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1
DONN, STEVEN M. "Neonatal Extracorporeal Membrane Oxygenation." Pediatrics 82, no. 2 (August 1, 1988): 276–77. http://dx.doi.org/10.1542/peds.82.2.276.
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The number of centers providing extracorporeal membrane oxygenation (ECMO) therapy to newborns with intractable respiratory failure has grown dramatically. The ECMO registry now includes 37 institutions in the United States,1 and there may be additional centers offering ECMO but not participating in the registry. To date, more than 1,400 patients have been treated with ECMO with a survival rate exceeding 80%. Widespread acceptance of ECMO therapy has been accomplished despite a paucity of controlled clinical trials2 and without the benefit of long-term follow-up of survivors. Initial fervor about neonatal ECMO has stemmed from the excellent survival statistics cited by most of the earlier investigators.2-4
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Thiara, AS. "Influence of Extracorporeal Membrane Oxygenation Circuit on Nutritional Supplements." Journal of Clinical Research and Reports 3, no. 5 (March 24, 2020): 01–09. http://dx.doi.org/10.31579/2690-1919/057.
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Background The main function of extracorporeal membrane oxygenation (ECMO) is to provide systemic perfusion and gas exchange for patients with severe, acute respiratory or cardiac illness. The ECMO system consists of blood pump and a membrane oxygenator. ECMO oxygenator fibers, blood pump and tubing may bind circulating compounds such as drugs and nutritional components during ECMO support. Any loss of vital nutrients due to adsorption to the ECMO circuits may lead to further nutritional debilitation in critical ill patients. Objective The purpose of study is to analyze the amount of nutritional supplements adsorbed to the ECMO circuit under controlled ex vivo conditions Methods Six identical ECMO circuits were primed with fresh human whole blood and maintained under physiological conditions at 36°C for 24 hours. A dose of nutritional supplement calculated for a 70 kg patient was added. 150 mL volume was drawn from priming bag for control samples and kept under similar conditions. Blood samples were obtained at predetermined time points and analyzed for concentrations of vitamins, minerals, lipids, and proteins. Statistical analyses were performed using mixed models with robust standard errors, which allows for repeated samples within each setup and incomplete data. Results No significant differences were found between the ECMO circuits and controls for any of the measured variables: cobalamin, folate, vitamin A, glucose, concentration of minerals, HDL cholesterol, LDL cholesterol, total cholesterol, triglycerides, and total proteins. There was an initial decrease and then and increase in the concentration of cobalamin and folate. Vitamin A concentrations decreased in both groups over time. There was a decrease in concentration of glucose and an increased concentration of lactate dehydrogenase over time in both groups. Conclusion There were no changes in the concentrations of nutritional supplements in an ex vivo ECMO circuit compared to control samples, indicating that parenteral nutrition can be given during ECMO support. However, the time span of this study was limited, and the design made it impossible to investigate any functional and structural changes over time in nutritional supplements which lead to diminished effects through the ECMO circuit.
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Richards, Guy A., and I. Joubert. "Extracorporeal membrane oxygenation (ECMO)." Southern African Journal of Critical Care 29, no. 1 (June 18, 2013): 7. http://dx.doi.org/10.7196/sajcc.161.
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Gupta, Sandip, Arpan Chakraborty, Kunal Sarkar, Dipanjan Chatterjee, and Pranay Oza. "Primary transport on extracorporeal membrane oxygenation: Two Indian center experience." Edorium Journal of Anesthesia 7, no. 1 (August 11, 2021): 1–8. http://dx.doi.org/10.5348/100021a05sg2021ra.
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Aims: Extracorporeal membrane oxygenation (ECMO) can be a lifesaving modality for patients with severe reversible pulmonary and/or cardiac failure, but its use remains restricted to a few highly equipped referral centers. Conventional transports to an ECMO center can be hazardous. Transport teams are usually trained to transfer stable patients across hospitals. As ECMO patients are extremely sick, specially trained critical care teams to deal with all possible complications in these critically ill patients will be required. Therefore, many ECMO centers have developed transport programs with the mobile ECMO team. In this study, we aim to present a brief account of the two-center experience of ECMO transport from India. Methods: Retrospective observational study is depicting the data of two mobile ECMO teams over 4 years, where 21 patients (16–74 years) were evaluated. Analysis was done for the transport arrangements, different characteristics of ECMO retrieval patients, their outcomes, and predictors of mortality of a total of 21 patients from two different referral centers of India. As it is a retrospective observational study, hence institutional ethical committee approval was waived off. Results: The mean distance of travel was 87.24±104.5 km (range 2–250 km) and transportation was by road in all cases. About 38% (n=8/21), patients had suffered from complications during transport like hypotension, cardiac arrest. There were no deaths in connection with transportation. The overall mortality rate was 33.3% with no difference over gender, age, duration of pre-ECMO ventilation, or duration of transport. The most common indication associated with ECMO transport was H1N1 infection. Conclusion: We found that patient transfer if done with proper protocols by a prepared team with full knowledge of problem areas to a referral institution while on ECMO support seems to be safe and adds no significant risk of mortality to ECMO patients.
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Prine, Kelli Beckvermit, Kimberly Goracke, and Lori Baas Rubarth. "Extracorporeal Membrane Oxygenation in the NICU." Neonatal Network 34, no. 3 (2015): 183–88. http://dx.doi.org/10.1891/0730-0832.34.3.183.
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ABSTRACTExtracorporeal membrane oxygenation (ECMO) was developed for adults but has been used in neonates as a life-saving rescue therapy for infants with respiratory failure and/or cardiac collapse as a result of congenital diaphragmatic hernia, meconium aspiration syndrome, persistent pulmonary hypertension, or systemic sepsis. ECMO has been proven to increase the survival rate for these diseases. This article provides an overview of neonatal ECMO: the history and development of neonatal ECMO, patient selection criteria, clinical management, the ECMO circuit, weaning from ECMO, and possible complications of ECMO.
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Lister, George. "Extracorporeal Membrane Oxygenation." International Journal of Technology Assessment in Health Care 7, S1 (January 1991): 52–55. http://dx.doi.org/10.1017/s0266462300012502.
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Extracorporeal membrane oxygenation (ECMO) is a means of diverting a fraction or all of the circulation through a device that permits gas exchange across a permeable membrane. The site of removal and the site of return of blood are dictated primarily by practical considerations based on the volume of flow of blood to be diverted and whether a particular organ is to be bypassed. The prototype of extracorporeal oxygenation is heart-lung bypass, used for various types of cardiac surgery, in which the entire venous return is diverted through an oxygenator (bubble or membrane type) and returned to the aorta. Since the earliest reports of the use of ECMO in neonates, venoarterial bypass has been the preferred route, with blood drained from the right atrium and returned either to the carotid artery or to the femoral artery, although the former seems to have been used most often (2;4;11;12;14;18). In some reports, veno-venous bypass has also been accomplished with removal of blood from the right atrium and return into the umbilical or femoral vein (13;19). Gas exchange across the lung may also continue, although the ventilator rate, tidal volume, or peak inspiratory pressure are usually reduced markedly during the period of extracorporeal oxygenation. Anticoagulation is accomplished with few problems by infusion of heparin sulfate throughout the duration of the procedure. There now have been enough reports in the literature (individual cases or series of patients) to demonstrate that the procedure can be carried out with a minimum of technical difficulties in newborn infants (2;3;4;11;12;18), although the selection of “appropriate” patients reduces the morbidity and technical challenges of the procedure.
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Butt, Warwick, and Graeme MacLaren. "Extracorporeal membrane oxygenation 2016: an update." F1000Research 5 (April 26, 2016): 750. http://dx.doi.org/10.12688/f1000research.8320.1.
