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.

The Impact of ECPELLA on Haemodynamics and Global Oxygen Delivery: A Comprehensive Simulation of Biventricular Failure

February 19, 2024 No Comments

This study explores ECPELLA, combining veno-arterial extracorporeal membrane oxygenation (ECMO) and Impella, for severe cardiogenic shock treatment. Through comprehensive simulation, it examines ECPELLA’s effects on haemodynamics and global oxygen delivery in biventricular failure scenarios. Findings reveal ECPELLA enhances systemic flow and achieves biventricular unloading, with veno-venous ECMO further improving oxygen delivery. Optimizing ECPELLA support is crucial for maximizing benefits in severe cardiogenic shock and acute respiratory failure cases.

Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol

February 13, 2024 No Comments

This article presents a comprehensive review and a pragmatic protocol for anticoagulation management in patients undergoing veno-venous extracorporeal membrane oxygenation (V-V ECMO), as practiced in a high-volume ECMO Referral Centre. It underscores the variability in anticoagulation practices among centers, attributed to the lack of high-quality data for personalizing management. The protocol advocates for a tailored approach to anticoagulation and monitoring, utilizing a range of laboratory tests such as anti-Xa, aPTT, ACT, viscoelastic tests, AT levels, platelet count, fibrinogen, and FXIII levels. The goal is to balance the risk of thrombosis and bleeding by personalizing anticoagulation regimens based on a comprehensive evaluation of coagulation status.

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

February 12, 2024 No Comments

This meta-analysis explores the impact of pre-ECMO timing and ECMO duration on the survival of severe COVID-19 patients, analyzing 54 studies involving 13,691 patients. Results indicate significant differences in pre-ECMO intervals between survivors and non-survivors, without a direct linear relationship between longer pre-ECMO times and mortality risk. The study highlights the need for further research to understand the optimal timing for ECMO initiation in severe COVID-19 cases, as current evidence does not conclusively link extended pre-ECMO periods with decreased survival rates.

Clinical Use of Bedside Portable Low-field Brain Magnetic Resonance Imaging in Patients on ECMO: The Results from Multicenter SAFE MRI ECMO Study

February 8, 2024 No Comments

This study evaluates the safety and efficacy of ultra-low-field portable MRI (ULF-pMRI) for detecting acute brain injuries in ECMO patients across two academic centers. ULF-pMRI was successfully used in 50 patients, showing good quality images of intracranial pathologies. Adverse events occurred in 6% of cases, demonstrating the procedure’s safety. The incidence of acute brain injury was 44%, with ULF-pMRI providing more sensitive detection of ischemic injuries compared to traditional head CT scans. This suggests ULF-pMRI’s potential in improving clinical care and research on ECMO-associated brain injuries.

Utilization of Shock Team and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in the Management of Cardiogenic Shock in Northern Ontario

February 6, 2024 No Comments

The article reviews the introduction of a specialized shock team and the use of VA-ECMO in Northern Ontario for cardiogenic shock (CS) management. Despite advances, CS outcomes were poor until this new approach, which is now feasible even in remote areas. A study at Health Sciences North in Sudbury evaluated the Impella device and the viability of a shock team to administer VA-ECMO. The results show a significant survival rate and demonstrate the potential to bridge urban-rural healthcare disparities in Ontario.

Bedside Repositioning of a Migrated Avalon ECMO Cannula in an Infant: Novel Technique

February 6, 2024 No Comments

This article presents a novel bedside method for repositioning a migrated Avalon ECMO cannula in an infant. The Avalon Elite bi-caval dual lumen catheter, essential for veno-venous extracorporeal membranous oxygenation, requires precise placement. The new technique, involving direct access of the ECMO inflow tube with a catheter and guide wire, proved successful in two instances of catheter migration without the need for additional venous access, highlighting an advancement in pediatric critical care.

Mechanical Circulatory Support – Primer for Consultant Specialists

February 5, 2024 No Comments

This article serves as a primer on mechanical life support therapies, focusing on nonrenal extracorporeal life support for cardiac and pulmonary functions. It targets nephrologist consultants involved in treating critically ill patients, often facing acute renal injury from cardiopulmonary shock and mechanical circulatory support. The review underscores the importance of these life-sustaining tools in managing organ failure, either as a bridge to recovery or as a gateway to more permanent mechanical support solutions.