomes and complications...
January 23, 2019: Annals of Intensive Care
Sara Volpi, Federico Sertic, Kamen Valchanov, Ravi De Silva
BACKGROUND: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) support for ARDS treatment after cardiac surgery has progressed remarkably in the last 20 years. However, one of the limitations of a successful recover is age, being a powerful predictor of mortality. CASE PRESENTATION: In this case report we discuss a 78-year-old man who underwent aortic valve and aortic root replacement. The postoperative period was complicated by ARDS following aspiration pneumonia treated with VV-ECMO weaned after 6 days...
January 14, 2019: Journal of Cardiothoracic Surgery
Jessica G Y Luc, Steven R Meyer, William J Murtha, Gurmeet Singh
Legionella community-acquired pneumonia necessitating veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome has been reported in adults. However, few options remain in cases of refractory hypoxemia on veno-venous extracorporeal membrane oxygenation. Herein, we describe adjunctive extended therapeutic hypothermia for refractory hypoxemia despite veno-venous extracorporeal membrane oxygenation for successful management of severe acute respiratory distress syndrome secondary to Legionella...
January 10, 2019: Perfusion
Tarik Alp Sargut, Stein Julia, Panagiotis Pergantis, Christoph Knosalla, Jan Knierim, Manfred Hummel, Volkmar Falk, Felix Schoenrath
Background Several risk models target the issue of posttransplant survival, but none of them have been validated in a large European cohort. This aspect is important, in a time of the planned change of the Eurotransplant allocation system to a scoring system. Material and Methods Data of 761 heart transplant recipients from the Eurotransplant region with a total follow up of 5027 patient-years were analyzed. We assessed 30-day to 10-year freedom from graft failure. Existing post-transplant mortality risk models, IMPACT, Meld-XI and Columbia Risk Stratification Score were (RSS) were evaluated...
December 19, 2018: Heart Surgery Forum
Valentina Della Torre, Chiara Robba, Paolo Pelosi, Federico Bilotta
PURPOSE OF REVIEW: The purpose of this review is to describe recent evidence regarding the use of extracorporeal membrane oxygenation (ECMO) as salvage therapy for severe cardiac or respiratory failure in patients with trauma. The characteristics of this cohort of patients, including the risk of bleeding and the need for systemic anticoagulation, are generally considered as relative contraindications to ECMO treatment. However, recent evidence suggests that the use of ECMO should be taken in consideration even in this group of patients...
January 2, 2019: Current Opinion in Anaesthesiology
2019-01-06 11:29:42
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