Relatively Increased CO2 Delivered to the Brain From the Descending Aorta Leading to an Elevated Respiratory Rate Causing Differential Hypocapnia (RIDDLER or East-West Syndrome): New Pitfalls in Awake Peripheral V-A ECMO

March 16, 2025 No Comments

This article describes a newly recognized physiological phenomenon, RIDDLER (East-West Syndrome), in patients on awake peripheral V-A ECMO. It occurs when CO2-rich blood from the ECMO circuit reaches the brain, triggering an increased respiratory rate despite paradoxically low CO2 levels in the right radial artery. This leads to a cycle of worsening hypercapnia, respiratory distress, and potential neurological injury. Proper CO2 monitoring strategies are needed to prevent mismanagement.

Indications for Extracorporeal Membrane Oxygenation in Older Adult Patients with Accidental Hypothermia and Hemodynamic Instability

March 16, 2025 No Comments

This study analyzes the efficacy of extracorporeal membrane oxygenation (ECMO) in older adults with accidental hypothermia (AH) and hemodynamic instability before cardiac arrest. A post-hoc analysis of the ICE-CRASH study (2019–2022) found no significant survival difference between ECMO and non-ECMO patients at 28 days. ECMO accelerated rewarming but increased bleeding complications. The study concludes ECMO may not benefit this patient group, challenging existing treatment criteria.

Pediatric Cardiac Patients with Pulmonary Hemorrhage Supported on ECMO: An ELSO Registry Study

March 15, 2025 No Comments

This study examines pediatric cardiac patients with pulmonary hemorrhage (PH) supported on extracorporeal membrane oxygenation (ECMO) using data from the ELSO registry (2011–2020). Analyzing 161 cases, the study identifies high-frequency oscillatory ventilation (HFOV) before ECMO cannulation as a key predictor of survival. The absence of hemorrhagic and renal complications also improved outcomes. Findings suggest that optimized pre-ECMO ventilation strategies may enhance survival rates in these high-risk patients.

Prolonged ECMO Support in a Pediatric Patient with Complex Cardiac Conditions During Wartime in Kyiv, Ukraine

March 14, 2025 No Comments

This case report details the prolonged extracorporeal membrane oxygenation (ECMO) support of a 12-year-old girl with severe congenital heart disease and myocarditis in wartime Kyiv. Due to a lack of transplant options and supply shortages, alternative oxygenators were used despite suboptimal long-term performance. The patient underwent 259 days of ECMO support but ultimately succumbed to multi-organ dysfunction. The study highlights the urgent need for medical resource mobilization in conflict zones.

Variability in Triggers for Mechanical Left Ventricular Unloading in VA-ECMO: A Literature Search

March 13, 2025 No Comments

VA-ECMO provides critical cardiopulmonary support but increases left ventricular afterload, potentially leading to left ventricular distension (LVD). This literature review explores various clinical, hemodynamic, and imaging-based triggers for mechanical LV unloading. Findings highlight significant variability in defining LVD and initiating mechanical unloading. The study underscores the need for standardized criteria to optimize patient outcomes while minimizing risks associated with invasive procedures.

Lethal Myocardial Infarction in a Neonate During Extracorporeal Membrane Oxygenation

March 4, 2025 No Comments

This case study explores a neonate with congenital diaphragmatic hernia (CDH) who experienced a lethal myocardial infarction (MI) while on extracorporeal membrane oxygenation (ECMO). The patient developed a large thrombus extending from the arterial cannula into the left main coronary artery, leading to severe cardiac dysfunction. Despite anticoagulation efforts, the clot progressed, resulting in a fatal outcome. The study highlights the challenges of managing neonatal ECMO and intracardiac thrombosis.

Kidney Injury Under Diminished Pulsatile Flow Induced by V-A ECMO in Sheep

February 25, 2025 No Comments

Extracorporeal membrane oxygenation (ECMO) is a lifesaving intervention used for critically ill patients, yet it is frequently associated with high incidences of kidney injury. This

Risk Factors Influencing the Prognosis of Patients with Acute Myocardial Infarction and Cardiogenic Shock Undergoing Extracorporeal Membrane Oxygenation Therapy

February 22, 2025 No Comments

This study examines risk factors affecting survival in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) treated with extracorporeal membrane oxygenation (ECMO). Analyzing 63 cases from 2020–2023, findings indicate that elevated arterial blood lactate, prolonged time to PCI, and higher vasoactive-inotropic scores (VIS) are key predictors of poor prognosis. Early intervention, including timely PCI and metabolic stabilization, is crucial to improving survival outcomes.

Survival After Endocarditis Surgery Needing Venoarterial Extracorporeal Membrane Oxygenation Support: Results from the Netherlands Heart Registration

February 17, 2025 No Comments

This study analyzes venoarterial extracorporeal membrane oxygenation (VA-ECMO) use after infective endocarditis (IE) surgery using Netherlands Heart Registration data (2013–2022). Among 3,468 cases, 1.4% required VA-ECMO, with 49% in-hospital mortality and 60.9% one-year mortality. Despite increased risk factors and complications, VA-ECMO outcomes were comparable to non-IE postcardiotomy VA-ECMO cases, challenging the exclusion of IE patients based on high anticipated mortality.

Outcomes in Children Who Undergo Postcardiotomy Extracorporeal Membrane Oxygenation: A Report From the STS-CHSD

February 8, 2025 No Comments

This study evaluates survival outcomes in children who undergo postcardiotomy extracorporeal membrane oxygenation (ECMO) following congenital heart surgery. Using data from the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD), the study found that ECMO initiation over 48 hours post-surgery correlated with the poorest outcomes. Postoperative septicemia, cardiac arrest, and neurological injury were strongly linked to mortality, while reintubation and unplanned noncardiac reoperation improved survival.