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Faccioli E, Terzi S, Pangoni A, Lomangino I, Rossi S, Lloret A, Cannone G, Marino C, Catelli C, Dell'Amore A. Extracorporeal membrane oxygenation in lung transplantation: Indications, techniques and results. World J Transplant 2021; 11:290-302. [PMID: 34316453 PMCID: PMC8290996 DOI: 10.5500/wjt.v11.i7.290] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/13/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
The use of extracorporeal membrane oxygenation (ECMO) in the field of lung transplantation has rapidly expanded over the past 30 years. It has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative setting. ECMO is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the recipient. For example, patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous (VV) ECMO or peripheral veno-arterial (VA) ECMO in the case of hemodynamic instability. Moreover, in an intra-operative setting, VV ECMO can be maintained or switched to a VA ECMO. The routine use of intra-operative ECMO and its eventual prolongation in the post-operative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion injury. This review will assess the current evidence on the role of ECMO in the different phases of lung transplantation, while analyzing different studies on pre, intra- and post-operative utilization of this extracorporeal support.
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Affiliation(s)
- Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Stefano Terzi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Alessandro Pangoni
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Ivan Lomangino
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Sara Rossi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Andrea Lloret
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Giorgio Cannone
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Carlotta Marino
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Chiara Catelli
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
| | - Andrea Dell'Amore
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova 35128, Italy
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Zayton TM, El-Reweny EM, Tammam HM, Gharbeya KM. Predicting successful weaning in patients treated with venovenous extracorporeal membrane oxygenation. ALEXANDRIA JOURNAL OF MEDICINE 2020. [DOI: 10.1080/20905068.2020.1728881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Tayseer M. Zayton
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ehab M. El-Reweny
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Haitham M. Tammam
- Department of Critical Care Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kareem M. Gharbeya
- Department of Critical Care Medicine, Alexandria Armed Forces Hospital, Alexandria, Egypt
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Zamper RPC, Bainbridge D, Nagpal D, Fujii S. [Management of a bi-caval dual lumen cannula clot obstruction after TEE guided diagnosis: a case-report]. Rev Bras Anestesiol 2020; 70:55-58. [PMID: 32173066 DOI: 10.1016/j.bjan.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/21/2019] [Accepted: 12/01/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Veno-venous extracorporeal membrane oxygenation is an established therapy for patients with refractory acute respiratory distress syndrome (ARDS). One complication related to the use of veno-venous extracorporeal membrane oxygenation is thrombosis despite proper anticoagulation. We report the diagnosis and management of a clot-obstruction in a single site cannula placed through the internal jugular vein, guided by transesophageal echocardiography. CASE REPORT A 39 year-old male developed acute respiratory distress syndrome and hemodynamic instability after an episode of pulmonary aspiration in the ICU. Eight hours after placement of a single site veno-venous extracorporeal membrane oxygenation, suddenly the perfusionist noticed a reduction in flow. TEE showed a thrombus-like mass obstructing the inflow port in SVC and inflow at IVC was intact. After unsuccessful attempts to reposition the cannula, the team decided to insert additional femoral inflow cannula through the IVC. The single site catheter was then pulled out until its tip was positioned in the right atrium and all three ports of the catheter were switched to the infusion ports. After this, flows and oxygenation improved significantly. Unfortunately, despite all of the efforts, the patient died 2 days later. DISCUSSION The diagnosis of veno-venous extracorporeal membrane oxygenation cannula obstruction is based on reduced inflow rates, hemodynamic instability and poor oxygenation of blood. TEE allows evaluation of the flows inside the cannula and in this case, an obstruction was found. The management presented points to the fact that in a situation of catheter obstruction caused by a clot, there is a feasible alternative to assure minimal interruption of the hemodynamic support offered by the veno-venous extracorporeal membrane oxygenation.
