Temporary Extracorporeal Life Support: Single-Center Experience with a New Concept

March 17, 2024 No Comments

This study explores the efficacy of a novel ECMELLA setup combining veno-arterial extracorporeal membrane oxygenation (va-ECMO) with a micro-axial flow pump in treating cardiogenic shock (CS). Analyzing data from 67 patients treated between December 2020 and December 2022, the study found the technique feasible and effective, with a 27% myocardial recovery rate and a 24% transition rate to durable LVADs. Despite a 49% mortality rate on support, the single-artery cannulation approach showed relatively low access-related complications. This single-center experience suggests ECMELLA 2.0/2.1 as a promising therapy for severe CS with a focus on reducing complications related to access sites.

Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic

March 16, 2024 No Comments

This study characterizes the burden and outcomes of ECMO use in U.S. hospitalizations during the pandemic, analyzing 17,520 cases from the National Inpatient Sample between 2019 and 2020. It highlights a significant increase in ECMO utilization, with a marked impact on inpatient mortality, length of hospital stay, and healthcare costs. Predominantly affecting patients with circulatory and respiratory diseases, ECMO hospitalizations showed a higher mortality rate (43.1%) compared to non-ECMO cases (2.1%), with an average hospital stay of 26 days and an average cost of US$967,647 per case. Factors like Hispanic descent, higher CCI score, age over 60, and a higher APRDRG risk were associated with increased mortality.

Identifying and Mitigating Risk of Post-Cardiotomy Cardiogenic Shock in Patients with Ischemic and Non-Ischemic Cardiomyopathy

March 14, 2024 No Comments

This study aimed to identify preoperative predictors of post-cardiotomy cardiogenic shock in patients with ischemic and non-ischemic cardiomyopathy, focusing on 238 patients undergoing cardiac surgery. It found that pulmonary artery pulsatility index and pulmonary capillary wedge pressure were key predictors, with the predictors varying between ischemic and non-ischemic conditions. The study highlights the importance of preoperative right heart catheterization in identifying patients at higher risk of cardiogenic shock. Ejection fraction improvements were noted at 12 months post-surgery.

Risk Factors for Neurological Disability Outcomes in Patients Under ECMO Following Cardiac Arrest: An Observational Study

March 12, 2024 No Comments

This observational study focused on identifying factors influencing neurological outcomes and disability in patients receiving extracorporeal membrane oxygenation (ECMO) after cardiac arrest, either in-hospital (IHCA) or out-of-hospital (OHCA). Analyzing data from 48 patients treated between February 2016 and March 2020, the study found that timely intervention—specifically shorter intervals from collapse to CPR and ECMO initiation—was crucial for better neurological outcomes and reduced disability. The findings underscore the importance of rapid response in cardiac arrest situations to improve patient recovery prospects.

Protocol for Venoarterial Extracorporeal Membrane Oxygenation to Reduce Morbidity and Mortality Following Bilateral Lung Transplantation: The ECMOToP Randomised Controlled Trial

March 10, 2024 No Comments

The ECMOToP trial aims to evaluate the effectiveness of two VA-ECMO initiation strategies in patients undergoing bilateral lung transplantation for obstructive or restrictive lung diseases. This multicentre randomised controlled trial contrasts an ‘on-demand’ approach, where VA-ECMO is initiated based on specific hemodynamic and respiratory needs, with a ‘systematic’ strategy of preemptive initiation. The primary endpoint is the number of ventilator-free days at day 28, with secondary endpoints including organ failure occurrence, vital status at day 28, day 90, and year 1, along with adverse events. This research endeavors to establish a more effective protocol for VA-ECMO initiation, potentially improving survival and quality of life for lung transplant recipients.

Using Extracorporeal Membrane Oxygenation in Donations After Cardiac Death or Brain Death: A Single-Center Experience and Long-Term Outcome

March 10, 2024 No Comments

This study explores the impact of using extracorporeal membrane oxygenation (ECMO) in liver transplants from donors after cardiac death (DCD) or brain death (DBD). Conducted as a retrospective study from January 2006 to December 2019 at a single center, it included 90 deceased donor liver transplants. The findings indicate no significant survival rate differences between the DBD and DCD groups with ECMO support. However, the DCD with ECMO group showed significant differences in warm and cold ischemia times and bilirubin levels compared to the DBD group. The study underscores ECMO’s role in enhancing the liver graft pool, contributing to 35.6% of liver transplants, with 5-year survival rates being 78.1% for DBD, 90.9% for DBD with ECMO, and 75.6% for DCD with ECMO groups.

Aortic Arch Blood Flow Measurements as a Predictor of Successful ECMO Weaning in Cardiogenic Shock

March 9, 2024 No Comments

This explorative pilot study investigates the role of aortic arch blood flow measurements, using ultrasonic cardiac output monitoring (USCOM), in predicting successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with acute cardiogenic shock. Including 12 patients eligible for a stepwise weaning process, the study found that peak velocity of flow in the aortic arch positively correlates with weaning success, independent of ECMO flow rates. While mean pressure gradient, minute distance, and stroke volume index showed only trends, the study suggests USCOM could complement current strategies by predicting weaning outcomes and preventing pulmonary congestion. Further research is needed to confirm these findings and establish standardized weaning protocols.

Risk Factors for the Mortality of Patients With Coronavirus Disease 2019 Requiring Extracorporeal Membrane Oxygenation in a Non-Centralized Setting: A Nationwide Study

March 8, 2024 No Comments

This nationwide study in Korea explored the mortality risk factors for COVID-19 patients needing Extracorporeal Membrane Oxygenation (ECMO) support across 19 hospitals from January 2020 to August 2021. Of 127 patients, 55.1% died within 90 days post-ECMO initiation. The study identified older age and the need for continuous renal replacement therapy (CRRT) as significant mortality risk factors. The research underscores the critical impact of age and CRRT on COVID-19 patient outcomes with ECMO, highlighting the need for tailored management strategies in these high-risk groups.

A Comprehensive Review of Extracorporeal Membrane Oxygenation: The Lifeline in Critical Moments

March 7, 2024 No Comments

Extracorporeal membrane oxygenation (ECMO) emerges as a crucial lifesaver in critical care for patients with severe respiratory or cardiac failure. This review delves into ECMO’s journey from its inception to the cutting-edge advancements and its profound impact in critical care. It highlights ECMO’s versatility in treating diverse conditions, the importance of patient selection, and managing complications. Technological progress, including miniaturization, innovative circuit designs, and remote monitoring, illustrates the evolving ECMO landscape. The article underscores ECMO’s significant role in enhancing survival rates, mobility, and leveraging remote expertise, portraying it as a beacon of hope and innovation in redefining life support boundaries.

Prognostic Effects of CPR Start Time and Interval Between CPR to ECPR on Patient Outcomes Under ECMO: A Single-Center, Retrospective Observational Study

March 7, 2024 No Comments

This study investigates the impact of the time from collapse to the start of CPR (NFT) and from the start of CPR to ECPR (LFT) on patient outcomes with ECMO in cardiac arrests. Conducted on 48 patients at Hamad General Hospital, Qatar, from 2016 to 2020, it found that longer NFT is associated with worse outcomes, such as longer CPR durations and lower survival rates, while longer LFT primarily affected CPR duration. This suggests NFT is a better predictor of clinical outcomes for patients undergoing ECMO after cardiac arrest, highlighting the importance of timely medical intervention.