Left Ventricular Unloading During VA-ECMO: A Gordian Knot of Physiology

February 2, 2024 No Comments

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) offers crucial support for severe cardiogenic shock and OHCA patients, with studies suggesting improved outcomes, especially using extracorporeal cardiopulmonary resuscitation (ECPR) for acute coronary syndrome. However, recent research, including from the SAVE-J II registry, questions the universal benefit of LV unloading strategies like IABP alongside VA-ECMO, indicating a need for more targeted investigations to optimize treatment approaches.

Timing of Initiation of Extracorporeal Membrane Oxygenation Support and Outcomes Among Patients With Cardiogenic Shock

January 30, 2024 No Comments

This study analyzed adult patients with cardiogenic shock receiving venoarterial ECMO, using data from the ELSO registry between 2009 and 2019. It found that initiating ECMO more than 24 hours after admission was associated with increased in-hospital mortality, suggesting the importance of timely ECMO initiation to improve survival outcomes.

Bilateral Femoral Cannulation Is Associated With Reduced Severe Limb Ischemia-Related Complications Compared With Unilateral Femoral Cannulation in Adult Peripheral Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Registry

January 26, 2024 No Comments

This retrospective cohort study compared unilateral and bilateral femoral cannulation strategies for peripheral venoarterial ECMO and found no significant difference in overall limb ischemia risk. However, bilateral cannulation was associated with lower incidences of compartment syndrome, cannulation site bleeding, vessel repair, and in-hospital mortality.

In-Hospital Mortality in Patients With Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation With Concomitant Use of Impella vs. Intra-Aortic Balloon Pump – A Retrospective Cohort Study Using a Japanese Claims-Based Database

January 26, 2024 No Comments

In a study comparing the effectiveness of Impella and intra-aortic balloon pump (IABP) in patients with refractory cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), no significant difference in in-hospital mortality was found between the two groups. However, the Impella group experienced longer mechanical ventilation support and hospital stays, and incurred higher medical costs than the IABP group, suggesting a need for further research to optimize the use of Impella in such clinical scenarios.

Outcomes of ECMO Support with Polypropylene Membrane During Pandemic Times: A Retrospective Cohort Study

January 25, 2024 No Comments

During the SARS-CoV-2 pandemic, a study compared clinical outcomes of patients on ECMO support using polypropylene (PP) oxygenation membranes versus poly-methylpentene (PMP) membranes. It found that PP membranes required more changes and had a higher frequency of renal replacement therapy as a complication, yet were a feasible alternative during supply shortages, without significant differences in mortality.

Predicting Acute Brain Injury in Venoarterial Extracorporeal Membrane Oxygenation Patients with Tree-Based Machine Learning: Analysis of the Extracorporeal Life Support Organization Registry

January 24, 2024 No Comments

This study utilized machine learning algorithms to predict acute brain injury (ABI) in patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO), analyzing data from the Extracorporeal Life Support Organization Registry. It found that longer ECMO duration and higher 24-hour pump flow were associated with ABI in both non-ECPR and ECPR VA-ECMO patient groups, highlighting key risk factors for neurological complications in these patients.

Intraoperative Extracorporeal Support during Lung Transplantation: Not Just for the High-Risk Patient

January 19, 2024 No Comments

In lung transplantation, the use of intraoperative mechanical support, particularly cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), has evolved over time due to their respective advantages and disadvantages. While CPB was traditionally preferred for its full hemodynamic support, it poses risks like systemic inflammation and coagulopathy; ECMO, on the other hand, offers many benefits of CPB with fewer risks, leading to better outcomes such as reduced primary graft dysfunction and overall improved survival, suggesting its potential as a standard protocol in lung transplants.

Extracorporeal Membrane Oxygenation for Pulmonary Embolism: A Systematic Review and Meta-Analysis

January 15, 2024 No Comments

This systematic review and meta-analysis of 39 studies involving 6409 patients reveal that more than 50% of patients with high-risk pulmonary embolism (HRPE) treated with extracorporeal membrane oxygenation (ECMO) survive, with mortality significantly lower in those receiving ECMO combined with catheter-directed therapy compared to systemic thrombolysis. Factors like cardiac arrest prior to ECMO and pre-ECMO heart rate are associated with mortality, highlighting the need for further research to compare ECMO with non-ECMO therapies.

Clinician Ethical Perspectives on Extracorporeal Membrane Oxygenation in Practice

January 15, 2024 No Comments

This study surveys clinicians across seven U.S. hospitals to understand the informed consent process for Extracorporeal Membrane Oxygenation (ECMO) and ethical complexities in its application. Results reveal variability in the time spent on obtaining consent, use of exclusion criteria for ECMO, and differences in approaches to withdrawing ECMO, highlighting significant ethical challenges and inconsistencies in practice.

Multi-Method Investigation of Blood Damage Induced by Blood Pumps in Different Clinical Support Modes

January 14, 2024 No Comments

This study investigates the impact of different operational modes of an extracorporeal blood pump (CentriMag) on blood flow patterns and the associated risks of bleeding, thrombosis, and hemolysis using computational fluid dynamics and hemocompatibility models. It finds that venous-arterial (V-A) ECMO mode results in the highest risk of these complications, with heart failure (HF) mode being the least risky, largely due to variations in flow patterns affecting cell and protein functions.