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Category: ECMO

ECMO Heart 2024

Intra-Aortic Balloon Pump After VA-ECMO Reduces Mortality in Cardiogenic Shock: Analysis from the Chinese Extracorporeal Life Support Registry

This multicenter study analyzed 5,492 patients with cardiogenic shock (CS) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Among them, 15.1% received intra-aortic balloon pump (IABP) for left ventricle unloading after VA-ECMO. The IABP group showed reduced in-hospital mortality (48.0% vs. 52.5%) and improved survival on VA-ECMO. However, increased risks of mechanical, bleeding, renal, and pulmonary complications were observed. Findings suggest IABP may enhance outcomes in CS patients on VA-ECMO but warrant further validation in randomized trials.

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December 2, 2024
Bivalirudin ECMO

Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Pediatric ECMO

This pilot randomized controlled trial compared bivalirudin and unfractionated heparin for anticoagulation in 30 pediatric ECMO patients. No difference was found in time at goal anticoagulation, the primary endpoint. However, bivalirudin was associated with higher thrombotic complications (37.5% vs. 0%; p=0.02) but required fewer RBC transfusions (median 6.3 vs. 12.2 mL/kg/day; p=0.02). The study demonstrates feasibility for larger trials to evaluate the safety and efficacy of bivalirudin in pediatric ECMO.

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November 28, 2024
ELSO Awake

“Awake” Cannulation of Patients for Venovenous Extracorporeal Membrane Oxygenation: An Analysis of the Extracorporeal Life Support Organization Registry

This study analyzed the outcomes of “awake” cannulation, where patients remain breathing spontaneously during venovenous ECMO cannulation, using data from over 28,000 patients. Only 2.8% underwent awake cannulation, which was associated with similar survival rates to mechanical ventilation cannulation after propensity score matching. Awake cannulation, increasingly utilized over time, shows potential for reducing ventilator-related lung injury but requires further research to identify optimal patient cohorts.

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November 24, 2024
Cerebral 2024

Wavelet and Time-Based Cerebral Autoregulation Analysis Using Diffuse Correlation Spectroscopy on Adults Undergoing Extracorporeal Membrane Oxygenation Therapy

This study examines cerebral autoregulation (CA) in adult patients on extracorporeal membrane oxygenation (ECMO) therapy using diffuse correlation spectroscopy (DCS), a noninvasive approach to monitoring cerebral blood flow. Neurological injuries, common in ECMO patients due to underlying conditions or the therapy itself, can impair CA, potentially worsening brain damage. Using wavelet coherence analysis (WCA), researchers found that DCS-based markers identified significant CA differences in ECMO patients with brain injuries versus those without, highlighting the potential of DCS as a monitoring tool for this population.

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November 3, 2024
VA ECMO

A Comparative Study of Femoral Artery and Combined Femoral and Axillary Artery Cannulation in Veno-Arterial Extracorporeal Membrane Oxygenation Patients

This study investigates the clinical outcomes of two cannulation strategies—femoral artery (FA) cannulation and combined femoral and axillary artery (FA+AA) cannulation—in patients receiving veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac surgery. The FA+AA group showed significant benefits in reducing chronic renal failure, platelet drop, and creatinine levels. Despite similar 30-day mortality rates, the combined approach led to fewer complications and faster recovery.

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October 5, 2024
Hemoperfusion

Efficacy of Adjunct Hemoperfusion Compared to Standard Medical Therapy on 28-Day Mortality in Leptospirosis Patients with Renal Failure and Shock: A Single-Center Randomized Controlled Trial

This study evaluates the impact of hemoperfusion (HP) on 28-day mortality in leptospirosis patients with renal failure and septic shock. A total of 37 patients were randomized to receive either standard medical therapy (SMT) or SMT with HP. The HP group showed a 36.84% risk reduction in 28-day mortality and significant improvements in inflammatory markers, renal function, and pulmonary function. Hemoperfusion was shown to be a safe and effective adjunct therapy, promoting faster recovery and increased survival rates.

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September 29, 2024
Thromboembolic Complications ECMO

Thromboembolic Complications in Continuous Versus Interrupted Anticoagulation During Venovenous Extracorporeal Membrane Oxygenation: A Multicenter Study

This study investigates thromboembolic complications in patients undergoing venovenous extracorporeal membrane oxygenation (ECMO) with continuous versus interrupted anticoagulation. Data from 346 patients across three ECMO centers were analyzed. Results showed no significant difference in thrombotic complications between the groups, although interruptions in anticoagulation were linked to increased thrombotic events as the frequency and duration of interruptions rose.

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September 28, 2024
Special K

Extraction of Ketamine and Dexmedetomidine by Extracorporeal Life Support Circuits

This study investigated the extraction of ketamine and dexmedetomidine by extracorporeal life support (ECLS) circuits such as ECMO and CRRT. Using an ex-vivo system, drug concentrations were measured over time in blood-primed circuits. Results showed significant reductions in drug recovery, with ketamine recovering only 43.8% from ECMO and 3.3% from CRRT after several hours. Dexmedetomidine recovery was similarly reduced, highlighting the need for dosage adjustments during ECLS support.

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September 26, 2024
Pediatric ECMO

Outcomes in Patients Who Received ECMO and/or Volatile Anesthetics as Rescue Therapies for Status Asthmaticus

This study explores the outcomes of pediatric patients with status asthmaticus (SA) who received either inhaled volatile anesthetics (IVA), extracorporeal membrane oxygenation (ECMO), or both as rescue therapies in a PICU setting. Among seven patients, most who received IVA were escalated to ECMO. The results suggest that early ECMO cannulation might be beneficial, though larger studies are needed to form conclusive guidelines for SA management in critically ill children.

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September 21, 2024
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