Enhancing Lung Transplantation with ECMO: A Comprehensive Review of Mechanisms, Outcomes, and Future Considerations

December 22, 2024 No Comments

Lung transplantation (LTx) is a transformative solution for patients with end-stage lung disease, but it comes with significant challenges, including limited donor availability and severe post-operative complications. This review focuses on the role of Extracorporeal Membrane Oxygenation (ECMO) in overcoming these hurdles and improving patient outcomes across all phases of the transplant process.

ECMO, initially developed for cardiac surgery, has become an essential tool in lung transplantation, particularly for its ability to provide cardiopulmonary support. Its applications span the preoperative, intraoperative, and postoperative stages, making it integral to modern LTx practices.

Interaction of Milrinone with Extracorporeal Life Support

December 22, 2024 No Comments

This study investigates the interactions between milrinone, a phosphodiesterase inhibitor used in critically ill patients, and extracorporeal life support (ECLS) systems, specifically extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). Ex vivo experiments demonstrated that milrinone exhibits negligible interaction with ECMO circuits but is rapidly cleared (99% within two hours) by CRRT circuits. These findings suggest that while ECMO dosing adjustments are unnecessary, CRRT requires tailored dosing. Future studies incorporating patient physiology are recommended to refine dosing strategies.

Intraoperative Extracorporeal Support for Lung Transplant: A Systematic Review and Network Meta-Analysis

December 20, 2024 No Comments

This systematic review and network meta-analysis investigates the comparative effectiveness of veno-arterial extracorporeal membrane oxygenation (V-A ECMO), cardiopulmonary bypass (CPB), and OffPump strategies for lung transplantation (LT). Based on 27 observational studies with 6113 patients, the study finds that OffPump approaches outperform both ECMO and CPB in all major outcomes, including reduced ICU stay, mechanical ventilation duration, and mortality. Among extracorporeal supports, V-A ECMO showed better performance than CPB. Factors such as age, gender, and BMI significantly influenced postoperative outcomes.

Anticoagulation Monitoring During ECMO Support: Monitor or Flip a Coin?

December 20, 2024 No Comments

This editorial reviews the complexities of anticoagulation monitoring during extracorporeal membrane oxygenation (ECMO), emphasizing the balance between preventing thromboembolic events and minimizing hemorrhagic risks. Current tools like ACT, aPTT, and anti-factor Xa assays are evaluated for their efficacy and limitations. While aPTT remains widely used, anti-factor Xa is emerging as a promising alternative. The authors call for more research and advanced monitoring strategies to improve clinical outcomes.

Novel Risk Scoring Model to Predict the Implementation of Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocarditis

December 13, 2024 No Comments

This study introduces the Korean Acute Myocarditis (KAM) score, a predictive model for assessing the likelihood of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use in acute myocarditis. Analyzing data from 841 patients across seven Korean hospitals, eight clinical parameters were identified as predictors, including cardiac arrest and left ventricular ejection fraction <40%. The KAM score demonstrated excellent discriminant ability, supporting its potential to guide timely interventions and improve patient outcomes.

The Effects of Blood Cell Salvage on Transfusion Requirements After Decannulation from Veno-Venous Extracorporeal Membrane Oxygenation: An Emulated Trial Analysis

December 10, 2024 No Comments

This study investigates the impact of blood cell salvage (BCS) during veno-venous extracorporeal membrane oxygenation (VV-ECMO) decannulation on transfusion needs. Using an emulated trial with 841 patients, the results showed BCS reduced transfusions of packed red blood cells (PRBC) and increased hemoglobin levels without affecting inflammatory or coagulation markers. These findings suggest BCS is an effective strategy for minimizing transfusion-related complications in VV-ECMO decannulation.

Anticoagulation Management for Veno-Venous ECMO in COVID-19 Patients: Argatroban as Rescue Therapy in Heparin-Associated Thrombocytopenia

December 7, 2024 No Comments

This study examines the use of argatroban as an alternative to unfractionated heparin (UFH) for anticoagulation during veno-venous ECMO in COVID-19 patients with heparin-associated thrombocytopenia (HIT). Data from 40 patients revealed a lower incidence of bleeding with argatroban compared to UFH, particularly at tracheal stoma sites. Platelet counts showed better preservation with argatroban, despite comparable efficacy in preventing thrombotic events. Argatroban offers a safer alternative for HIT cases in ECMO.

Algorithm of High-Risk Massive Pulmonary Thromboembolism with Extracorporeal Membrane Oxygenation

December 4, 2024 No Comments

This study evaluates the use of extracorporeal membrane oxygenation (ECMO) in treating high-risk massive pulmonary embolism (PE) in 27 patients from 2018 to 2023. ECMO was initiated pre-, intra-, or post-operatively in conjunction with surgical embolectomy or catheter-based thrombectomy. ECMO demonstrated significant benefits, including hemodynamic stabilization, reduced right ventricular overload, and improved survival (81.5%). Challenges included Harlequin syndrome and procedural complications. Findings support ECMO as a bridge to recovery, emphasizing the need for optimized patient selection and management strategies.

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

December 2, 2024 No Comments

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.

Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Pediatric ECMO

November 28, 2024 No Comments

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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Enhancing Lung Transplantation with ECMO: A Comprehensive Review of Mechanisms, Outcomes, and Future Considerations

Interaction of Milrinone with Extracorporeal Life Support

Intraoperative Extracorporeal Support for Lung Transplant: A Systematic Review and Network Meta-Analysis

Anticoagulation Monitoring During ECMO Support: Monitor or Flip a Coin?

Novel Risk Scoring Model to Predict the Implementation of Veno-Arterial Extracorporeal Membrane Oxygenation in Patients With Acute Myocarditis

The Effects of Blood Cell Salvage on Transfusion Requirements After Decannulation from Veno-Venous Extracorporeal Membrane Oxygenation: An Emulated Trial Analysis

Anticoagulation Management for Veno-Venous ECMO in COVID-19 Patients: Argatroban as Rescue Therapy in Heparin-Associated Thrombocytopenia

Algorithm of High-Risk Massive Pulmonary Thromboembolism with Extracorporeal Membrane Oxygenation

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

Prospective Randomized Pilot Study Comparing Bivalirudin Versus Heparin in Pediatric ECMO

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