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The use of extracorporeal membrane oxygenation (ECMO) is an important issue for intensivists, critical care nurses, surgeons, cardiologists, and many others. There has been a continued increase in the number of centres performing ECMO. This review examines novel applications and recent trends in the use of ECMO over the last 2 years. These include ECMO to facilitate the safe use of other treatments, changing the timing of initiation, newer equipment and better biocompatibility, and the ability of ECMO programs to essentially choose which cluster of potential complications they are prepared to accept. ECMO continues to evolve, diversify in its applications, and improve in safety.
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Yu, Xindi, Yinyu Yang, Wei Zhang, Zheng Guo, Jia Shen, Zhuoming Xu, Haibo Zhang, and Wei Wang. "Postcardiotomy Extracorporeal Membrane Oxygenation in Neonates." Thoracic and Cardiovascular Surgeon 69, S 03 (July 29, 2021): e41-e47. http://dx.doi.org/10.1055/s-0041-1730034.
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Abstract Background Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates. Materials and Methods Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. Results Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500 g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24 hours (p = 0.008 and 0.001, respectively), longer time to lactate normalization (p = 0.001), lactate > 10 mmol/L before ECMO (p = 0.01), lower weight (p = 0.01), longer ECMO duration (p = 0.005), lower platelet count (p = 0.001), more surgical site bleeding (p = 0.001), and surgical residual malformation (p = 0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24 hours (p = 0.003), longer ECMO duration (p = 0.015), and surgical site bleeding (p = 0.025) were independent risk factors. Conclusion ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.
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Mehta, Chitra, and Yatin Mehta. "Nosocomial Infections in Extracorporeal Membrane Oxygenation." Journal of Cardiac Critical Care 7 (January 30, 2023): 12–16. http://dx.doi.org/10.25259/mm_jccc_302.
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Extra corporeal membrane oxygenation (ECMO) has become an important modality in ICU for treating patients with severe hemodynamic and respiratory failure. It helps clinicians gain time for the primary disease to recover with definitive treatment, and aids in cardio pulmonary recovery of the patient. Most of the patients who require ECMO support are quite sick and fragile. Nosocomial infection is second most common complication after hemorrhage in ECMO patients.It affects about two-third of patients receiving ECMO. There is a lack of sufficient knowledge in this particular area. More focused efforts should be made in future to combat nosocomial infection in ECMO patients.
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., Chandni. "A 22 Year Old Female Case Scenario: Veno-venous Extracorporeal Membrane Oxygenation." Indian Journal of Holistic Nursing 12, no. 1 (March 27, 2021): 13–16. http://dx.doi.org/10.24321/2348.2133.202103.
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ECMO (Extracorporeal membrane oxygenation) is one of the epic innovations of medical science to support the life of a human, in various conditions of lung failure, where it is difficult to maintain oxygenation of the body. ECMO was considered a very good option for conventional cardiopulmonary bypass technique and evolved into treatment of severe acute respiratory distress syndrome (ARDS) during the 1970s. Many kinds of research have been done on a similar topic. The initial reports on the utilisation of ECMO in ARDS patients were very exciting, and afterwards, ECMO proved to be certainly advantageous in infants having acute respiratory failure with a survival rate of almost 80%. There were two large randomised controlled trials, done during the period of 1979-1994 in adults with ARDS, that showed the failure of ECMO, with the survival rate range between 10% to 33%in the ECMO groups. Since then, ECMO treatment for ARDS patients has undergone further advancements by combining with lung-protective ventilation strategies and further by applying heparin-coated equipment, membranes, and tubings. Many healthcare facilities have used this advanced ECMO technology and achieved survival rates of more than 50%. However, whether improved ECMO can really challenge the advanced conventional treatment of adult ARDS is still a matter of debate and needs further studies.It was seen that acute respiratory failure requires intensive care. In few cases where ventilator support doesn’t prove effective, only the option of V-V ECMO remains. The present article describes the case of a 22-year-old female patient who was admitted with severe acute respiratory distress syndrome with associated multiple organ failure. The patient was admitted to the emergency of the Fortis Hospital with suspected acute kidney injury of unknown aetiology. After the initial 4 days of diagnostics at the ward, the patient required a further 24 days of hospital treatment and spent 16 days at the Intensive Care Unit. There, she underwent ECMO V-V therapy, lasting 14 days, which resulted initially in the improvement of his arterial blood gas parameters and clinical condition but later on, she developed pneumothorax and her condition worsened day by day gradually becoming critical.
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Villa, Gianluca, Nevin Katz, and Claudio Ronco. "Extracorporeal Membrane Oxygenation and the Kidney." Cardiorenal Medicine 6, no. 1 (October 17, 2015): 50–60. http://dx.doi.org/10.1159/000439444.
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Background: Extracorporeal membrane oxygenation (ECMO) is an effective therapy for patients with reversible cardiac and/or respiratory failure. Acute kidney injury (AKI) often occurs in patients supported with ECMO; it frequently evolves into chronic kidney damage or end-stage renal disease and is associated with a reported 4-fold increase in mortality rate. Although AKI is generally due to the hemodynamic alterations associated with the baseline disease, ECMO itself may contribute to maintaining kidney dysfunction through several mechanisms. Summary: AKI may be related to conditions derived from or associated with extracorporeal therapy, leading to a reduction in renal oxygen delivery and/or to inflammatory damage. In particular, during pathological conditions requiring ECMO, the biological defense mechanisms maintaining central perfusion by a reduction of perfusion to peripheral organs (such as the kidney) have been identified as pretreatment and patient-related risk factors for AKI. Hormonal pathways are also impaired in patients supported with ECMO, leading to failures in mechanisms of renal homeostasis and worsening fluid overload. Finally, inflammatory damage, due to the primary disease, heart and lung crosstalk with the kidney or associated with extracorporeal therapy itself, may further increase the susceptibility to AKI. Renal replacement therapy can be integrated into the main extracorporeal circuit during ECMO to provide for optimal fluid management and removal of inflammatory mediators. Key Messages: AKI is frequently observed in patients supported with ECMO. The pathophysiology of the associated AKI is chiefly related to a reduction in renal oxygen delivery and/or to inflammatory damage. Risk factors for AKI are associated with a patient's underlying disease and ECMO-related conditions.
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Pakaya, Nasrun, Iin Pratiwi Adjami, and Susanty Monoarfa. "Efek Extracorporeal Membrane Oxygenation Terhadap Hemodinamik Pasien Kritis Dengan Acute Respiratory Distress Syndrome di Intensive Care Unit : Literature Review." Ahmar Metastasis Health Journal 1, no. 4 (March 31, 2022): 150–59. http://dx.doi.org/10.53770/amhj.v1i4.95.
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Acute Respiratory Distress Syndrome (ARDS) termasuk penyakit paru ditandai dengan terjadinya hipoksia serta paru-paru yang kaku dan peningkatan permeabilitas pembuluh darah . Salah satu tindakan kolaboratif yang dapat digunakan yaitu Extracorporeal Membrane Oxygenation (ECMO). Tujuan studi literature ini adalah Untuk mensintesis bukti-bukti atau literatur tentang Efek Extracorporeal Membrane Oxygenation (ECMO) Terhadap Hemodinamik Pasien Kritis Dengan Acute Respiratory Distress Syndrome (ARDS). Metode penelitian literature riview ini menggunakan data base PUBMED 8 artikel jurnal, Science direct 3 artikel jurnal, dan research gate 3 artikel jurnal. Hasil penelitian menunjukan ada hubungan Extracorporeal Membrane Oxygenation (ECMO) dengan status pernapasan dan hemodinamik pasien. Penggunaan Extracorporeal Membrane Oxygenation (ECMO) sebagian besar dapat meningkatkan status pernapasan serta status hemodinamik pasien kritis dengan Acute Respiratory Distress Syndrome (ARDS). Sebagian besar artikel jurnal yang dianalisis menunjukkan ECMO dapat meningkatkan status pernapasan dibandingkan dengan status hemodinamik pasien kritis dengan Acute Respiratory Distress Syndrome (ARDS).