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Affiliation(s)
- Raffael Pereira Cezar Zamper
- Western University, University Hospital - London Health Sciences Centre, Department of Anesthesiology and Perioperative Medicine, London, Ontario, Canada.
| | - Daniel Bainbridge
- Western University, University Hospital - London Health Sciences Centre, Department of Anesthesiology and Perioperative Medicine, London, Ontario, Canada
| | - Dave Nagpal
- University of Western Ontario, Critical Care and Cardiac Surgery, Department of Surgery, London, Ontario, Canada
| | - Satoru Fujii
- University Hospital - London Health Sciences Centre, Western University, Department of Anesthesiology and Perioperative Medicine, London, Ontario, Canada
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Abstract
Extracorporeal life support in lung transplantation has been associated with poor posttransplant outcomes. However, recent advances have resulted in more favorable posttransplant outcomes. The increased use of this technology must be weighed against the risks inherent in its use, especially when complications arising in extracorporeal membrane oxygenation (ECMO)-dependent patients result in loss of transplant candidacy, leaving them with no viable alternative for long-term support. Existing and emerging data support the judicious use of this technology in carefully selected patients at high-volume transplant and ECMO centers that prioritize minimization of sedation, avoidance of endotracheal intubation, and early mobilization.
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Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, PH 8E, Room 101, New York, NY 10032, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, PH 8E, Room 101, New York, NY 10032, USA
| | - Selim M Arcasoy
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, PH 14E, Room 104, New York, NY 10032, USA.
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Paolone S. Extracorporeal Membrane Oxygenation (ECMO) for Lung Injury in Severe Acute Respiratory Distress Syndrome (ARDS): Review of the Literature. Clin Nurs Res 2016; 26:747-762. [PMID: 27836935 DOI: 10.1177/1054773816677808] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite advances in mechanical ventilation, severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality rates ranging from 26% to 58%. Extracorporeal membrane oxygenation (ECMO) is a modified cardiopulmonary bypass circuit that serves as an artificial membrane lung and blood pump to provide gas exchange and systemic perfusion for patients when their own heart and lungs are unable to function adequately. ECMO is a complex network that provides oxygenation and ventilation and allows the lungs to rest and recover from respiratory failure while minimizing iatrogenic ventilator-induced lung injury. In critical care settings, ECMO is proven to improve survival rates and outcomes in patients with severe ARDS. This review defines severe ARDS; describes the ECMO circuit; and discusses recent research, optimal use of the ECMO circuit, limitations of therapy including potential complications, economic impact, and logistical factors; and discusses future research considerations.
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Liu X, Xu Y, Zhang R, Huang Y, He W, Sang L, Chen S, Nong L, Li X, Mao P, Li Y. Survival Predictors for Severe ARDS Patients Treated with Extracorporeal Membrane Oxygenation: A Retrospective Study in China. PLoS One 2016; 11:e0158061. [PMID: 27336170 PMCID: PMC4919028 DOI: 10.1371/journal.pone.0158061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/09/2016] [Indexed: 12/12/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is increasingly being applied as life support for acute respiratory distress syndrome (ARDS) patients. However, the outcomes of this procedure have not yet been characterized in severe ARDS patients. The aim of this study was to evaluate the outcomes of severe ARDS patients supported with ECMO and to identify potential predictors of mortality in these patients. A total of 38 severe ARDS patients (aged 51.39±13.27 years, 32 males) who were treated with ECMO in the specialized medical intensive care unit of Guangzhou Institute of Respiratory Diseases from July 2009 to December 2014 were retrospectively reviewed. The clinical data of the patients on the day before ECMO initiation, on the first day of ECMO treatment and on the day of ECMO removal were collected and analyzed. All patients were treated with veno-venous ECMO after a median mechanical ventilation duration of 6.4±7.6 days. Among the 20 patients (52.6%) who were successfully weaned from ECMO, 16 patients (42.1%) survived to hospital discharge. Of the identified pre-ECMO factors, advanced age, a long duration of ventilation before ECMO, a higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, underlying lung disease, and pulmonary barotrauma prior to ECMO were associated with unsuccessful weaning from ECMO. Furthermore, multiple logistic regression analysis indicated that both barotrauma pre-ECMO and underlying lung disease were independent predictors of hospital mortality. In conclusion, for severe ARDS patients treated with ECMO, barotrauma prior to ECMO and underlying lung disease may be major predictors of ARDS prognosis based on multivariate analysis.
