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Category: ECMO

The Superiority of Veno-Arterial Over Veno-Venous Extracorporeal Membrane Oxygenation for Operative Support of Lung Transplantation

The Superiority of Veno-Arterial Over Veno-Venous Extracorporeal Membrane Oxygenation for Operative Support of Lung Transplantation

This study compares the effectiveness of veno-arterial (V-A) and veno-venous (V-V) extracorporeal membrane oxygenation (ECMO) in lung transplantation. Analyzing 62 patients over eight years, results show that V-A ECMO provides superior pulmonary circulatory unloading and improved survival outcomes. Patients on V-A ECMO had lower pulmonary artery pressure, better oxygenation, and reduced pulmonary edema compared to V-V ECMO. Findings suggest V-A ECMO should be the preferred choice when clinically appropriate.

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January 23, 2025
Predictive Value of Trendelenburg Position

Predictive Value of Trendelenburg Position and Carotid Ultrasound for Fluid Responsiveness in Patients on VV-ECMO with Acute Respiratory Distress Syndrome in the Prone Position

This study evaluates the effectiveness of Trendelenburg position and carotid ultrasound in predicting fluid responsiveness in VV-ECMO patients with ARDS in the prone position. Findings reveal that carotid corrected flow time (FTcBaseline) and stroke volume index variation (ΔSVITrend) are accurate and non-invasive predictors. These methods outperform traditional markers like pulse pressure variation, enhancing fluid management strategies in critical care.

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January 2, 2025
Fluid Management in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: A Scoping Review

Fluid Management in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: A Scoping Review

This review explores fluid management in patients supported by venoarterial extracorporeal membrane oxygenation (VA-ECMO). It highlights the lack of evidence for optimal fluid strategies, comparing liberal vs. restrictive approaches, or types like crystalloids and albumin. Fluid overload negatively affects survival and kidney outcomes, emphasizing the need for precise strategies. The study calls for rigorous research to determine effective fluid resuscitation approaches and improve clinical outcomes.

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December 24, 2024
Lung ECMO

Enhancing Lung Transplantation with ECMO: A Comprehensive Review of Mechanisms, Outcomes, and Future Considerations

Lung transplantation (LTx) is a transformative solution for patients with end-stage lung disease, but it comes with significant challenges, including limited donor availability and severe post-operative complications. This review focuses on the role of Extracorporeal Membrane Oxygenation (ECMO) in overcoming these hurdles and improving patient outcomes across all phases of the transplant process.

ECMO, initially developed for cardiac surgery, has become an essential tool in lung transplantation, particularly for its ability to provide cardiopulmonary support. Its applications span the preoperative, intraoperative, and postoperative stages, making it integral to modern LTx practices.

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December 22, 2024
Milrinone

Interaction of Milrinone with Extracorporeal Life Support

This study investigates the interactions between milrinone, a phosphodiesterase inhibitor used in critically ill patients, and extracorporeal life support (ECLS) systems, specifically extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Ex vivo experiments demonstrated that milrinone exhibits negligible interaction with ECMO circuits but is rapidly cleared (99% within two hours) by CRRT circuits. These findings suggest that while ECMO dosing adjustments are unnecessary, CRRT requires tailored dosing. Future studies incorporating patient physiology are recommended to refine dosing strategies.

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December 22, 2024
ECMO Lung

Intraoperative Extracorporeal Support for Lung Transplant: A Systematic Review and Network Meta-Analysis

This systematic review and network meta-analysis investigates the comparative effectiveness of veno-arterial extracorporeal membrane oxygenation (V-A ECMO), cardiopulmonary bypass (CPB), and OffPump strategies for lung transplantation (LT). Based on 27 observational studies with 6113 patients, the study finds that OffPump approaches outperform both ECMO and CPB in all major outcomes, including reduced ICU stay, mechanical ventilation duration, and mortality. Among extracorporeal supports, V-A ECMO showed better performance than CPB. Factors such as age, gender, and BMI significantly influenced postoperative outcomes.

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December 20, 2024
ECMO Scales

Anticoagulation Monitoring During ECMO Support: Monitor or Flip a Coin?

This editorial reviews the complexities of anticoagulation monitoring during extracorporeal membrane oxygenation (ECMO), emphasizing the balance between preventing thromboembolic events and minimizing hemorrhagic risks. Current tools like ACT, aPTT, and anti-factor Xa assays are evaluated for their efficacy and limitations. While aPTT remains widely used, anti-factor Xa is emerging as a promising alternative. The authors call for more research and advanced monitoring strategies to improve clinical outcomes.

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December 20, 2024
ECMO Scale

Novel Risk Scoring Model to Predict the Implementation of Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocarditis

This study introduces the Korean Acute Myocarditis (KAM) score, a predictive model for assessing the likelihood of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use in acute myocarditis. Analyzing data from 841 patients across seven Korean hospitals, eight clinical parameters were identified as predictors, including cardiac arrest and left ventricular ejection fraction <40%. The KAM score demonstrated excellent discriminant ability, supporting its potential to guide timely interventions and improve patient outcomes.

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December 13, 2024
Transfusion 102

The Effects of Blood Cell Salvage on Transfusion Requirements After Decannulation from Veno-Venous Extracorporeal Membrane Oxygenation: An Emulated Trial Analysis

This study investigates the impact of blood cell salvage (BCS) during veno-venous extracorporeal membrane oxygenation (VV-ECMO) decannulation on transfusion needs. Using an emulated trial with 841 patients, the results showed BCS reduced transfusions of packed red blood cells (PRBC) and increased hemoglobin levels without affecting inflammatory or coagulation markers. These findings suggest BCS is an effective strategy for minimizing transfusion-related complications in VV-ECMO decannulation.

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December 10, 2024
ECMO Anticoagulation

Anticoagulation Management for Veno-Venous ECMO in COVID-19 Patients: Argatroban as Rescue Therapy in Heparin-Associated Thrombocytopenia

This study examines the use of argatroban as an alternative to unfractionated heparin (UFH) for anticoagulation during veno-venous ECMO in COVID-19 patients with heparin-associated thrombocytopenia (HIT). Data from 40 patients revealed a lower incidence of bleeding with argatroban compared to UFH, particularly at tracheal stoma sites. Platelet counts showed better preservation with argatroban, despite comparable efficacy in preventing thrombotic events. Argatroban offers a safer alternative for HIT cases in ECMO.

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December 7, 2024
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