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Perry, Tanya, Tyler Brown, Andrew Misfeldt, David Lehenbauer, and David S. Cooper. "Extracorporeal Membrane Oxygenation in Congenital Heart Disease." Children 9, no. 3 (March 9, 2022): 380. http://dx.doi.org/10.3390/children9030380.
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Mechanical circulatory support (MCS) is a key therapy in the management of patients with severe cardiac disease or respiratory failure. There are two major forms of MCS commonly employed in the pediatric population—extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD). These modalities have overlapping but distinct roles in the management of pediatric patients with severe cardiopulmonary compromise. The use of ECMO to provide circulatory support arose from the development of the first membrane oxygenator by George Clowes in 1957, and subsequent incorporation into pediatric cardiopulmonary bypass (CPB) by Dorson and colleagues. The first successful application of ECMO in children with congenital heart disease undergoing cardiac surgery was reported by Baffes et al. in 1970. For the ensuing nearly two decades, ECMO was performed sparingly and only in specialized centers with varying degrees of success. The formation of the Extracorporeal Life Support Organization (ELSO) in 1989 allowed for the collation of ECMO-related data across multiple centers for the first time. This facilitated development of consensus guidelines for the use of ECMO in various populations. Coupled with improving ECMO technology, these advances resulted in significant improvements in ECMO utilization, morbidity, and mortality. This article will review the use of ECMO in children with congenital heart disease.
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Kapoor, Poonam Malhotra, Pranay Oza, Venkat Goyal, Yatin Mehta, and Muralidhar Kanchi. "Extracorporeal Membrane Oxygenation Carbon Dioxide Removal." Journal of Cardiac Critical Care 7 (January 30, 2023): 6–11. http://dx.doi.org/10.25259/mm_jccc_304.
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Protective lung ventilation is the mainstay ventilation strategy for patients on extracorporeal membrane oxygenation (ECMO), as prolonged mechanical ventilation increases morbidity and mortality; the technicalities of ventilation with ECMO have evolved in the last decade. ECMO on the other end of the spectrum is a complete or total extracorporeal support, which supplies complete physiological blood gas exchanges, normally performed by the native lungs and thus is capable of delivering oxygen (O2) and removing CO equal to the metabolic needs of the patient, it requires higher flows, is more complex, and uses bigger cannulas, higher dose of heparin and higher blood volume for priming. This review describes in detail carbon dioxide removal on ECMO.
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Morioka, Tohru. "ECMO (extracorporeal membrane oxygenation) in ICU." Nihon Shuchu Chiryo Igakukai zasshi 23, no. 1 (2016): 3–5. http://dx.doi.org/10.3918/jsicm.23.3.
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Harnisch, Lars-Olav, Sebastian Riech, Marion Mueller, Vanessa Gramueller, Michael Quintel, and Onnen Moerer. "Longtime Neurologic Outcome of Extracorporeal Membrane Oxygenation and Non Extracorporeal Membrane Oxygenation Acute Respiratory Distress Syndrome Survivors." Journal of Clinical Medicine 8, no. 7 (July 12, 2019): 1020. http://dx.doi.org/10.3390/jcm8071020.
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Neurologic complications following acute respiratory distress syndrome (ARDS) are well described, however, information on the neurologic outcome regarding peripheral nervous system complications in critically ill ARDS patients, especially those who received extracorporeal membrane oxygenation (ECMO) are lacking. In this prospective observational study 28 ARDS patients who survived after ECMO or conventional nonECMO treatment were examined for neurological findings. Nine patients had findings related to cranial nerve innervation, which differed between ECMO and nonECMO patients (p = 0.031). ECMO patients had severely increased patella tendon reflex (PTR) reflex levels (p = 0.027 vs. p = 0.125) as well as gastrocnemius tendon reflex (GTR) (p = 0.041 right, p = 0.149 left) were affected on the right, but not on the left side presumably associated with ECMO cannulation. Paresis (14.3% of patients) was only found in the ECMO group (p = 0.067). Paresthesia was frequent (nonECMO 53.8%, ECMO 62.5%; p = 0.064), in nonECMO most frequently due to initial trauma and polyneuropathy, in the ECMO group mainly due to impairments of N. cutaneus femoris lateralis (4 vs. 0; p = 0.031). Besides well-known central neurologic complications, more subtle complications were detected by thorough clinical examination. These findings are sufficient to hamper activities of daily living and impair quality of life and psychological health and are presumably directly related to ECMO therapy.
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SHORT, BILLIE LOU. "The Extracorporeal Membrane Oxygenation Debate." Pediatrics 85, no. 3 (March 1, 1990): 380–81. http://dx.doi.org/10.1542/peds.85.3.380.
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To the Editor.— I would like to thank Dr Dworetz and associates1 for their concern for the use of retrospective criteria in determining ECMO (extracorporeal membrane oxygenation) entry criteria, a concern that is common to all of us. It should be pointed out that a controlled trial comparing ECMO to hyperventilation was completed at Boston Children's Hospital2 showing an improved survival with extracorporeal membrane oxygenation. Even though the criteria of the Boston study were tested prospectively, a year after that study, we must deal with how to change the criteria to reflect new therapeutic modalities.
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Victor, Kelly, Nicholas A. Barrett, Stuart Gillon, Abigail Gowland, Christopher I. S. Meadows, and Nicholas Ioannou. "CRITICAL CARE ECHO ROUNDS: Extracorporeal membrane oxygenation." Echo Research and Practice 2, no. 2 (April 2015): D1—D11. http://dx.doi.org/10.1530/erp-14-0111.
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Extracorporeal membrane oxygenation (ECMO) is an advanced form of organ support indicated in selected cases of severe cardiovascular and respiratory failure. Echocardiography is an invaluable diagnostic and monitoring tool in all aspects of ECMO support. The unique nature of ECMO, and its distinct effects upon cardio-respiratory physiology, requires the echocardiographer to have a sound understanding of the technology and its interaction with the patient. In this article, we introduce the key concepts underpinning commonly used modes of ECMO and discuss the role of echocardiography.CaseA 38-year-old lady, with no significant past medical history, was admitted to her local hospital with group A Streptococcal pneumonia. Rapidly progressive respiratory failure ensued and, despite intubation and maximal ventilatory support, adequate oxygenation proved impossible. She was attended by the regional severe respiratory failure service who established her on veno-venous (VV)-ECMO for respiratory support. Systemic oxygenation improved; however, significant cardiovascular compromise was encountered and echocardiography demonstrated a severe septic cardiomyopathy (ejection fraction <15%, aortic velocity time integral 5.9 cm and mitral regurgitation dP/dt 672 mmHg/s). Her ECMO support was consequently converted to a veno-veno-arterial configuration, thus providing additional haemodynamic support. As the sepsis resolved, arterial ECMO support was weaned under echocardiographic guidance; subsequent resolution of intrinsic respiratory function allowed the weaning of VV-ECMO support. The patient was liberated from ECMO 7 days after hospital admission.
