ProtekDuo Percutaneous Ventricular Support System: Physiology and Clinical Applications

February 4, 2024 No Comments

The ProtekDuo cannula is a dual-lumen device used for right ventricular (RV) mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) support when connected to a pump and oxygenator. Inserted via the right internal jugular vein, it improves pulmonary flow, left atrial filling pressures, and left ventricular preload in RV failure cases. This review covers its clinical applications in managing critically ill patients, including RV myocardial infarction, LV assist device implantation-associated RVF, post-heart transplantation, and post-lung transplantation care. The ProtekDuo system’s easy deployment, mobility, and compatibility with various pumps and oxygenators highlight its significance in RVF management and the need for further research to optimize its use.

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

February 4, 2024 No Comments

This simple review details the evolution of Extracorporeal Membrane Oxygenation (ECMO) as a crucial life-support intervention in critical care, highlighting its history, technological advancements, and significant role in treating severe respiratory or cardiac failure. It emphasizes the importance of patient selection, management strategies for complications, and ECMO’s contribution to improving survival rates, mobility, and the application of remote medical expertise, marking it as a key innovation in critical care.

Direct and Continuous Dosing of Propofol Can Saturate Ex Vivo ECMO Circuit to Improve Propofol Recovery

February 3, 2024 No Comments

This study investigated propofol adsorption in ex vivo ECMO circuits, finding that direct dosing with propofol, both as a bolus and continuous infusion, can saturate the ECMO circuit components, leading to significantly improved drug recovery rates. These findings suggest that direct and continuous dosing strategies for propofol may overcome issues related to altered drug exposure in patients on ECMO, providing a potential optimization for drug dosing in this critical care context.

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.