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Affiliation(s)
- Xiaoqing Liu
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yonghao Xu
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Rong Zhang
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yongbo Huang
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Weiqun He
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Ling Sang
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Sibei Chen
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Lingbo Nong
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Xi Li
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Pu Mao
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yimin Li
- The State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
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Abrams D, Baldwin MR, Champion M, Agerstrand C, Eisenberger A, Bacchetta M, Brodie D. Thrombocytopenia and extracorporeal membrane oxygenation in adults with acute respiratory failure: a cohort study. Intensive Care Med 2016; 42:844-852. [PMID: 27007099 DOI: 10.1007/s00134-016-4312-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/07/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE The association between extracorporeal membrane oxygenation (ECMO) use and the development of thrombocytopenia is widely presumed yet weakly demonstrated. We hypothesized that longer duration of ECMO support would be independently associated with worsened thrombocytopenia. METHODS We performed a single-center retrospective cohort study of 100 adults who received ECMO for acute respiratory failure. We used generalized estimating equations to test the association between days on ECMO and daily percentage of platelets compared to the first post-cannulation platelet count. We constructed a multivariable logistic regression model with backwards stepwise elimination to identify clinical predictors of severe thrombocytopenia (≤50,000/μL) while on ECMO. RESULTS Days on ECMO was not associated with a decrease in platelet count in the unadjusted analysis (β -0.85, 95 % CI -2.05 to 0.36), nor after considering and controlling for days hospitalized prior to ECMO, APACHE II score, platelet transfusions, and potential thrombocytopenia-inducing medications (β -0.83, 95 % CI -1.9 to 0.25). Twenty-two subjects (22 %) developed severe thrombocytopenia. The APACHE II score and platelet count at the time of cannulation predicted the development of severe thrombocytopenia. The odds of developing severe thrombocytopenia increased 35 % for every 5-point increase in APACHE II score (OR 1.35, 95 % CI 0.94-1.94) and increased 35 % for every 25,000/μL platelets below a mean at cannulation of 188,000/μL (OR 1.35, 95 % CI 1.10-1.64). CONCLUSIONS Duration of ECMO is not associated with the development of thrombocytopenia. The severity of critical illness and platelet count at the time of cannulation predict the development of severe thrombocytopenia while receiving ECMO for respiratory failure. Future studies should validate these findings, especially in cohorts with more venoarterial ECMO patients, and should characterize the association between thrombocytopenia and bleeding events while on ECMO.
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Affiliation(s)
- Darryl Abrams
- Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Matthew R Baldwin
- Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Matthew Champion
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Cara Agerstrand
- Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Andrew Eisenberger
- Division of Hematology and Oncology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Matthew Bacchetta
- Division of Thoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Daniel Brodie
- Division of Pulmonary and Critical Care, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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Kessler A, Coker B, Townsley M, Zaky A. Extracorporeal Membrane Oxygenator Rotational Cannula Catastrophe: A Role of Echocardiography in Rescue. J Cardiothorac Vasc Anesth 2015; 30:720-4. [PMID: 26472179 DOI: 10.1053/j.jvca.2015.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Adam Kessler
- Department of Emergency Medicine, Department of Anesthesiology, Division of Critical Care and Perioperative Medicine, University of Alabama School of Medicine, Birmingham, AL.
| | - Bradley Coker
- Department of Emergency Medicine, Department of Anesthesiology, Division of Critical Care and Perioperative Medicine, University of Alabama School of Medicine, Birmingham, AL
| | - Matthew Townsley
- Department of Emergency Medicine, Department of Anesthesiology, Division of Critical Care and Perioperative Medicine, University of Alabama School of Medicine, Birmingham, AL
| | - Ahmed Zaky
- Department of Emergency Medicine, Department of Anesthesiology, Division of Critical Care and Perioperative Medicine, University of Alabama School of Medicine, Birmingham, AL
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Abrams D, Roncon-Albuquerque R, Brodie D. What's new in extracorporeal carbon dioxide removal for COPD? Intensive Care Med 2015; 41:906-8. [PMID: 25643904 DOI: 10.1007/s00134-015-3677-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, 622 W. 168th St, PH 8E 101, New York, NY, 10032, USA,
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Le Guen M, Parquin F. [The place of extra-corporeal oxygenation in pulmonary diseases]. Rev Mal Respir 2015; 32:358-69. [PMID: 25957015 PMCID: PMC7125747 DOI: 10.1016/j.rmr.2014.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 08/25/2014] [Indexed: 01/22/2023]
Abstract
Extra-corporeal membrane oxygenation (ECMO) effectively replaces the lung in providing oxygenation and carbon dioxide (CO2) removal. For some years, and in parallel to the H1N1 influenza pandemic, this technique has gained interest in relation to significant technological improvements, leading to new concepts of "awake and mobile ECMO" or rehabilitation with ECMO. Finally, the publication of randomized controlled trials giving encouraging results in the adult respiratory distress syndrome (ARDS) has helped to validate this technique and further studies are warranted. This general review aims to outline the definition, classification and principles of ECMO and to give some current information about the indications and possibilities of the technique to the pulmonologist and intensivist. Further possible uses for this technique include extra-corporeal removal of CO2 during hypercapnic respiratory failure and assistance during lung transplantation from the preoperative to the early postoperative period.