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Suk, Pavel, Vladimír Šrámek, and Ivan Čundrle. "Extracorporeal Membrane Oxygenation Use in Thoracic Surgery." Membranes 11, no. 6 (May 31, 2021): 416. http://dx.doi.org/10.3390/membranes11060416.
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This narrative review is focused on the application of extracorporeal membrane oxygenation (ECMO) in thoracic surgery, exclusive of lung transplantation. Although the use of ECMO in this indication is still rare, it allows surgery to be performed in patients where conventional ventilation is not feasible—especially in single lung patients, sleeve lobectomy or pneumonectomy and tracheal or carinal reconstructions. Comparisons with other techniques, various ECMO configurations, the management of anticoagulation, anesthesia, hypoxemia during surgery and the use of ECMO in case of postoperative respiratory failure are reviewed and supported by two cases of perioperative ECMO use, and an overview of published case series.
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Aokage, Toshiyuki, and Shinhiro Takeda. "Extracorporeal membrane oxygenation (ECMO) for severe respiratory failure due to influenza pneumonia." Journal of the Japanese Society of Intensive Care Medicine 21, no. 5 (2014): 478–80. http://dx.doi.org/10.3918/jsicm.21.478.
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Li, Weimin, and Dongyan Yang. "Extracorporeal Membrane Oxygenation in Refractory Cardiogenic Shock." Heart Surgery Forum 23, no. 6 (November 30, 2020): E888—E894. http://dx.doi.org/10.1532/hsf.3263.
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Background: Many clinicians do not know under what exact conditions extracorporeal membrane oxygenation (ECMO) can get the best results. In this study, we explored the optimal indications for ECMO in patients with refractory cardiogenic shock. Methods: From October 2014 to November 2019, 23 patients with refractory cardiogenic shock were treated with ECMO in our hospital, including 11 cases with acute left anterior myocardial infarction, 3 with acute left inferior and right ventricular myocardial infarction, and 9 with fulminant myocarditis. These cases were divided into survivors (n = 10) and nonsurvivors (n = 13), and the clinical data of the 2 groups were compared. Results: The weaning rate of ECMO was 60.9%. The discharge survival rate was 43.5%. There were significant differences in age, sequential organ failure assessment (SOFA) score, vasoactive-inotropic (VIS) score, lactic acid concentrations, primary disease, and smoking history between survivors and nonsurvivors before ECMO (P < .05). There were significant differences in blood pressure (systolic and diastolic), oxygen partial pressure, and left ventricular ejection fraction between survivors and nonsurvivors 1 day before the removal of ECMO (P < .05). Conclusions: The reversibility of the primary disease causing refractory cardiogenic shock is critical to the survival rate of ECMO. Etiological treatment is essential, and extra attention should be paid to the use of ECMO in patients with irreversible primary disease. ECMO should be regarded as a first aid device and is not suitable for long-term cardiac assistance; left ventricular assist or heart transplantation is a better option.
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Bartlett, R. H. "Historical Perspectives: Extracorporeal Membrane Oxygenation (ECMO)." NeoReviews 6, no. 6 (June 1, 2005): e251-e254. http://dx.doi.org/10.1542/neo.6-6-e251.
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Khilnani, Praveen. "Anticoagulation on extracorporeal membrane oxygenation (ECMO)." Qatar Medical Journal 2017, no. 1 (February 2017): 20. http://dx.doi.org/10.5339/qmj.2017.swacelso.20.
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Al Disi, Mohammed, Abdullah Alsalemi, Yahya Alhomsi, Fayçal Bensaali, Abbes Amira, and Guillaume Alinier. "Using thermochromism to simulate blood oxygenation in extracorporeal membrane oxygenation." Perfusion 34, no. 2 (September 7, 2018): 106–15. http://dx.doi.org/10.1177/0267659118798140.
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Introduction: Extracorporeal membrane oxygenation (ECMO) training programs employ real ECMO components, causing them to be extremely expensive while offering little realism in terms of blood oxygenation and pressure. To overcome those limitations, we are developing a standalone modular ECMO simulator that reproduces ECMO’s visual, audio and haptic cues using affordable mechanisms. We present a central component of this simulator, capable of visually reproducing blood oxygenation color change using thermochromism. Methods: Our simulated ECMO circuit consists of two physically distant modules, responsible for adding and withdrawing heat from a thermochromic fluid. This manipulation of heat creates a temperature difference between the fluid in the drainage line and the fluid in the return line of the circuit and, hence, a color difference. Results: Thermochromic ink mixed with concentrated dyes was used to create a recipe for a realistic and affordable blood-colored fluid. The implemented “ECMO circuit” reproduced blood’s oxygenation and deoxygenation color difference or lack thereof. The heat control circuit costs 300 USD to build and the thermochromic fluid costs 40 USD/L. During a ten-hour in situ demonstration, nineteen ECMO specialists rated the fidelity of the oxygenated and deoxygenated “blood” and the color contrast between them as highly realistic. Conclusions: Using low-cost yet high-fidelity simulation mechanisms, we implemented the central subsystem of our modular ECMO simulator, which creates the look and feel of an ECMO circuit without using an actual one.
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Jain, Aashish, and Yatin Mehta. "Sepsis Associated with Extracorporeal Membrane Oxygenation." Journal of Cardiac Critical Care TSS 06, no. 02 (July 2022): 146–50. http://dx.doi.org/10.1055/s-0042-1757392.
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AbstractSepsis in patients on extracorporeal membrane oxygenation (ECMO) remains a serious complication. Its presence is a poor prognostic marker and increases overall mortality. Adult patients with prolonged duration on ECMO are at high risk of developing sepsis. Ventilator-associated pneumonia and bloodstream infections are the main sources of infection these patients. A strong early suspicion, drawing adequate volume for blood cultures, and early and timely administration of empirical antibiotics can help control the infection and decrease the morbidity and mortality. The diagnostic and the treatment are both challenging. Cardiac patients have increased risk of nosocomial infection while on ECMO, which may be in part due to longer cannulation times, as well as increased likelihood of undergoing major procedures or having an open chest.
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Cornish, J. Devn, and Reese H. Clark. "Principles and Practice of Venovenous Extracorporeal Membrane Oxygenation." Journal of Intensive Care Medicine 11, no. 6 (November 1996): 289–301. http://dx.doi.org/10.1177/088506669601100601.
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Over the past several years, the use of venovenous extracorporeal membrane oxygenation (ECMO) has increased. The primary advantage of venovenous (VV) over venoarterial (VA) ECMO is preservation of the carotid artery. Its primary disadvantage is that it does not provide circulatory support. While VV ECMO is technically similar to VA ECMO, clinical application of VV ECMO is quite different from VA ECMO. Recent clinical data show that VV ECMO is safe and effective. The purpose of this review is to discuss these differences between VV and VA ECMO, to review the various forms of VV ECMO, and finally to offer recommendations on the safe clinical use of VV ECMO.
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LEBLANC, MICHAEL H. "ECMO and Sepsis." Pediatrics 90, no. 1 (July 1, 1992): 127. http://dx.doi.org/10.1542/peds.90.1.127.
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To the Editor.— The article by Hocker et al, "Extracorporeal Membrane Oxygenation and Early Onset Group B Streptococcal Sepsis,"1 purports to show that extracorporeal membrane oxygenation (ECMO) is effective in Group B Sepsis. The study begins comparing results prior to ECMO therapy with results after ECMO therapy. The incidence of death from Group B Sepsis went from 3 of 28 or 11% prior to the institution of ECMO to 9 of 53 or 17% after the institution of ECMO.
