Comparison of Bivalirudin Versus Heparin for Anticoagulation During Extracorporeal Membrane Oxygenation

March 3, 2024 No Comments

This systematic review and meta-analysis evaluated the efficacy and safety of bivalirudin compared to heparin in patients undergoing extracorporeal membrane oxygenation (ECMO). After reviewing eleven studies focusing on short-term mortality, findings revealed that bivalirudin is associated with significantly lower short-term mortality than heparin, with an odds ratio of 0.71. This suggests bivalirudin may be a preferable anticoagulant for patients on ECMO, though further prospective research is needed to confirm these results.

A Risk Score for Predicting Extracorporeal Membrane Oxygenation Support Before Lung Transplantation

March 1, 2024 No Comments

This study introduces a risk score model to predict the necessity for extracorporeal membrane oxygenation (ECMO) support during lung transplantation. Developed through the analysis of 248 patients’ data from 2016 to 2021, the model uses factors like primary disease diagnosis, pulmonary artery pressure, sex, surgical type, and specific biomarkers to forecast ECMO need. Its effectiveness is confirmed through robust statistical methods, offering a tool for identifying patients at various risk levels for requiring intraoperative ECMO, thereby facilitating better clinical decision-making.

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

February 29, 2024 No Comments

This retrospective study explores the role of echocardiography in assessing pulmonary damage and its correlation with outcomes in ECMO patients with septic shock of pulmonary origin. Among 277 patients screened, 9 had both CT and echocardiography performed. The findings suggest that CT scans were ineffective in differentiating viable lung parenchyma between survivors and non-survivors. However, echocardiography revealed significant differences in pulmonary blood flow (PBF) changes, indicating its potential as a predictive tool for pulmonary recovery in ECMO-treated patients. Specifically, non-survivors experienced a marked decline in PBF, suggesting its utility in prognostication.

Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock

February 27, 2024 No Comments

This study analyzes 39,864 patients with infarct-associated cardiogenic shock (AMICS), comparing outcomes between those treated with mechanical circulatory support devices (tMCS) like IABP, Impella, and V-A ECMO, versus standard care alone. Findings indicate higher in-hospital complications and mortality rates in patients receiving V-A ECMO and Impella compared to those treated with IABP or no tMCS. IABP use was associated with a survival benefit, highlighting the need for careful device selection in managing AMICS.

A Descriptive Analysis of Hybrid Cannulated Extracorporeal Life Support

February 26, 2024 No Comments

This study examines the use of hybrid extracorporeal life support (ECLS) systems, which incorporate a third cannula for cases where traditional cannulation methods are insufficient. Analyzing data from 28 out of 903 ECLS procedures at the University Hospital Zurich from 2007 to 2019, the research found a 3.1% implementation rate for hybrid ECLS, with a notably high in-hospital mortality rate of 67.9%. Mortality varied significantly across indications such as ARDS, refractory cardiogenic shock, and cardiopulmonary resuscitation. Survivors tended to have lower SAPS II scores and required fewer platelet transfusions, underscoring the importance of careful patient selection for this procedure.

Healthcare-Associated Infections in Patients with Severe COVID-19 Supported with Extracorporeal Membrane Oxygenation: A Nationwide Cohort Study

February 24, 2024 No Comments

This study investigates the incidence and microbiology of healthcare-associated infections (HAI) in severe COVID-19 patients receiving extracorporeal membrane oxygenation (ECMO) support, analyzing data from 701 patients in France. It found a 36% incidence rate of ECMO-associated infections (ECMO-AI), with bloodstream infections and ventilator-associated pneumonia being the most common. The infections were primarily caused by Enterobacteriaceae, Enterococcus species, and non-fermenting Gram-negative bacilli. Interestingly, the study concludes that ECMO-AI were not significantly associated with hospital death rates.

Left-Ventricular Unloading With Impella During Refractory Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis

February 22, 2024 No Comments

This systematic review and meta-analysis evaluates the efficacy of left-ventricular (LV) unloading with Impella, compared to standard venoarterial extracorporeal membrane oxygenation (VA-ECMO), during extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Analyzing data from 1014 patients across 32 hospitals, the study finds that ECMELLA (combined Impella and VA-ECMO) is associated with improved survival and neurological outcomes, especially in patients with acute myocardial infarction, compared to VA-ECMO alone. Despite a higher rate of complications, ECMELLA shows promise in enhancing patient recovery, underscoring the need for standardized guidelines for its use in ECPR.

Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest: An Overview of Current Practice and Evidence

February 21, 2024 No Comments

This narrative review explores the use of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest (CA), highlighting its role in providing haemodynamic and respiratory stabilization when conventional CPR fails. With the potential to reduce low-flow time and improve neurological outcomes, ECPR has shown promise in certain patient categories facing out-of-hospital cardiac arrest (OHCA). The possibility of pre-hospital implementation to minimize brain damage is being explored, with the ON-SCENE trial expected to offer new insights. This overview presents recent developments in ECPR, aiming to shed light on its effectiveness and integration into advanced cardiac life support protocols.

Adding Extracorporeal Membrane Oxygenation to Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest Due to Pulmonary Embolism: A Case Report

February 21, 2024 No Comments

This case report presents a life-saving intervention for a 21-year-old woman experiencing out-of-hospital cardiac arrest (OHCA) due to pulmonary embolism, following a lower limb fracture. The rapid application of extracorporeal membrane oxygenation (ECMO) alongside cardiopulmonary resuscitation (CPR) and systemic thrombolysis significantly contributed to her survival. Despite facing severe complications, the collaborative effort of a multidisciplinary medical team, including vascular surgery and interventional radiology, played a crucial role in her recovery without deficits. This highlights the importance of ECMO in enhancing survival rates in critical care, especially in cases complicated by massive pulmonary embolism.

Flow Characterization of Maquet and Bio-Medicus Multi-Stage Drainage Cannulae During Venoarterial Extracorporeal Membrane Oxygenation

February 20, 2024 No Comments

This study employs computational fluid dynamics (CFD) to analyze the flow characteristics of Maquet and Bio-Medicus drainage cannulae used in venoarterial extracorporeal membrane oxygenation (VA ECMO). Through 3D modeling and turbulence simulation, the research identifies significant differences in flow dynamics and thrombosis risk between the two cannula designs. The Bio-Medicus model, in particular, showed a higher stagnant blood volume, suggesting an increased thrombosis risk. These findings underline the importance of cannula design in optimizing VA ECMO therapy and reducing complications.