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Affiliation(s)
- M Le Guen
- Service anesthésie, département d'anesthésie-réanimation, hôpital Foch, université de Versailles Saint-Quentin-en-Yvelines, 40, rue Worth, 92151 Suresnes, France.
| | - F Parquin
- Unité de soins intensifs respiratoires, hôpital Foch, université de Versailles Saint-Quentin-en-Yvelines, Suresnes, France
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Tramm R, Ilic D, Davies AR, Pellegrino VA, Romero L, Hodgson C. Extracorporeal membrane oxygenation for critically ill adults. Cochrane Database Syst Rev 2015; 1:CD010381. [PMID: 25608845 PMCID: PMC6353247 DOI: 10.1002/14651858.cd010381.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is a form of life support that targets the heart and lungs. Extracorporeal membrane oxygenation for severe respiratory failure accesses and returns blood from the venous system and provides non-pulmonary gas exchange. Extracorporeal membrane oxygenation for severe cardiac failure or for refractory cardiac arrest (extracorporeal cardiopulmonary resuscitation (ECPR)) provides gas exchange and systemic circulation. The configuration of ECMO is variable, and several pump-driven and pump-free systems are in use. Use of ECMO is associated with several risks. Patient-related adverse events include haemorrhage or extremity ischaemia; circuit-related adverse effects may include pump failure, oxygenator failure and thrombus formation. Use of ECMO in newborns and infants is well established, yet its clinical effectiveness in adults remains uncertain. OBJECTIVES The primary objective of this systematic review was to determine whether use of veno-venous (VV) or venous-arterial (VA) ECMO in adults is more effective in improving survival compared with conventional respiratory and cardiac support. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and EMBASE (Ovid) on 18 August 2014. We searched conference proceedings, meeting abstracts, reference lists of retrieved articles and databases of ongoing trials and contacted experts in the field. We imposed no restrictions on language or location of publications. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs and cluster-RCTs that compared adult ECMO versus conventional support. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of all retrieved citations against the inclusion criteria. We independently reviewed full-text copies of studies that met the inclusion criteria. We entered all data extracted from the included studies into Review Manager. Two review authors independently performed risk of bias assessment. All included studies were appraised with respect to random sequence generation, concealment of allocation, blinding of outcome assessment, incomplete outcome data, selective reporting and other bias. MAIN RESULTS We included four RCTs that randomly assigned 389 participants with acute respiratory failure. Risk of bias was low in three RCTs and high in one RCT. We found no statistically significant differences in all-cause mortality at six months (two RCTs) or before six months (during 30 days of randomization in one trial and during hospital stay in another RCT). The quality of the evidence was low to moderate, and further research is very likely to impact our confidence in the estimate of effects because significant changes have been noted in ECMO applications and treatment modalities over study periods to the present.Two RCTs supplied data on disability. In one RCT survival was low in both groups but none of the survivors had limitations in their daily activities six months after discharge. The other RCT reported improved survival without severe disability in the intervention group (transfer to an ECMO centre ± ECMO) six months after study randomization but no statistically significant differences in health-related quality of life.In three RCTs, participants in the ECMO group received greater numbers of blood transfusions. One RCT recorded significantly more non-brain haemorrhage in the ECMO group. Another RCT reported two serious adverse events in the ECMO group, and another reported three adverse events in the ECMO group.Clinical heterogeneity between studies prevented meta-analyses across outcomes. We found no completed RCT that had investigated ECMO in the context of cardiac failure or arrest. We found one ongoing RCT that examined patients with acute respiratory failure and two ongoing RCTs that included patients with acute cardiac failure (arrest). AUTHORS' CONCLUSIONS Extracorporeal membrane oxygenation remains a rescue therapy. Since the year 2000, patient treatment and practice with ECMO have considerably changed as the result of research findings and technological advancements over time. Over the past four decades, only four RCTs have been published that compared the intervention versus conventional treatment at the time of the study. Clinical heterogeneity across these published studies prevented pooling of data for a meta-analysis.We recommend combining results of ongoing RCTs with results of trials conducted after the year 2000 if no significant shifts in technology or treatment occur. Until these new results become available, data on use of ECMO in patients with acute respiratory failure remain inconclusive. For patients with acute cardiac failure or arrest, outcomes of ongoing RCTs will assist clinicians in determining what role ECMO and ECPR can play in patient care.