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Batra, Kiran, Manish Mohanka, Srinivas Bollineni, Vaidehi Kaza, Prabhakar Rajiah, Yin Xi, Amy Hackmann, Michael Wait, Fernando Torres, and Amit Banga. "Effects of Extracorporeal Membrane Oxygenation Initiation on Oxygenation and Pulmonary Opacities." Journal of Critical Care Medicine 7, no. 1 (January 1, 2021): 6–13. http://dx.doi.org/10.2478/jccm-2020-0040.
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Abstract Introduction There is limited data on the impact of extracorporeal membrane oxygenation (ECMO) on pulmonary physiology and imaging in adult patients. The current study sought to evaluate the serial changes in oxygenation and pulmonary opacities after ECMO initiation. Methods Records of patients started on veno-venous, or veno-arterial ECMO were reviewed (n=33; mean (SD): age 50(16) years; Male: Female 20:13). Clinical and laboratory variables before and after ECMO, including daily PaO2 to FiO2 ratio (PFR), were recorded. Daily chest radiographs (CXR) were prospectively appraised in a blinded fashion and scored for the extent and severity of opacities using an objective scoring system. Results ECMO was associated with impaired oxygenation as reflected by the drop in median PFR from 101 (interquartile range, IQR: 63-151) at the initiation of ECMO to a post-ECMO trough of 74 (IQR: 56-98) on post-ECMO day 5. However, the difference was not statistically significant. The appraisal of daily CXR revealed progressively worsening opacities, as reflected by a significant increase in the opacity score (Wilk’s Lambda statistic 7.59, p=0.001). During the post-ECMO period, a >10% increase in the opacity score was recorded in 93.9% of patients. There was a negative association between PFR and opacity scores, with an average one-unit decrease in the PFR corresponding to a +0.010 increase in the opacity score (95% confidence interval: 0.002 to 0.019, p-value=0.0162). The median opacity score on each day after ECMO initiation remained significantly higher than the pre-ECMO score. The most significant increase in the opacity score (9, IQR: -8 to 16) was noted on radiographs between pre-ECMO and forty-eight hours post-ECMO. The severity of deteriorating oxygenation or pulmonary opacities was not associated with hospital survival. Conclusions The use of ECMO is associated with an increase in bilateral opacities and a deterioration in oxygenation that starts early and peaks around 48 hours after ECMO initiation.
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Mujahidin, Mujahidin. "Extracorporeal Membrane Oxygention (ECMO) Pada Pasien Bedah Jantung Dewasa." JAI (Jurnal Anestesiologi Indonesia) 8, no. 3 (November 1, 2016): 144. http://dx.doi.org/10.14710/jai.v8i3.19813.
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Extracorporeal Life Support (ECLS) merupakan suatu tindakan medis yang dilakukan untuk mempertahankan oksigenasi dan eliminasi dari karbon dioksida yang adekuat untuk mengembalikan fungsi pernapasan yang sudah terganggu. ECLS terdiri dari beberapa jenis, yaitu Extracorporeal lung assist (ECLA), Extracorporeal membrane oxygenation (ECMO), Extracorporeal carbon dioxide removal (ECOO2R), and Extracorporeal cardiopulmonary resuscitation (ECPR). Wabah virus H1N1 (flu babi) yang terjadi pada tahun 2009 dan 2010 menjadikan penggunaan ECMO menjadi popular. ECMO menggunakan teknologi yang diturunkan dari penggunaan cardiopulmonary bypass (CPB) yang memungkinkan terjadinya pertukaran gas di luar tubuh, penggunaannya lebih praktis dan dapat digunakan dalam jangka waktu yang lama. Indikasi penggunaan ECMO pada pasien dengan permasalahan jantung dan paru yang berat yang tidak respon terhadap terapi konvensional, permasalahan seperti acute respiratory distress syndrome, shock kardiogenik yang berulang atau henti jantung. Circuit ECMO terdiiri dari 3 pengaturan yang memiliki fitur masing-masing, yaitu veno-arterial ECMO, Veno-venous ECMO dan arterio-venous ECM). Survival rate penggunaan ECMO pada gagal napas akut berkisar antara 50-70 persen, tetapi belum cukup untuk menjadikan ECMO sebagai rekomendasi umum penatalaksanaan gagal napas akut, tetapi penggunaan ECMO dapat dipertimbangkan jika terapi lainnya gagal. Pemahaman tentang ECMO yang semakin meningkat menjanjikan luaran yang lebih .
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Lepper, Philipp M., Nicholas A. Barrett, Justyna Swol, Roberto Lorusso, Matteo Di Nardo, Mirko Belliato, Jan Bělohlávek, and Lars Mikael Broman. "Perception of prolonged extracorporeal membrane oxygenation in Europe: an EuroELSO survey." Perfusion 35, no. 1_suppl (May 2020): 81–85. http://dx.doi.org/10.1177/0267659120909740.
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The substantial increase in the number of patients receiving extracorporeal membrane oxygenation over the last decade has led to an evolution of indications and an expansion into wider patient groups. One of the unanticipated benefits of the increase in extracorporeal membrane oxygenation has been a change in the understanding of the natural history of many respiratory diseases. Development in technology and materials, reduced extracorporeal membrane oxygenation–specific complications, and improvement of critical care, in general, have facilitated longer extracorporeal membrane oxygenation runs, and the definition of prolonged extracorporeal membrane oxygenation was recently expanded to continuous support for more than 28 days. This survey aimed to describe European ECMO centers’ perception and arbitrary definition of prolonged extracorporeal membrane oxygenation, patient management, and futility. Of 94 center responses, 37% regarded 14-21 days, 30% 21-28 days, and 28% >28 days as prolonged treatment. Bridge to recovery (64%) or to transplantation (20%) was the most common causes. Awake, and ambulation while on extracorporeal membrane oxygenation was reported from 34% of the centers. In case of perceived futility, decision to withdraw was taken in 65% of the centers in agreement between profession and family and in 30% by profession only. One-fourth of the centers did not discontinue support. Large differences prevail among European ECMO centers concerning local perception and patient management in prolonged extracorporeal membrane oxygenation.
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Kim, Jin-Young, and Sang-Bum Hong. "Treatment of acute respiratory failure: extracorporeal membrane oxygenation." Journal of the Korean Medical Association 65, no. 3 (March 10, 2022): 157–66. http://dx.doi.org/10.5124/jkma.2022.65.3.157.
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Background: Extracorporeal membrane oxygenation (ECMO) support for tissue oxygenation can improve the survival of patients with life-threatening respiratory distress syndrome or cardiac failure.Current Concepts: Recently, the use of ECMO in acute respiratory distress syndrome has first been reported by a multicenter randomized controlled trial, known as the conventional ventilation or ECMO for severe adult respiratory failure trial. The ECMO application is dramatically increasing with the increasing number of patients experiencing acute respiratory failure due to coronavirus disease 2019 pneumonia. In this review, we explain the indications of the ECMO application and ECMO-associated complications.Discussion and Conclusion: The ECMO application in lung diseases, such as coronavirus disease 2019 and acute respiratory distress syndrome, has significant outcomes in securing the treatment periods and reducing mortality. Therefore, accumulating knowledge and experience in the ECMO application can produce positive outcomes.
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Peek, Giles J., Andrew Thompson, Hilliary M. Killer, and Richard K. Firmin. "Spallation performance of extracorporeal membrane oxygenation tubing." Perfusion 15, no. 5 (September 2000): 457–66. http://dx.doi.org/10.1177/026765910001500509.
