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Dugar SP, Sato R, Charlton M, Hasegawa D, Antonini MV, Nasa P, Yusuff H, Schultz MJ, Harnegie MP, Ramanathan K, Shekar K, Schmidt M, Zochios V, Duggal A. Right Ventricular Injury Definition and Management in Veno-Venous Extracorporeal Membrane Oxygenation. ASAIO J 2025:00002480-990000000-00617. [PMID: 39787611 DOI: 10.1097/mat.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025] Open
Abstract
Right ventricular injury (RVI) in respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A scoping review is necessary to map the current literature and guide future research regarding the definition and management of RVI in patients receiving VV ECMO. We searched for relevant publications on RVI in patients receiving VV ECMO in Medline, EMBASE, and Web of Science. Of 1,868 citations screened, 30 studies reported on RVI (inclusive of right ventricular dilation, right ventricular dysfunction, and right ventricular failure) during VV ECMO. Twenty-three studies reported on the definition of RVI including echocardiographic indices of RV function and dimensions, whereas 13 studies reported on the management of RVI, including veno-pulmonary (VP) ECMO, veno-arterial (VA) ECMO, positive inotropic agents, pulmonary vasodilators, ultra-lung-protective ventilation (Ultra-LPV), and optimization of positive end-expiratory pressure (PEEP). The definitions of RVI in patients receiving VV ECMO used in the literature are heterogeneous. Despite the high incidence of RVI during VV ECMO support and its strong association with mortality, studies investigating therapeutic strategies for RVI are also lacking. To fill the existing knowledge gaps, a consensus on the definition of RVI and research investigating RV-targeted therapies during VV ECMO is urgently warranted.
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Affiliation(s)
- Siddharth Pawan Dugar
- From the Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, Hawaii
| | - Matthew Charlton
- University Hospitals of Leicester National Health Service Trust, Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Daisuke Hasegawa
- Department of Internal Medicine, Mount Sinai Beth Israel, New York, New York
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Prashant Nasa
- Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Internal Medicine, College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Hakeem Yusuff
- NIHR Leicester Biomedical Research Unit, Glenfield Hospital, Leicester, United Kingdom
- National University Hospital, Singapore, Singapore
| | - Marcus J Schultz
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Anaesthesiology, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Mary Pat Harnegie
- The Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio
| | - Kollengode Ramanathan
- National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kiran Shekar
- Adult Intensive Care Services, Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
- University of Queensland, Brisbane and Bond University, Gold Coast, Queensland, Australia
| | - Matthieu Schmidt
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, AP-HP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Paris, France
| | - Vasileios Zochios
- University Hospitals of Leicester National Health Service Trust, Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Abhijit Duggal
- From the Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
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Isha S, Narra SA, Batool H, Jonna S, Giri A, Herrmann O, Dyson A, Nichols MD, Hannon R, Pham S, Moreno Franco P, Baz M, Sanghavi D, Kiley S, Waldron N, Pandompatam G, Bohman JKK, Chaudhary S, Rosenbaum DN, Guru PK, Bhattacharyya A. Assessing Right Ventricle Over Time in Patients on Veno-Venous Extracorporeal Membrane Oxygenation: Insights From Serial Echocardiography. ASAIO J 2024; 70:1033-1039. [PMID: 38819317 DOI: 10.1097/mat.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is often used in acute respiratory distress syndrome (ARDS) with refractory hypoxemia. There is limited literature highlighting the development of right ventricular (RV) failure while on ECMO. We conducted a retrospective multicenter observational study including 70 patients who were placed on veno-venous (VV)-ECMO for respiratory failure at Mayo Clinic, Jacksonville, and Mayo Clinic, Rochester, between January 2018 and June 2022 and had at least two post-ECMO transthoracic echoes. The primary outcomes were the incidence and progression of RV dysfunction and dilatation. The secondary outcome was in-patient mortality. Among 70 patients in our cohort, 60.6% had a normal RV function at the time of ECMO placement, whereas only 42% had a normal RV function at the second post-ECMO echo. On multinomial regression, a moderate decrease in RV function was associated with ECMO flow (odds ratio [OR] = 2.32, p = 0.001) and ECMO duration (OR = 1.01, p = 0.01). A moderately dilated RV size was also associated with ECMO flow (OR = 2.62, p < 0.001) and ECMO duration (OR = 1.02, p = 0.02). An increasing degree of RV dysfunction was associated with worse outcomes. Our study showed that the increasing duration and flow of VV-ECMO correlated with progressive RV dilatation and dysfunction, which were associated with poor survival.