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Affiliation(s)
- Ralph Tramm
- Monash UniversityAustralian and New Zealand Intensive Care Research Centre (ANZIC‐RC), Department of Epidemiology and Preventive MedicineLevel 6 The Alfred Centre, 99 Commercial RoadMelbourneVictoriaAustralia3004
| | - Dragan Ilic
- Monash UniversityDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine553 St Kilda RoadMelbourneVictoriaAustralia3004
| | - Andrew R Davies
- Monash UniversityAustralian and New Zealand Intensive Care Research Centre (ANZIC‐RC), Department of Epidemiology and Preventive MedicineLevel 6 The Alfred Centre, 99 Commercial RoadMelbourneVictoriaAustralia3004
| | - Vincent A Pellegrino
- The Alfred HospitalDepartment of Intensive CareCommercial RoadMelbourneAustralia3181
| | - Lorena Romero
- The Alfred HospitalThe Ian Potter Library55 Commercial RoadMelbourneVictoriaAustralia3000
| | - Carol Hodgson
- Monash UniversityAustralian and New Zealand Intensive Care Research Centre (ANZIC‐RC), Department of Epidemiology and Preventive MedicineLevel 6 The Alfred Centre, 99 Commercial RoadMelbourneVictoriaAustralia3004
- The Alfred HospitalDepartment of PhysiotherapyMelbourneAustralia
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Abrams D, Brodie D. Extracorporeal circulatory approaches to treat acute respiratory distress syndrome. Clin Chest Med 2014; 35:765-79. [PMID: 25453424 DOI: 10.1016/j.ccm.2014.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The early history of extracorporeal membrane oxygenation (ECMO) for adult patients with the acute respiratory distress syndrome (ARDS) evolved slowly over decades, a consequence of extracorporeal technology with high risk and unclear benefit. However, advances in component technology, accumulating evidence, and growing experience in recent years have resulted in a resurgence of interest in ECMO. Extracorporeal support, though currently lacking high-level evidence, has the potential to improve outcomes, including survival, in ARDS. In the near future, novel extracorporeal management strategies may, in fact, lead to a new paradigm in the approach to certain patients with ARDS.
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Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, PH 8E 101, New York, NY 10032, USA
| | - Daniel Brodie
- Division of Pulmonary, Allergy and Critical Care, Columbia University College of Physicians and Surgeons, PH 8E 101, New York, NY 10032, USA.
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Pruijsten R, van Thiel R, Hool S, Saeijs M, Verbiest M, Miranda DR. Mobilization of patients on venovenous extracorporeal membrane oxygenation support using an ECMO helmet. Intensive Care Med 2014; 40:1595-7. [DOI: 10.1007/s00134-014-3410-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/29/2022]
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Platts DG, Diab S, Dunster KR, Shekar K, Burstow DJ, Sim B, Tunbridge M, McDonald C, Chemonges S, Chan J, Fraser JF. Feasibility of perflutren microsphere contrast transthoracic echocardiography in the visualization of ventricular endocardium during venovenous extracorporeal membrane oxygenation in a validated ovine model. Echocardiography 2014; 32:548-56. [PMID: 25059883 DOI: 10.1111/echo.12695] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Transthoracic echocardiography (TTE) during extra corporeal membrane oxygenation (ECMO) is important but can be technically challenging. Contrast-specific TTE can improve imaging in suboptimal studies. These contrast microspheres are hydrodynamically labile structures. This study assessed the feasibility of contrast echocardiography (CE) during venovenous (VV) ECMO in a validated ovine model. METHOD Twenty-four sheep were commenced on VV ECMO. Parasternal long-axis (Plax) and short-axis (Psax) views were obtained pre- and postcontrast while on VV ECMO. Endocardial definition scores (EDS) per segment were graded: 1 = good, 2 = suboptimal 3 = not seen. Endocardial border definition score index (EBDSI) was calculated for each view. Endocardial length (EL) in the Plax view for the left ventricle (LV) and right ventricle (RV) was measured. RESULTS Summation EDS data for the LV and RV for unenhanced TTE (UE) versus CE TTE imaging: EDS 1 = 289 versus 346, EDS 2 = 38 versus 10, EDS 3 = 33 versus 4, respectively. Wilcoxon matched-pairs rank-sign tests showed a significant ranking difference (improvement) pre- and postcontrast for the LV (P < 0.0001), RV (P < 0.0001) and combined ventricular data (P < 0.0001). EBDSI for CE TTE was significantly lower than UE TTE for the LV (1.05 ± 0.17 vs. 1.22 ± 0.38, P = 0.0004) and RV (1.06 ± 0.22 vs. 1.42 ± 0.47, P = 0.0.0006) respectively. Visualized EL was significantly longer in CE versus UE for both the LV (58.6 ± 11.0 mm vs. 47.4 ± 11.7 mm, P < 0.0001) and the RV (52.3 ± 8.6 mm vs. 36.0 ± 13.1 mm, P < 0.0001), respectively. CONCLUSIONS Despite exposure to destructive hydrodynamic forces, CE is a feasible technique in an ovine ECMO model. CE results in significantly improved EDS and increased EL.
