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.

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

November 24, 2024 No Comments

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.

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

November 3, 2024 No Comments

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.

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

October 5, 2024 No Comments

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.

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

September 29, 2024 No Comments

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.

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

September 28, 2024 No Comments

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.

Standardized Therapies After ECMO Program (STEP): A Novel Approach to Pediatric Post-ECMO Care

September 27, 2024 No Comments

This study evaluated the effectiveness of the Standardized Therapy after ECMO Program (STEP), a structured discharge pathway for pediatric ECMO survivors. It compared compliance with post-ECMO care guidelines before and after STEP implementation in a U.S. pediatric hospital. After STEP, compliance increased for neurodevelopmental testing, neurology and audiology evaluations, and referrals for therapy services. The program significantly improved both inpatient and outpatient follow-up, ensuring comprehensive post-ECMO care.

Extraction of Ketamine and Dexmedetomidine by Extracorporeal Life Support Circuits

September 26, 2024 No Comments

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.