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Affiliation(s)
- Shahin Isha
- From the Department of Internal Medicine, Ascension Saint Joseph Hospital, Chicago, Illinois
| | - Sai Abhishek Narra
- Department of Internal Medicine, Mercy Fitzgerald Hospital, Philadelphia, Pennsylvania
| | - Humera Batool
- Department of Internal Medicine, Mercy Fitzgerald Hospital, Philadelphia, Pennsylvania
| | - Sadhana Jonna
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Abhishek Giri
- Department of Internal Medicine, Fairview Hospital, Cleveland, Ohio
| | - Olivia Herrmann
- Cope Lab, Department of Biomedical Engineering, Georgia Institute of Technology,, Atlanta, Georgia
| | - Amari Dyson
- Florida State College, Jacksonville, Florida
| | - Mick D Nichols
- Department of Nursing, Mayo Clinic, Jacksonville, Florida
| | - Rachel Hannon
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Si Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | - Maher Baz
- Department of Transplant, Mayo Clinic, Jacksonville, Florida
| | - Devang Sanghavi
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Sean Kiley
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Nathan Waldron
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Govind Pandompatam
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Sanjay Chaudhary
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
| | - Drew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, Florida
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Zochios V, Nasa P, Yusuff H, Schultz MJ, Antonini MV, Duggal A, Dugar S, Ramanathan K, Shekar K, Schmidt M. Definition and management of right ventricular injury in adult patients receiving extracorporeal membrane oxygenation for respiratory support using the Delphi method: a PRORVnet study. Expert position statements. Intensive Care Med 2024; 50:1411-1425. [PMID: 39102027 PMCID: PMC11838017 DOI: 10.1007/s00134-024-07551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is an integral part of the management algorithm of patients with severe respiratory failure refractory to evidence-based conventional treatments. Right ventricular injury (RVI) pertaining to abnormalities in the dimensions and/or function of the right ventricle (RV) in the context of VV-ECMO significantly influences mortality. However, in the absence of a universally accepted RVI definition and evidence-based guidance for the management of RVI in this very high-risk patient cohort, variations in clinical practice continue to exist. METHODS Following a systematic search of the literature, an international Steering Committee consisting of eight healthcare professionals involved in the management of patients receiving ECMO identified domains and knowledge gaps pertaining to RVI definition and management where the evidence is limited or ambiguous. Using a Delphi process, an international panel of 52 Experts developed Expert position statements in those areas. The process also conferred RV-centric overarching open questions for future research. Consensus was defined as achieved when 70% or more of the Experts agreed or disagreed on a Likert-scale statement or when 80% or more of the Experts agreed on a particular option in multiple-choice questions. RESULTS The Delphi process was conducted through four rounds and consensus was achieved on 31 (89%) of 35 statements from which 24 Expert position statements were derived. Expert position statements provided recommendations for RVI nomenclature in the setting of VV-ECMO, a multi-modal diagnostic approach to RVI, the timing and parameters of diagnostic echocardiography, and VV-ECMO settings during RVI assessment and management. Consensus was not reached on RV-protective driving pressure thresholds or the effect of prone positioning on patient-centric outcomes. CONCLUSION The proposed definition of RVI in the context of VV-ECMO needs to be validated through a systematic aggregation of data across studies. Until further evidence emerges, the Expert position statements can guide informed decision-making in the management of these patients.
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Affiliation(s)
- Vasileios Zochios
- Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, University Hospitals of Leicester National Health Service Trust, Glenfield, Groby Road, Leicester, LE3 9QP, UK.