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During the prolonged roller pump use of extracorporeal membrane oxygenation (ECMO), tubing wear generates spallation. The spallation performance of Tygon® S-65-HL was measured and compared with a potential new ECMO tubing, LVA (Portex 800-500-575). Spallation was measured by on-line laser diode particle counting (HIAC) during simulated ECMO. The effects of differing levels of occlusion and pump speed were examined, as was the effect of spallation over time. The spallation produced by Tygon S-65-HL was less than that seen with LVA during 24 h of simulated ECMO ( p < 0.001), and after 72 h had fallen almost to zero. Spallation with Tygon tubing increases with increasing pump speed and decreases over time. There appears to be only a weak correlation with occlusion, which is surprising. The spallation performance of Tygon S-65-HL was variable and under some conditions exceeded that of LVA. Overall, however, Tygon S-65-HL produced less spallation than LVA. Therefore, LVA cannot be recommended for clinical ECMO use.
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Ham, P. Benson, Brice Hwang, Linda J. Wise, K. Christian Walters, Walter L. Pipkin, Charles G. Howell, Jatinder Bhatia, and Robyn Hatley. "Venovenous Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure." American Surgeon 82, no. 9 (September 2016): 787–88. http://dx.doi.org/10.1177/000313481608200937.
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Conventional treatment of respiratory failure involves positive pressure ventilation that can worsen lung damage. Extracorporeal membrane oxygenation (ECMO) is typically used when conventional therapy fails. In this study, we evaluated the use of venovenous (VV)-ECMO for the treatment of severe pediatric respiratory failure at our institution. A retrospective analysis of pediatric patients (age 1–18) placed on ECMO in the last 15 years (1999–2014) by the pediatric surgery team for respiratory failure was performed. Five pediatric patients underwent ECMO (mean age 10 years; range, 2–16). All underwent VV-ECMO. Diagnoses were status asthmaticus (2), acute respiratory distress syndrome due to septic shock (1), aspergillus pneumonia (1), and respiratory failure due to parainfluenza (1). Two patients had severe barotrauma prior to ECMO initiation. Average oxygenation index (OI) prior to cannulation was 74 (range 23–122). No patients required conversion to VA-ECMO. The average ECMO run time was 4.4 days (range 2–6). The average number of days on the ventilator was 15 (range 4–27). There were no major complications due to the procedure. Survival to discharge was 100%. Average follow up is 4.4 years (range 1–15). A short run of VV-ECMO can be lifesaving for pediatric patients in respiratory failure. Survival is excellent despite severely elevated oxygen indices. VV-ECMO may be well tolerated and can be considered for severe pediatric respiratory failure.
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Hervey-Jumper, Shawn L., Gail M. Annich, Andrea R. Yancon, Hugh J. L. Garton, Karin M. Muraszko, and Cormac O. Maher. "Neurological complications of extracorporeal membrane oxygenation in children." Journal of Neurosurgery: Pediatrics 7, no. 4 (April 2011): 338–44. http://dx.doi.org/10.3171/2011.1.peds10443.
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Object Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving treatment for patients in refractory cardiorespiratory failure. Neurological complications that result from ECMO treatment are known to significantly impact patient survival and quality of life. The purpose of this study was to review the incidence of neurological complications of ECMO in the pediatric population and the role of neurosurgery in the treatment of these patients. Methods Data were obtained from the national Extracorporeal Life Support Organization (ELSO) Registry for the years 1990 to 2009. The neurological complications recorded by the registry include CNS hemorrhage, CNS infarction, and seizure. The ECMO Registry at the authors' institution was then searched, and 3 pediatric patients who had undergone craniotomy during ECMO treatment were identified. Results Children in the ELSO Registry who were treated with ECMO survived to hospital discharge in 65% of cases. Intracranial hemorrhage occurred in 7.4% of the ECMO-treated patients, with 36% of those surviving to hospital discharge. Hemorrhage was more likely in patients younger than 30 days old and in those requiring ECMO for cardiac indications. Cerebral infarction occurred in 5.7% of all ECMO-treated patients. Clinically diagnosed seizures occurred in 8.4% of all ECMO-treated patients. The ECMO Registry at the authors' institution revealed that 1898 patients were treated there. Intracranial hemorrhage was diagnosed in 81 patients (5.8%), and 3 of these patients were treated with craniotomy. Two of the patients were alive with minimal neurological impairment and normal school performance at 10 and 16 years of follow-up. Conclusions Intracranial hemorrhage is a serious complication of ECMO treatment. While the surgical risk is substantial, there may be a role for surgical evacuation of hemorrhage in well-selected patients.
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Putowski, Zbigniew, Anna Szczepańska, Marcelina Czok, and Łukasz J. Krzych. "Veno-Venous Extracorporeal Membrane Oxygenation in COVID-19—Where Are We Now?" International Journal of Environmental Research and Public Health 18, no. 3 (January 28, 2021): 1173. http://dx.doi.org/10.3390/ijerph18031173.
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The recent development in extracorporeal life support (ECLS) has created new therapeutic opportunities for critically ill patients. An interest in extracorporeal membrane oxygenation (ECMO), the pinnacle of ECLS techniques, has recently increased, as for the last decade, we have observed improvements in the survival of patients suffering from severe acute respiratory distress syndrome (ARDS) while on ECMO. Although there is a paucity of conclusive data from clinical research regarding extracorporeal oxygenation in COVID-19 patients, the pathophysiology of the disease makes veno-venous ECMO a promising option.
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McDermott, Beth Kaplan, and Martha A. Q. Curley. "Extracorporeal Membrane Oxygenation: Current Use and Future Directions." AACN Advanced Critical Care 1, no. 2 (August 1, 1990): 348–64. http://dx.doi.org/10.4037/15597768-1990-2014.
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Extracorporeal membrane oxygenation (ECMO) is the process of using prolonged cardiopulmonary bypass to support patients with reversible respiratory and/or cardiac failure who are refractory to maximal conventional therapy. This process has been used extensively for critically ill neonates, with encouraging results. The use of ECMO in the pediatric population has been limited but is increasing. The history, mechanics, and current applications of ECMO are discussed in this article. Critical care nursing management of the pediatric or neonatal ECMO patient focuses on optimizing recovery of the pulmonary and/or cardiac system while preventing complications. A case study of a pediatric ECMO patient is presented which illustrates the complex nursing care issues related to use of this intervention. Future directions for ECMO are addressed
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Shelukhin, D. A., A. V. Karpov, M. V. Ketskalo, and K. K. Gubarev. "Russian Experience of Transport Extracorporeal Membrane Oxygenation." Russian Sklifosovsky Journal "Emergency Medical Care" 9, no. 4 (January 22, 2021): 521–28. http://dx.doi.org/10.23934/2223-9022-2020-9-4-521-528.