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Affiliation(s)
- David G Platts
- Department of Echocardiography, The Prince Charles Hospital, Brisbane, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia; The University of Queensland, Brisbane, Australia
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Abrams D, Combes A, Brodie D. Extracorporeal Membrane Oxygenation in Cardiopulmonary Disease in Adults. J Am Coll Cardiol 2014; 63:2769-78. [DOI: 10.1016/j.jacc.2014.03.046] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 02/25/2014] [Accepted: 03/04/2014] [Indexed: 12/17/2022]
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. [Extracorporeal life support for patients with acute respiratory distress syndrome (adult and paediatric). Consensus conference organized by the French Intensive Care Society]. Rev Mal Respir 2014; 31:779-95. [PMID: 25391514 DOI: 10.1016/j.rmr.2014.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/24/2014] [Indexed: 01/19/2023]
Affiliation(s)
- C Richard
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - L Argaud
- Service de réanimation médicale, groupement hospitalier Édouard-Herriot, hospices civils de Lyon, 69437 Lyon, France
| | - A Blet
- Département d'anesthésie-réanimation, centre de traitement des brulés, hôpitaux universitaires Saint-Louis, Lariboisière, Fernand-Widal, hôpital Saint Louis, AP-HP, 75010 Paris, France
| | - T Boulain
- Service de réanimation polyvalente, hôpital de La Source, centre hospitalier régional Orléans, 45067 Orléans, France
| | - L Contentin
- Service de réanimation polyvalente, hôpital Bretonneau, CHRU de Tours, 37000 Tours, France
| | - A Dechartres
- Inserm U1153, équipe « méthodes en évaluation thérapeutique des maladies chroniques », centre de recherche épidémiologie et biostatistique, centre Cochrane français, Hôtel-Dieu, 75004 Paris, France
| | - J-M Dejode
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - L Donetti
- Service de réanimation, centre hospitalier Le Raincy-Montfermeil, 93370 Montfermeil, France
| | - M Fartoukh
- Unité de réanimation médicochirurgicale, hôpitaux universitaire Est Parisien, hôpital Tenon, AP-HP, 75020 Paris, France
| | - D Fletcher
- Département d'anesthésie, hôpitaux universitaires Paris Île-de-France Ouest, hôpital Raymond-Poincaré, AP-HP, 92380 Garches, France
| | - K Kuteifan
- Service de réanimation médicale, hôpital Émile-Muller, 68070 Mulhouse, France
| | - S Lasocki
- Pôle d'anesthésie réanimation, LUNAM université, université d'Angers, CHU d'Angers, 49000 Angers, France
| | - J-M Liet
- Réanimation pédiatrique, hôpital Mère-Enfant, CHU de Nantes, 40000 Nantes, France
| | - A-C Lukaszewicz
- Département d'anesthésie réanimation - réanimation chirurgicale et postopératoire, groupe hospitalier Saint-Louis-Lariboisière-Fernand-Widal, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - H Mal
- Service de pneumologie, hôpitaux universitaires Paris Nord Val-de-Seine, hôpital Bichat, AP-HP, 75018 Paris, France
| | - E Maury
- Service de réanimation médicale, hôpitaux universitaire Est Parisien, hôpital Saint-Antoine, AP-HP, 75020 Paris, France
| | - D Osman
- Service de réanimation médicale, EA 4533, université Paris-Sud, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Outin
- Service de réanimation médicochirurgicale, centre hospitalier intercommunal de Poissy-Saint-Germain-en-Laye, 78300 Poissy, France
| | - J-C Richard
- Service de réanimation médicale, hospices civils de Lyon, hôpital de la Croix-Rousse, 69004 Lyon, France
| | - F Schneider
- Service de réanimation médicale, faculté de médecine, université de Strasbourg, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, Hautepierre, France
| | - F Tamion
- Inserm U1096, IRIB, service de réanimation médicale, université de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