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Prashant Nasa
- Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Internal Medicine, College of Medicine and Health Sciences, Al Ain, Abu Dhabi, United Arab Emirates
| | - Hakeem Yusuff
- Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, University Hospitals of Leicester National Health Service Trust, Glenfield, Groby Road, Leicester, LE3 9QP, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Marcus J Schultz
- Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Anesthesiology, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital, AUSL Della Romagna, Cesena, Italy
- PhD program in Cardio-Nephro-Thoracic Sciences, University of Bologna, Bologna, Italy
| | - Abhijit Duggal
- Department of Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kollengode Ramanathan
- National University Hospital, Singapore, 119074, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- University of Queensland, Brisbane and Bond University, Gold Coast, QLD, Australia
| | - Matthieu Schmidt
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, AP-HP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 75013, Paris, France
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Shah P, Miller C, Parilla G, Daneshmand M, Creel-Bulos C. Outcomes associated with prolonged ECMO in COVID-19 associated ARDS: A single center experience. Perfusion 2024; 39:1213-1221. [PMID: 37970730 DOI: 10.1177/02676591231184710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSE OF STUDY The COVID-19 pandemic has led to a significant increase in the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a bridge to transplantation versus recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of V-V ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. METHODS Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-transplant free survival, mortality and discharge rates-of patients requiring V-V ECMO support for greater than 50 days. RESULTS The median age of the cohort was 48 years and 13 patients (72%) were males. The median duration of ECMO support was 84 days (IQR 55-106). 11 patients (61%) had right ventricular dysfunction and 13 patients (72%) had pneumothoraces. There was a 33% percent (n = 6) mortality rate within cohort. One patient continues to require ECMO support at time of abstract submission. 11 patients (61%) patients were discharged, of which 3 patients required a lung transplant. SUMMARY Prolonged V-V ECMO can be associated with comparable outcomes to conventional V-V ECMO runs that are relatively shorter in duration. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population.
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Affiliation(s)
- Purav Shah
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, McKelvey Lung Transplant Center, Emory University School of Medicine, Atlanta, USA
| | - Casey Miller
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Gustavo Parilla
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Mani Daneshmand
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Christina Creel-Bulos
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA
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Dimarakis I, Aldea GS. Commentary: Extreme cardiorespiratory pathophysiology: Critical care evolution in response to a pandemic. J Thorac Cardiovasc Surg 2024; 167:1842-1844. [PMID: 36764913 PMCID: PMC9859641 DOI: 10.1016/j.jtcvs.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Affiliation(s)
- Ioannis Dimarakis
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash.
| | - Gabriel S Aldea
- Division of Cardiothoracic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Wash
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Bagate F, Masi P, Boukantar M, Radu C, Saiydoun G, Fiore A, Chiaroni PM, Teiger E, Folliguet T, Gallet R, Mekontso Dessap A. Refractory cor pulmonale under extracorporeal membrane oxygenation for acute respiratory distress syndrome: the role of conversion to veno-pulmonary arterial assist-a case series. Front Med (Lausanne) 2024; 11:1348077. [PMID: 38725464 PMCID: PMC11079173 DOI: 10.3389/fmed.2024.1348077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Pulmonary vascular dysfunction during severe acute respiratory distress syndrome (ARDS) may lead to right ventricle (RV) dysfunction and acute cor pulmonale (ACP). The occurrence/persistence of ACP despite conventional extracorporeal membrane oxygenation (ECMO) is a challenging situation. We explored the usefulness of a specific dual-lumen cannula that bypasses the RV, and on which a veno-pulmonary arterial assist (V-P ECMO) was mounted, in ARDS patients. Methods We report a case-series of ARDS patients put on conventional veno-arterial or veno-venous ECMO and presented refractory ACP as an indication for a reconfiguration to V-P ECMO using the ProtekDuo cannula. The primary endpoint was the mitigation of RV and pulmonary vascular dysfunction as assessed by the change in end-diastolic RV/left ventricle (LV) surface ratio. Results Six patients had their conventional ECMO reconfigured to V-P ECMO to treat refractory ACP. There was a decrease in end-diastolic RV/LV surface ratio, as well as end-systolic LV eccentricity index, and lactatemia immediately after V-P ECMO initiation. The resolution of refractory ACP was immediately achieved in four of our six (66%) patients. The V-P ECMO was weaned after a median of 26 [8-93] days after implantation. All but one patient were discharged home. We detected one case of severe hemolysis with V-P ECMO and two suspected cases of right-sided infective endocarditis. Conclusion V-P ECMO is useful to mitigate RV overload and to improve hemodynamics in case of refractory ACP despite conventional ECMO.
