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.

Development and Validation of a Robust and Interpretable Early Triaging Support System for Patients Hospitalized With COVID-19: Predictive Algorithm Modeling and Interpretation Study

January 13, 2024 No Comments

The study developed and validated RIETS, a machine learning-based system using 11 routine clinical and laboratory biomarkers to predict COVID-19 severity upon hospitalization, showing high accuracy and low bias risk. RIETS demonstrated excellent predictive performance, including during the Omicron variant period, and provided interpretable data for clinical use, suggesting its potential for improving patient triaging and resource allocation in hospitals.

Utilizing Machine Learning to Predict Neurological Injury in Venovenous Extracorporeal Membrane Oxygenation Patients: An Extracorporeal Life Support Organization Registry Analysis

January 12, 2024 No Comments

In a study analyzing 37,473 VV-ECMO patients, machine learning was used to predict acute brain injury (ABI), revealing a 7.1% incidence of ABI and identifying pre-ECMO cardiac arrest as the most significant risk factor. The study’s machine learning models, however, showed sub-optimal performance in predicting ABI, attributed to the low prevalence of ABI and the lack of standardized neuromonitoring and imaging protocols in the ELSO Registry data.

Impact of the COVID-19 Pandemic on Prehospital and In-Hospital Treatment and Outcomes of Patients After Out-of-Hospital Cardiac Arrest: A Japanese Multicenter Cohort Study

January 11, 2024 No Comments

This study compared prehospital care, in-hospital treatment, and outcomes among out-of-hospital cardiac arrest (OHCA) patients before and after the COVID-19 pandemic, revealing that survival rates and favorable outcomes at 1 month post-OHCA deteriorated in the post-pandemic period, with longer EMS response times and increased advanced airway management by EMS. Despite these changes, most prehospital and in-hospital treatments remained unchanged between the pre- and post-pandemic periods.

ECMO and Impella Support Strategies as a Bridge to Surgical Repair of Post-Infarction Ventricular Septal Rupture

January 9, 2024 No Comments

This review evaluates the use of Impella and venoarterial extracorporeal membranous oxygenation (VA-ECMO) as strategies to stabilize patients with post-infarct ventricular septal rupture (PIVSR) before surgical repair, based on a case report and a systematic literature review. While both Impella and VA-ECMO have shown better outcomes compared to traditional management, they present unique advantages and challenges; Impella effectively unloads the left ventricle but may cause shunt reversal, whereas VA-ECMO improves organ perfusion but has higher complication risks and may require additional ventricular unloading.

Post-COVID Changes in Lung Function 6 Months After Veno-Venous Extracorporeal Membrane Oxygenation: A Prospective Observational Clinical Trial

January 7, 2024 No Comments

Six months after hospital discharge, patients with severe COVID-19 who received veno-venous extracorporeal membrane oxygenation (V-V ECMO) showed persistent impairments in small airway function and reduced respiratory tissue elasticity, compared to healthy controls. These findings indicate moderate but ongoing lung function impairment in severe acute COVID-19 cases, even after recovery from the critical phase of the infection.

Inpatient Costs of Treating Patients With COVID-19

January 7, 2024 No Comments

This study analyzed the mean cost of inpatient care for COVID-19 patients in the US from March 2020 to March 2022, finding an overall increase from $10,394 to $13,072, with higher costs for patients with comorbidities like obesity and coagulation deficiency. The significant rise in costs, over five times the rate of medical inflation, was partly attributed to increased use of treatments like extracorporeal membrane oxygenation (ECMO) over time.

Using Cardiohelp, Quadrox, and Nautilus Extracorporeal Membrane Oxygenators as Vascular Access for Hemodialysis, Continuous Renal Replacement Therapy, and Plasmapheresis: A Brief Technical Report

January 2, 2024 No Comments

This technical report details methods for performing dialytic therapies, such as intermittent hemodialysis (iHD) and continuous renal replacement therapy (CRRT), safely and effectively through an ECMO circuit, eliminating the need for a separate dialysis catheter in patients with acute kidney injury (AKI) and end-stage renal disease (ESRD). It outlines the connection of these kidney replacement therapies to various oxygenators and discusses performing plasmapheresis alongside ECMO and iHD or CRRT, emphasizing the technique’s safety as it doesn’t require modifications to ECMO cannulas/tubing.

Test Bench for Right Ventricular Failure Reversibility: The Hybrid BiVAD Concept

December 29, 2023 No Comments

Patients with biventricular cardiogenic shock, ineligible for heart transplantation, may benefit from a micro-invasive hybrid BiVAD approach, combining the ProtekDuo cannula and the Impella 5.5 trans-aortic pump. This strategy, beyond ECMO, allows for physiological circulation, biventricular unloading, and accurate evaluation of right ventricular function, leading to the possibility of transitioning to less invasive, durable left ventricular assist device (LVAD) implantation.