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Relevance. The present time can be called a period of accumulation of experience of national health systems in different countries of the world in the application of transport extracorporeal membrane oxygenation (ECMO) technology at the pre- and inter-hospital stages of evacuation of patients to specialized ECMO-therapy centers. The role of such centers is to provide timely advice and, if necessary, perform inter-hospital evacuation.Material and methods. The study summarized and analyzed with the help of the national register “RosECMO” the own experience of 13 hospitals in the Russian Federation, who performed 68 inter-hospital evacuations under ECMO conditions by different modes of transport in patients of different age groups with symptoms of circulatory and respiratory failure. The following parameters were evaluated: characteristics of transport ECMO, clinical manifestations of potentially negative effects of transport, hospital survival, as well as the effect of experience (less and more than 10 cases of transport ECMO) of the presented clinics on the difference in the results obtained.Results. Connecting patients to the ECMO device reduces the likelihood of death on the SOFA and APACHE IV scales by 1.2 times (p <0.0001) and 1.4 times (p<0.0001), respectively. Despite the absence of deaths during inter-hospital transportation of patients under ECMO conditions, 14.93% of patients died within 3 days from the moment of their execution, without a significant difference in clinics with different practical experience. The overall hospital survival rate of ECMO transport scenarios in all 13 clinics of the Russian Federation was comparable to the data of the international register 48.52% versus 48.81%, at the same time it was significantly lower (1.3 times) in the group of clinics with less clinical experience 40% versus 52.08% (p<0.0001).Conclusion. The results of the first stage of the study we obtained indicate the prospects of using the method of extracorporeal membrane oxygenation at the stage of inter-hospital evacuation, due to the effective stabilization of the patient’s condition and a significant reduction in the risks of the likelihood of death. Clinics with less clinical experience showed significantly worse results of hospital survival of patients who underwent inter-hospital transportation under conditions of extracorporeal membrane oxygenation compared to clinics with more clinical experience, which can be a significant argument in adopting a model for the development of specialized regional centers for extracorporeal membrane oxygenation. The experience accumulated over the past six years and the analysis of new data from the register of transport cases of extracorporeal membrane oxygenation of the national healthcare system will make it possible to formulate the correct trajectory for the development of the method of extracorporeal membrane oxygenation and its application, including at the stage of pre- and inter-hospital evacuations of patients.
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Napp, L. Christian, Stephan Ziegeler, and Detlef Kindgen-Milles. "Rationale of Hemoadsorption during Extracorporeal Membrane Oxygenation Support." Blood Purification 48, no. 3 (2019): 203–14. http://dx.doi.org/10.1159/000500015.
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Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support are increasingly used for treating various forms of shock, lung failure, protected interventions and life support including resuscitation. Most patients on ECMO are affected by a systemic inflammatory response caused by the underlying disease as well as the ECMO support itself, which contributes to vasoplegia, multi-organ failure, deterioration and death. Unfortunately, effective strategies for control of inflammation and related organ failure and shock on ECMO are lacking. Recently, a new polystyrene-based device for hemoadsorption, which aims to reduce excessive levels of inflammatory molecules such as interleukins, cytokines as well as damage- and pathogen-associated molecular patterns, has become available. Here we summarize the rationale, available data and technical aspects of polystyrene-based hemoadsorption during ECMO support, and give recommendations based on existing experience.
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Linke, Natalie J., Bentley J. Fulcher, Daniel M. Engeler, Shannah Anderson, Michael J. Bailey, Stephen Bernard, Jasmin V. Board, et al. "A survey of extracorporeal membrane oxygenation practice in 23 Australian adult intensive care units." Critical Care and Resuscitation 22, no. 2 (June 1, 2020): 166–70. http://dx.doi.org/10.51893/2020.2.sur7.
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In Australia, extracorporeal membrane oxygenation (ECMO) is one of the most expensive diagnosis-related groups, costing $305 463 per complex admission to the intensive care unit(ICU). Mortality in this group of patients is high, about 43% for respiratory failure and 68% for cardiac failure. ECMO is associated with significant risk to the patient and requires specialist training andexpertise. Variation in clinical practice for patients supported with ECMO may compromise patient care and outcomes.
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Buck, Marcia L. "Control of Coagulation during Extracorporeal Membrane Oxygenation." Journal of Pediatric Pharmacology and Therapeutics 10, no. 1 (January 1, 2005): 26–35. http://dx.doi.org/10.5863/1551-6776-10.1.26.
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The use of extracorporeal membrane oxygenation (ECMO) requires maintaining a delicate balance between the prevention of thrombosis and the avoidance of hemorrhage. Anticoagulation is necessary to maintain circuit flow. It counteracts the activation of clotting mechanisms that occurs as a result of the interaction between circulating blood and the foreign surfaces of the ECMO equipment as well as endothelial damage within the vasculature. Heparin remains the anticoagulant of choice; however, the difficulty in adjusting dosages and the risk of developing heparin-induced thrombocytopenia have led to the use of alternative therapies such as argatroban and lepirudin. In addition, thrombolysis with alteplase is now being used in patients who develop clots despite anticoagulation. Aminocaproic acid has been used for more than a decade to manage or prevent hemorrhage in patients on ECMO, but a new report suggests that activated recombinant factor VII may also be useful as a hemostatic agent. Over the next decade, it is likely that the role of these newer agents will grow, making them important tools in the management of patients on ECMO.
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Parrilla, Gustavo A., Nicolás Dosso, Daniel Absi, Sebastián Defranchi, Juan M. Osses, José L. González, and Alejandro Bertolotti. "Resección de nódulo pulmonar en pulmón trasplantado bajo asistencia con membrana de oxigenación extracorpórea." Revista Argentina de Cirugía 111, no. 3 (September 1, 2019): 184–90. http://dx.doi.org/10.25132/raac.v111.n3.1415.es.
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The use of perioperative support with extracorporeal membrane oxygenation (ECMO) systems is a novel concept in general thoracic surgery We report the case of a male patient with a history of right lung transplant due to idiopathic pulmo- nary fibrosis (IPF) who required resection of a right pulmonary nodule under veno-venous (VV) ECMO support. The use of VV-ECMO is a feasible option in selected cases when complications are expected to occur with one lung ventilation.
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Goyal, Venkat, and Pranay Oza. "Extracorporeal Membrane Oxygenation in Cardiac Intensive Care Unit." Journal of Cardiac Critical Care TSS 01, no. 01 (August 2017): 010–14. http://dx.doi.org/10.1055/s-0037-1605345.
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AbstractIn critical care units, doctors usually witness patients coming with single organ failure and subsequently suffer multiorgan failure before they succumb to the destiny. It is well-known that hardly a few patients die of single organ failure, and with addition of every organ, the risk of mortality increases by 10%. The multiorgan failure is secondary to inadequate organ function, tissue perfusion, and oxygenation or due to iatrogenic causes. Extracorporeal membrane oxygenation (ECMO) is not a treatment by itself but a mechanical assist device or rather a replacement therapy to sustain life, to give rest to the organs, and to maintain adequate perfusion and oxygenation. There are various articles discussing the outcomes of ECMO in cardiogenic shock with varied etiology. ECMO support can rescue 40% of patients with otherwise fatal cardiogenic shock (mortality without ECMO is > 80%). As per ELSO data January 2017, 10,982 patients were reported in adult cardiac ECMO, out of whom 56% survived ECLS and 40% survived to discharge. The newer scoring system named SAVE score (its online calculator [www.save-score.com]) offers a validated tool to predict survival for patients receiving ECMO for refractory cardiogenic shock.
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Soynov, Ilya A., Igor A. Kornilov, Yuriy Y. Kulyabin, Alexey V. Zubritskiy, Dmitry N. Ponomarev, Nataliya R. Nichay, Ivan S. Murashov, and Alexander V. Bogachev-Prokophiev. "Residual Lesion Diagnostics in Pediatric Postcardiotomy Extracorporeal Membrane Oxygenation and Its Outcomes." World Journal for Pediatric and Congenital Heart Surgery 12, no. 5 (October 2021): 605–13. http://dx.doi.org/10.1177/21501351211026594.