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Affiliation(s)
- François Bagate
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Médecine Intensive Réanimation, Créteil, France
- Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, France
| | - Paul Masi
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Médecine Intensive Réanimation, Créteil, France
- Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, France
| | - Madjid Boukantar
- APHP, Hôpitaux Universitaires Henri Mondor, Service de Cardiologie, Créteil, France
| | - Costin Radu
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | - Gabriel Saiydoun
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | - Antonio Fiore
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | | | - Emmanuel Teiger
- APHP, Hôpitaux Universitaires Henri Mondor, Service de Cardiologie, Créteil, France
| | - Thierry Folliguet
- APHP, Hôpitaux Universitaires Henri Mondor, Département de Chirurgie Cardiaque, Créteil, France
| | - Romain Gallet
- APHP, Hôpitaux Universitaires Henri Mondor, Service de Cardiologie, Créteil, France
- U955-IMRB, Equipe 03, Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d’Alfort (EnVA), Maisons-Alfort, France
| | - Armand Mekontso Dessap
- AP-HP, Hôpitaux Universitaires Henri Mondor, DHU A-TVB, Service de Médecine Intensive Réanimation, Créteil, France
- Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, France
- INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
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Pans N, Vanherf J, Vandenbrande J, Lehaen J, Yilmaz A, Verwerft J, Van Tornout M, Geebelen L, Callebaut I, Herbots L, Dubois J, Stessel B. Predictors of poor outcome in critically ill patients with COVID-19 pneumonia treated with extracorporeal membrane oxygenation. Perfusion 2024; 39:151-161. [PMID: 36219740 PMCID: PMC9554572 DOI: 10.1177/02676591221131487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION We aimed to identify risk factors associated with ICU mortality in critically ill patients with COVID-19 pneumonia treated with Extracorporeal membrane oxygenation (ECMO). We also aimed to assess protocol violations of the local eligibility criteria of ECMO initiation. METHODS All 31 consecutive adult patients with confirmed COVID-19 pneumonia admitted to ICU and treated with ECMO from March 13th 2020 to 8 December 2021 were enrolled. Eligibility criteria for ECMO initiation were: P/F-ratio<50 mmHg >3 hours, P/F-ratio<80 mmHg >6 hours or pH<7.25 + PaCO2>60 mmHg >6 hours, despite maximal protective invasive ventilation. Primary outcome was ICU mortality. Univariate logistic regression analyses were performed to identify predictors of ICU mortality. RESULTS 12 out of 31 patients (38.7%) did not survive ECMO treatment in ICU. Half of the non-survivors suffered from acute kidney failure compared to 3 out of 19 survivors (15.79%) (p = .04). Half of the non-survivors required CRRT treatment versus 1 patient in the survivor group (5.3%) (p < .01). Higher age (2.45 (0.97-6.18), p = .05), the development of AKI (5.33 (1.00-28.43), p = .05), need of CRRT during ICU stay (18.00 (1.79-181.31), p = .01) and major bleeding during ECMO therapy (0.51 (0.19-0.89), p < .01) were identified to be predictors of ICU mortality. CONCLUSION Almost 60% of patients could be treated successfully with ECMO with sustained results at 3 months. Predictors for ICU mortality were development of AKI and need of CRRT during ICU stay, higher age category and major bleeding. Inadvertent ECMO allocation was noted in almost one in five patients.
