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Category: ECMO

Lung Transplant

Protocol for Venoarterial Extracorporeal Membrane Oxygenation to Reduce Morbidity and Mortality Following Bilateral Lung Transplantation: The ECMOToP Randomised Controlled Trial

The ECMOToP trial aims to evaluate the effectiveness of two VA-ECMO initiation strategies in patients undergoing bilateral lung transplantation for obstructive or restrictive lung diseases. This multicentre randomised controlled trial contrasts an ‘on-demand’ approach, where VA-ECMO is initiated based on specific hemodynamic and respiratory needs, with a ‘systematic’ strategy of preemptive initiation. The primary endpoint is the number of ventilator-free days at day 28, with secondary endpoints including organ failure occurrence, vital status at day 28, day 90, and year 1, along with adverse events. This research endeavors to establish a more effective protocol for VA-ECMO initiation, potentially improving survival and quality of life for lung transplant recipients.

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March 10, 2024
Toe Tag

Using Extracorporeal Membrane Oxygenation in Donations After Cardiac Death or Brain Death: A Single-Center Experience and Long-Term Outcome

This study explores the impact of using extracorporeal membrane oxygenation (ECMO) in liver transplants from donors after cardiac death (DCD) or brain death (DBD). Conducted as a retrospective study from January 2006 to December 2019 at a single center, it included 90 deceased donor liver transplants. The findings indicate no significant survival rate differences between the DBD and DCD groups with ECMO support. However, the DCD with ECMO group showed significant differences in warm and cold ischemia times and bilirubin levels compared to the DBD group. The study underscores ECMO’s role in enhancing the liver graft pool, contributing to 35.6% of liver transplants, with 5-year survival rates being 78.1% for DBD, 90.9% for DBD with ECMO, and 75.6% for DCD with ECMO groups.

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March 10, 2024
Aortic Flow

Aortic Arch Blood Flow Measurements as a Predictor of Successful ECMO Weaning in Cardiogenic Shock

This explorative pilot study investigates the role of aortic arch blood flow measurements, using ultrasonic cardiac output monitoring (USCOM), in predicting successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with acute cardiogenic shock. Including 12 patients eligible for a stepwise weaning process, the study found that peak velocity of flow in the aortic arch positively correlates with weaning success, independent of ECMO flow rates. While mean pressure gradient, minute distance, and stroke volume index showed only trends, the study suggests USCOM could complement current strategies by predicting weaning outcomes and preventing pulmonary congestion. Further research is needed to confirm these findings and establish standardized weaning protocols.

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March 9, 2024
Korea

Risk Factors for the Mortality of Patients With Coronavirus Disease 2019 Requiring Extracorporeal Membrane Oxygenation in a Non-Centralized Setting: A Nationwide Study

This nationwide study in Korea explored the mortality risk factors for COVID-19 patients needing Extracorporeal Membrane Oxygenation (ECMO) support across 19 hospitals from January 2020 to August 2021. Of 127 patients, 55.1% died within 90 days post-ECMO initiation. The study identified older age and the need for continuous renal replacement therapy (CRRT) as significant mortality risk factors. The research underscores the critical impact of age and CRRT on COVID-19 patient outcomes with ECMO, highlighting the need for tailored management strategies in these high-risk groups.

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March 8, 2024
ECMO Summary

A Comprehensive Review of Extracorporeal Membrane Oxygenation: The Lifeline in Critical Moments

Extracorporeal membrane oxygenation (ECMO) emerges as a crucial lifesaver in critical care for patients with severe respiratory or cardiac failure. This review delves into ECMO’s journey from its inception to the cutting-edge advancements and its profound impact in critical care. It highlights ECMO’s versatility in treating diverse conditions, the importance of patient selection, and managing complications. Technological progress, including miniaturization, innovative circuit designs, and remote monitoring, illustrates the evolving ECMO landscape. The article underscores ECMO’s significant role in enhancing survival rates, mobility, and leveraging remote expertise, portraying it as a beacon of hope and innovation in redefining life support boundaries.

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March 7, 2024
ECPR ECMO

Prognostic Effects of CPR Start Time and Interval Between CPR to ECPR on Patient Outcomes Under ECMO: A Single-Center, Retrospective Observational Study

This study investigates the impact of the time from collapse to the start of CPR (NFT) and from the start of CPR to ECPR (LFT) on patient outcomes with ECMO in cardiac arrests. Conducted on 48 patients at Hamad General Hospital, Qatar, from 2016 to 2020, it found that longer NFT is associated with worse outcomes, such as longer CPR durations and lower survival rates, while longer LFT primarily affected CPR duration. This suggests NFT is a better predictor of clinical outcomes for patients undergoing ECMO after cardiac arrest, highlighting the importance of timely medical intervention.

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March 7, 2024
Lactate ECMO

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation

This retrospective study evaluated the impact of lactate levels and lactate clearance on mortality in patients under 18 who required venoarterial ECMO support after surgery for congenital heart defects. Analyzing 55 patients from 1,844 congenital heart surgeries, it found that lower lactate levels at the 6th, 12th, and 24th hours and higher lactate clearance at the 24th hour were significantly associated with successful weaning from ECMO and lower mortality. Lactate levels ≥2.9 and lactate clearance ≤69.44% were predictive of mortality, highlighting the importance of these factors in managing ECMO patients.

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March 4, 2024
Heparin Vs.

Comparison of Bivalirudin Versus Heparin for Anticoagulation During Extracorporeal Membrane Oxygenation

This systematic review and meta-analysis evaluated the efficacy and safety of bivalirudin compared to heparin in patients undergoing extracorporeal membrane oxygenation (ECMO). After reviewing eleven studies focusing on short-term mortality, findings revealed that bivalirudin is associated with significantly lower short-term mortality than heparin, with an odds ratio of 0.71. This suggests bivalirudin may be a preferable anticoagulant for patients on ECMO, though further prospective research is needed to confirm these results.

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March 3, 2024
ECMO Risk

A Risk Score for Predicting Extracorporeal Membrane Oxygenation Support Before Lung Transplantation

This study introduces a risk score model to predict the necessity for extracorporeal membrane oxygenation (ECMO) support during lung transplantation. Developed through the analysis of 248 patients’ data from 2016 to 2021, the model uses factors like primary disease diagnosis, pulmonary artery pressure, sex, surgical type, and specific biomarkers to forecast ECMO need. Its effectiveness is confirmed through robust statistical methods, offering a tool for identifying patients at various risk levels for requiring intraoperative ECMO, thereby facilitating better clinical decision-making.

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March 1, 2024
Lung ECMO

Severe Lung Dysfunction and Pulmonary Blood Flow during Extracorporeal Membrane Oxygenation

This retrospective study explores the role of echocardiography in assessing pulmonary damage and its correlation with outcomes in ECMO patients with septic shock of pulmonary origin. Among 277 patients screened, 9 had both CT and echocardiography performed. The findings suggest that CT scans were ineffective in differentiating viable lung parenchyma between survivors and non-survivors. However, echocardiography revealed significant differences in pulmonary blood flow (PBF) changes, indicating its potential as a predictive tool for pulmonary recovery in ECMO-treated patients. Specifically, non-survivors experienced a marked decline in PBF, suggesting its utility in prognostication.

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February 29, 2024
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