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Background: To assess the impact of diagnostic procedures in identifying residual lesions during extracorporeal membrane oxygenation (ECMO) on survival after pediatric cardiac surgery. Methods: Between January 2012 and December 2017, 74 patients required postcardiotomy ECMO. Patients were retrospectively divided into 2 groups: Group I underwent only echocardiography ([echo only] 46 patients, 62.2%) and group II (echo+) underwent additional diagnostic tests (ie, computed tomography [CT] or cardiac catheterization; 28 patients, 37.8%). Propensity score matching was used to balance the 2 groups by baseline characteristics. Results: Two equal groups (28 patients in each group) were formed by propensity score matching. Fourteen (50%) patients in the echo-only group and 20 (71%) patients in the echo+ group were successfully weaned from ECMO ( P = .17). Four (14.3%) patients survived in the echo-only group and 15 (53.5%) patients survived in the echo+ group ( P = .004). Patients in the echo+ group had a lower chance of dying compared to the echo-only group (odds ratio, 0.14.6; 95% CI, 0.039-0.52; P = .003). The residual lesions, which may have served as a mortality factor, were found by autopsy in 8 (40%) patients in the echo-only group, while none were found in the echo+ group ( P = .014). Conclusions: The autopsies of patients who died despite postcardiotomy ECMO support showed that in 40% of cases that had been investigated by echo only, residual lesions that had not been detected by echocardiography were present. The cardiac catheterization and CT during ECMO are effective and safe for identifying residual lesions. Early detection and repair of residual lesions may increase the survival rate of pediatric cardiac patients on ECMO.
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Ślusarz, Krystian, Paulina Kurdyś, Paul Armatowicz, Piotr Knapik, and Ewa Trejnowska. "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) – IN THE TREATMENT OF SEVERE, LIFE-THREATENING RESPIRATORY FAILURE." Wiadomości Lekarskie 72, no. 9 (2019): 1822–28. http://dx.doi.org/10.36740/wlek201909221.
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Extracorporeal membrane oxygenation (ECMO) is a technique involving oxygenation of blood and elimination of carbon dioxide in patients with life-threatening, but potentially reversible conditions. Thanks to the modification of extracorporeal circulation used during cardiac surgeries, this technique can be used in intensive care units. Venovenous ECMO is used as a respiratory support, while venoarterial ECMO as a cardiac and/or respiratory support. ECMO does not cure the heart and/or lungs, but it gives the patient a chance to survive a period when these organs are inefficient. In addition, extracorporeal membrane oxygenation reduces or eliminates the risk of lung damage associated with invasive mechanical ventilation in patients with severe ARDS (acute respiratory distress syndrome). ECMO is a very invasive therapy, therefore it should only be used in patients with extremely severe respiratory failure, who failed to respond to conventional therapies. According to the Extracorporeal Life Support Organization (ELSO) Guidelines, inclusion criteria are: PaO2 / FiO2 < 80 for at least 3 hours or pH < 7.25 for at least 3 hours. Proper ECMO management requires advanced medical care. This article discusses the history of ECMO development, clinical indications, contraindications, clinical complications and treatment outcomes.
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Giani, Marco, Antonio Arcadipane, and Gennaro Martucci. "Challenges in the Extracorporeal Membrane Oxygenation Era." Membranes 11, no. 11 (October 27, 2021): 829. http://dx.doi.org/10.3390/membranes11110829.
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Patvardhan, Chinmay, and Kamen Valchanov. "Oxygenator failure in acute myeloid leukaemia. A case report." Perfusion 32, no. 4 (November 21, 2016): 333–35. http://dx.doi.org/10.1177/0267659116679882.
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Extracorporeal membrane oxygenation (ECMO) therapy can be used to rescue patients who develop respiratory failure with acute myeloid leukaemia. We describe a unique case of rapid failure of an oxygenator on ECMO, secondary to high leukocyte count and cell lysis in an adult patient with acute myeloid leukaemia.
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Pot, Louis, Alizée Porto, Audrey Le Saux, Amandine Bichon, Emi Cauchois, Marc Gainnier, Julien Carvelli, and Jeremy Bourenne. "Two Venovenous Extracorporeal Membrane Oxygenation for One Gunshot." Case Reports in Critical Care 2022 (July 20, 2022): 1–3. http://dx.doi.org/10.1155/2022/1070830.
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Venovenous extracorporeal membrane oxygenation (VV-ECMO) is an adjuvant treatment for severe acute respiratory distress syndrome (ARDS) with refractory hypoxemia. Contraindications to therapeutic anticoagulation must be ruled out prior to ECMO implementation. We report the case of a 17-year-old male admitted in intensive care unit (ICU) for penetrating chest trauma due to multiple gunshot wounds. The body computed tomography (body CT scan) documented right pulmonary contusions and a homolateral hemothorax. His condition rapidly deteriorated with refractory hypoxemia due to lung contusion requiring invasive mechanical ventilation (IMV) and polytransfused hemorrhagic shock. During his stay in ICU, venovenous ECMO (VV-ECMO) was implemented twice, firstly for trauma-induced ARDS and secondly after thoracic surgery. This case emphasizes the successful use of VV-ECMO in posttraumatic ARDS without increasing the risk of bleeding.
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GROSS, IAN. "The Extracorporeal Membrane Oxygenation Debate." Pediatrics 85, no. 3 (March 1, 1990): 383–84. http://dx.doi.org/10.1542/peds.85.3.383.
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In Reply.— Drs Short, Rhine et al, and Clark et al raise a number of interesting issues in their letters, some of which were addressed in our article.1 Before responding to the specific issues, I would like to emphasize that our paper does not contest the fact that ECMO may be a effective rescue therapy for some infants with persistent pulmonary hypertension, particularly those who are in dire straights on arrival from a referring hospital.
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RHINE, WILLIAM D., ALLEN F. FISCHER, and DAVID K. STEVENSON. "The Extracorporeal Membrane Oxygenation Debate." Pediatrics 85, no. 3 (March 1, 1990): 381–82. http://dx.doi.org/10.1542/peds.85.3.381.
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To the Editor.— We are concerned about the statistical inferences, assumptions for comparisons, and arguments of logic implicit in the recent article on survival of infants with persistent pulmonary hypertension with ECMO (extracorporeal membrane oxygenation).1 The authors did acknowledge the difficulties of retrospective review, especially over 8 years when obstetrical and neonatal care should be improving. However, other details not reported on their patient population and classification might yield important information for this historical comparison.
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Tan, Vi Ean, Alan T. Evangelista, Dominick M. Carella, Daniel Marino, Wayne S. Moore, Nadji Gilliam, Arun Chopra, and Jeffrey J. Cies. "Sterility Duration of Preprimed Extracorporeal Membrane Oxygenation Circuits." Journal of Pediatric Pharmacology and Therapeutics 23, no. 4 (July 1, 2018): 311–14. http://dx.doi.org/10.5863/1551-6776-23.4.311.
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OBJECTIVES There is a lack of standardization and supporting data regarding the duration preassembled and preprimed extracorporeal membrane oxygenation (ECMO) circuits are expected to be sterile. Therefore, the purpose of this study was to prospectively evaluate whether preassembled and preprimed ECMO circuits could maintain sterility for a period up to 65 days. DESIGN Four ECMO circuits (2 neonatal/pediatric¼” and 2 adolescent/adult ⅜ ”) were assembled and primed under sterile conditions and maintained at room temperature. Culture samples were obtained from each circuit and plated within 1 hour. Culture samples were obtained on day 0 when assembled and primed then every 5 days up to day 65. Samples were plated on several different media including the following: blood agar plate: trypticase soy agar with 5% sheep blood, MacConkey agar, and thioglycollate broth then incubated at 35°C for 3 days. RESULTS All cultures obtained from the priming solution from of the¼” and ⅜ ” ECMO circuits produced no microbial or fungal growth for the 65-day study period. CONCLUSION These pilot data suggest preprimed ECMO circuits may maintain sterility for a period up to 65 days. Additional studies evaluating a larger number of ECMO circuits are needed to confirm these findings.