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Affiliation(s)
- Nick Pans
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Jul Vanherf
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Vandenbrande
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Jeroen Lehaen
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | - Jan Verwerft
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Michiel Van Tornout
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Laurien Geebelen
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Ina Callebaut
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Belgium
| | - Lieven Herbots
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Jasperina Dubois
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
| | - Björn Stessel
- Department of Intensive Care and Anesthesiology, Jessa Hospital, Hasselt, Belgium
- UHasselt, Faculty of Medicine and Life Sciences, LCRC, Agoralaan, Belgium
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Kołodziejczak MM, Sierakowska K, Tkachenko Y, Kowalski P. Artificial Intelligence in the Intensive Care Unit: Present and Future in the COVID-19 Era. J Pers Med 2023; 13:891. [PMID: 37373880 PMCID: PMC10304011 DOI: 10.3390/jpm13060891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
The development of artificial intelligence (AI) allows for the construction of technologies capable of implementing functions that represent the human mind, senses, and problem-solving skills, leading to automation, rapid data analysis, and acceleration of tasks. These solutions has been initially implemented in medical fields relying on image analysis; however, technological development and interdisciplinary collaboration allows for the introduction of AI-based enhancements to further medical specialties. During the COVID-19 pandemic, novel technologies established on big data analysis experienced a rapid expansion. Yet, despite the possibilities of advancements with these AI technologies, there are number of shortcomings that need to be resolved to assert the highest and the safest level of performance, especially in the setting of the intensive care unit (ICU). Within the ICU, numerous factors and data affect clinical decision making and work management that could be managed by AI-based technologies. Early detection of a patient's deterioration, identification of unknown prognostic parameters, or even improvement of work organization are a few of many areas where patients and medical personnel can benefit from solutions developed with AI.
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Affiliation(s)
- Michalina Marta Kołodziejczak
- Department of Anesthesiology and Intensive Care, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Antoni Jurasz University Hospital No.1, 85-094 Bydgoszcz, Poland;
| | - Katarzyna Sierakowska
- Department of Anesthesiology and Intensive Care, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University Torun, Antoni Jurasz University Hospital No.1, 85-094 Bydgoszcz, Poland;
| | - Yurii Tkachenko
- Department of Anesthesiology and Intensive Care, Władysław Biegański Regional Specialized Hospital, 86-300 Grudziadz, Poland; (Y.T.); (P.K.)
| | - Piotr Kowalski
- Department of Anesthesiology and Intensive Care, Władysław Biegański Regional Specialized Hospital, 86-300 Grudziadz, Poland; (Y.T.); (P.K.)
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Lazzeri C, Bonizzoli M, Batacchi S, Cianchi G, Franci A, Socci F, Chiostri M, Peris A. Right ventricle dysfunction does not predict mortality in patients with SARS-CoV-2-related acute respiratory distress syndrome on extracorporeal membrane oxygenation support. World J Cardiol 2023; 15:165-173. [PMID: 37124973 PMCID: PMC10130894 DOI: 10.4330/wjc.v15.i4.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/15/2022] [Accepted: 03/17/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The prognostic role of right ventricle dilatation and dysfunction (RVDD) has not been elucidated in patients with coronavirus disease (COVID)-related respiratory failure refractory to standard treatment needing extracorporeal membrane oxygenation (ECMO) support.
AIM To assess whether pre veno-venous (VV) ECMO RVDD were related to in-intensive care unit (ICU) mortality.
METHODS We enrolled 61 patients with COVID-related acute respiratory distress syndrome refractory to conventional treatment submitted to VV ECMO and consecutively admitted to our ICU (an ECMO referral center) from 31th March 2020 to 31th August 2021. An echocardiographic exam was performed immediately before VV ECMO implantation.
RESULTS Males were prevalent (73.8%) and patients with a body mass index > 30 kg/m2 were the majority (46/61, 75%). The overall in-ICU mortality rate was 54.1% (33/61). RVDD was detectable in more than half of the population (34/61, 55.7%) and associated with higher simplified organ functional assessment (SOFA) values (P = 0.029) and a longer mechanical ventilation duration prior to ECMO support (P = 0.046). Renal replacement therapy was more frequently needed in RVDD patients (P = 0.002). A higher in-ICU mortality (P = 0.024) was observed in RVDD patients. No echo variables were independent predictors of in-ICU death.