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Extracorporeal life support for patients with acute respiratory distress syndrome: report of a Consensus Conference. Ann Intensive Care 2014; 4:15. [PMID: 24936342 PMCID: PMC4046033 DOI: 10.1186/2110-5820-4-15] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/28/2014] [Indexed: 12/15/2022] Open
Abstract
The influenza H1N1 epidemics in 2009 led a substantial number of people to develop severe acute respiratory distress syndrome and refractory hypoxemia. In these patients, extracorporeal membrane oxygenation was used as rescue oxygenation therapy. Several randomized clinical trials and observational studies suggested that extracorporeal membrane oxygenation associated with protective mechanical ventilation could improve outcome, but its efficacy remains uncertain. Organized by the Société de Réanimation de Langue Française (SRLF) in conjunction with the Société Française d’Anesthésie et de Réanimation (SFAR), the Société de Pneumologie de Langue Française (SPLF), the Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP), the Société Française de Perfusion (SOFRAPERF), the Société Française de Chirurgie Thoracique et Cardiovasculaire (SFCTV) et the Sociedad Española de Medecina Intensiva Critica y Unidades Coronarias (SEMICYUC), a Consensus Conference was held in December 2013 and a jury of 13 members wrote 65 recommendations to answer the five following questions regarding the place of extracorporeal life support for patients with acute respiratory distress syndrome: 1) What are the available techniques?; 2) Which patients could benefit from extracorporeal life support?; 3) How to perform extracorporeal life support?; 4) How and when to stop extracorporeal life support?; 5) Which organization should be recommended? To write the recommendations, evidence-based medicine (GRADE method), expert panel opinions, and shared decisions taken by all the thirteen members of the jury of the Consensus Conference were taken into account.
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Roncon-Albuquerque R, Almeida V, Lopes M, Castro L, Pedrosa A, Paiva JA. Cost analysis of miniaturized ECMO in H1N1-related ARDS managed by a single caregiver. Intensive Care Med 2014; 40:910-1. [PMID: 24756380 DOI: 10.1007/s00134-014-3286-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Roberto Roncon-Albuquerque
- Department of Emergency and Intensive Care Medicine, Centro Hospitalar S. João, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal,
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Richard C, Argaud L, Blet A, Boulain T, Contentin L, Dechartres A, Dejode JM, Donetti L, Fartoukh M, Fletcher D, Kuteifan K, Lasocki S, Liet JM, Lukaszewicz AC, Mal H, Maury E, Osman D, Outin H, Richard JC, Schneider F, Tamion F. Assistance extracorporelle au cours du syndrome de détresse respiratoire aiguë (chez l’adulte et l’enfant, à l’exclusion du nouveau-né). Conférence de consensus organisée par la Société de réanimation de langue française. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s13546-014-0858-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abrams D, Combes A, Brodie D. What's new in extracorporeal membrane oxygenation for cardiac failure and cardiac arrest in adults? Intensive Care Med 2014; 40:609-12. [PMID: 24474528 DOI: 10.1007/s00134-014-3212-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 01/06/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Darryl Abrams
- Division of Pulmonary, Allergy, and Critical Care, Columbia University College of Physicians and Surgeons, 622 W. 168th St, PH 8E 101, New York, NY, 10032, USA,
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Year in review in Intensive Care Medicine 2013: II. Sedation, invasive and noninvasive ventilation, airways, ARDS, ECMO, family satisfaction, end-of-life care, organ donation, informed consent, safety, hematological issues in critically ill patients. Intensive Care Med 2014; 40:305-19. [PMID: 24458282 DOI: 10.1007/s00134-014-3217-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 01/02/2023]
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