CONCLUSION In patients with COVID-related respiratory failure on ECMO support, RVDD (dilatation and dysfunction) is a common finding and identifies a subset of patients characterized by a more severe disease (as indicated by higher SOFA values and need of renal replacement therapy) and by a higher in-ICU mortality. RVDD (also when considered separately) did not result independently associated with in-ICU mortality in these patients.
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10
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Levy D, Desnos C, Lebreton G, Théry G, Pineton de Chambrun M, Leprince P, Hammoudi N, Schmidt M, Combes A, Hékimian G. Early Reversal of Right Ventricular Dysfunction after Venovenous Extracorporeal Membrane Oxygenation in Patients with COVID-19 Pneumonia. Am J Respir Crit Care Med 2023; 207:784-787. [PMID: 36459095 PMCID: PMC10037471 DOI: 10.1164/rccm.202208-1486le] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- David Levy
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Cyrielle Desnos
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Chirurgie Cardiaque et thoracique, Institut de Cardiologie, and
| | - Guillaume Théry
- Service de Médecine Intensive-Réanimation
- Service de Médecine Intensive-Réanimation, Hôpital Universitaire de Reims, Reims, France; and
| | - Marc Pineton de Chambrun
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
- Service de Médecine Interne 2, Centre de référence Lupus Systémique, SAPL et Autres Maladies Auto-immunes et Systémiques Rares, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Leprince
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Chirurgie Cardiaque et thoracique, Institut de Cardiologie, and
| | - Nadjib Hammoudi
- ACTION Study Group, INSERM UMR_S 1166 and Hôpital Pitié-Salpêtrière (AP-HP), Boulevard de l'hôpital, Sorbonne Université, Paris, France
| | - Matthieu Schmidt
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
| | - Guillaume Hékimian
- Institute of Cardiometabolism and Nutrition, INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
- Service de Médecine Intensive-Réanimation
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11
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Essig R, Sundland R, Chokshi N. Lessons Learned from Extracorporeal Membrane Oxygenation Use During the COVID-19 Pandemic. Pediatr Ann 2022; 51:e281-e285. [PMID: 35858215 DOI: 10.3928/19382359-20220504-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
With the rise of the coronavirus disease 2019 (COVID-19) respiratory pandemic, there has been an increased need to consider the use of extracorporeal membrane oxygenation (ECMO) technology. In the early phases of the pandemic, adults constituted most of the critically ill patients, and ECMO management strategies were developed for use in this population. During the course of the pandemic, there has been a rise in the number of critically ill children infected with COVID-19. Although ECMO has been used in the care of pediatric patients for more than half a century, it has been challenging to apply the lessons learned from adult patients with COVID-19 directly to critically ill children for whom ECMO is under consideration. This article reviews ECMO technology and highlights a number of important changes in pediatric ECMO regarding those patients infected with COVID-19. [Pediatr Ann. 2022;51(7):e281-e285.].
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12
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Abstract
Not applicable.
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Affiliation(s)
- Amit Banga
- Lung Transplant Program, University of Texas Southwestern Medical Center, Dallas, TX, United States
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13
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Ling RR, Ramanathan K, Sim JJL, Wong SN, Chen Y, Amin F, Fernando SM, Rochwerg B, Fan E, Barbaro RP, MacLaren G, Shekar K, Brodie D. Evolving outcomes of extracorporeal membrane oxygenation during the first 2 years of the COVID-19 pandemic: a systematic review and meta-analysis. Crit Care 2022; 26:147. [PMID: 35606884 PMCID: PMC9125014 DOI: 10.1186/s13054-022-04011-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background Extracorporeal membrane oxygenation (ECMO) has been used extensively for coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Reports early in the pandemic suggested that mortality in patients with COVID-19 receiving ECMO was comparable to non-COVID-19-related ARDS. However, subsequent reports suggested that mortality appeared to be increasing over time. Therefore, we conducted an updated systematic review and meta-analysis, to characterise changes in mortality over time and elucidate risk factors for poor outcomes.
Methods We conducted a meta-analysis (CRD42021271202), searching MEDLINE, Embase, Cochrane, and Scopus databases, from 1 December 2019 to 26 January 2022, for studies reporting on mortality among adults with COVID-19 receiving ECMO. We also captured hospital and intensive care unit lengths of stay, duration of mechanical ventilation and ECMO, as well as complications of ECMO. We conducted random-effects meta-analyses, assessed risk of bias of included studies using the Joanna Briggs Institute checklist and evaluated certainty of pooled estimates using GRADE methodology.
Results Of 4522 citations, we included 52 studies comprising 18,211 patients in the meta-analysis. The pooled mortality rate among patients with COVID-19 requiring ECMO was 48.8% (95% confidence interval 44.8–52.9%, high certainty). Mortality was higher among studies which enrolled patients later in the pandemic as opposed to earlier (1st half 2020: 41.2%, 2nd half 2020: 46.4%, 1st half 2021: 62.0%, 2nd half 2021: 46.5%, interaction p value = 0.0014). Predictors of increased mortality included age, the time of final patient enrolment from 1 January 2020, and the proportion of patients receiving corticosteroids, and reduced duration of ECMO run. Conclusions The mortality rate for patients receiving ECMO for COVID-19-related ARDS has increased as the pandemic has progressed. The reasons for this are likely multifactorial; however, as outcomes for these patients evolve, the decision to initiate ECMO should include the best contextual estimate of mortality at the time of ECMO initiation. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04011-2.
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Affiliation(s)
- Ryan Ruiyang Ling
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Kollengode Ramanathan
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore. .,Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, Singapore, 119228.
| | - Jackie Jia Lin Sim
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Suei Nee Wong
- Medical Resource Team, National University of Singapore Libraries, Singapore, Singapore
| | - Ying Chen
- Agency for Science, Technology and Research, Singapore, Singapore
| | - Faizan Amin
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Shannon M Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ryan P Barbaro
- Division of Paediatrics Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Graeme MacLaren
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, Singapore, 119228
| | - Kiran Shekar
- Adult Intensive Care Services, Prince Charles Hospital, Brisbane, QLD, Australia.,Queensland University of Technology, Brisbane, Australia.,University of Queensland, Brisbane and Bond University, Gold Coast, QLD, Australia
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.,Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, USA
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14
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Usman AA, Gutsche JT. Mechanical Circulatory Support for the Right Ventricle: The Right Ventricle is No Longer Forgotten. J Cardiothorac Vasc Anesth 2022; 36:3202-3204. [PMID: 35581052 PMCID: PMC9027528 DOI: 10.1053/j.jvca.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022]
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15
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Plack DL, Royer O, Couture EJ, Nabzdyk CG. Sepsis Induced Cardiomyopathy Reviewed: The Case for Early Consideration of Mechanical Support. J Cardiothorac Vasc Anesth 2022; 36:3916-3926. [DOI: 10.1053/j.jvca.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/31/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023]
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16
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Lazzeri C, Bonizzoli M, Peris A. The Clinical Role of Right Ventricle Changes in COVID-19 Respiratory Failure Depends on Disease Severity. J Cardiothorac Vasc Anesth 2021; 36:922-923. [PMID: 34937675 PMCID: PMC8685304 DOI: 10.1053/j.jvca.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department, Florence, Italy.
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department, Florence, Italy
| | - Adirano Peris
- Intensive Care Unit and Regional ECMO Referral Centre Emergency Department, Florence, Italy
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17
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Kopanczyk R, Kumar N, Iyer MH, Bhatt AM. Right Ventricular Dysfunction in COVID-19 ECMO-A Red Herring or the Real Deal? J Cardiothorac Vasc Anesth 2021; 36:921-922. [PMID: 34674931 PMCID: PMC8467505 DOI: 10.1053/j.jvca.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Rafal Kopanczyk
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicolas Kumar
- The Ohio State University College of Medicine, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amar M Bhatt
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
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