International Perfusion Association

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IPA

Category: ECMO

Shock

Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock

This study analyzes 39,864 patients with infarct-associated cardiogenic shock (AMICS), comparing outcomes between those treated with mechanical circulatory support devices (tMCS) like IABP, Impella, and V-A ECMO, versus standard care alone. Findings indicate higher in-hospital complications and mortality rates in patients receiving V-A ECMO and Impella compared to those treated with IABP or no tMCS. IABP use was associated with a survival benefit, highlighting the need for careful device selection in managing AMICS.

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February 27, 2024
ECMO

A Descriptive Analysis of Hybrid Cannulated Extracorporeal Life Support

This study examines the use of hybrid extracorporeal life support (ECLS) systems, which incorporate a third cannula for cases where traditional cannulation methods are insufficient. Analyzing data from 28 out of 903 ECLS procedures at the University Hospital Zurich from 2007 to 2019, the research found a 3.1% implementation rate for hybrid ECLS, with a notably high in-hospital mortality rate of 67.9%. Mortality varied significantly across indications such as ARDS, refractory cardiogenic shock, and cardiopulmonary resuscitation. Survivors tended to have lower SAPS II scores and required fewer platelet transfusions, underscoring the importance of careful patient selection for this procedure.

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February 26, 2024
COVID-19 Cost

Healthcare-Associated Infections in Patients with Severe COVID-19 Supported with Extracorporeal Membrane Oxygenation: A Nationwide Cohort Study

This study investigates the incidence and microbiology of healthcare-associated infections (HAI) in severe COVID-19 patients receiving extracorporeal membrane oxygenation (ECMO) support, analyzing data from 701 patients in France. It found a 36% incidence rate of ECMO-associated infections (ECMO-AI), with bloodstream infections and ventilator-associated pneumonia being the most common. The infections were primarily caused by Enterobacteriaceae, Enterococcus species, and non-fermenting Gram-negative bacilli. Interestingly, the study concludes that ECMO-AI were not significantly associated with hospital death rates.

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February 24, 2024
ECMO

Left-Ventricular Unloading With Impella During Refractory Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis evaluates the efficacy of left-ventricular (LV) unloading with Impella, compared to standard venoarterial extracorporeal membrane oxygenation (VA-ECMO), during extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest. Analyzing data from 1014 patients across 32 hospitals, the study finds that ECMELLA (combined Impella and VA-ECMO) is associated with improved survival and neurological outcomes, especially in patients with acute myocardial infarction, compared to VA-ECMO alone. Despite a higher rate of complications, ECMELLA shows promise in enhancing patient recovery, underscoring the need for standardized guidelines for its use in ECPR.

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February 22, 2024
ECMO 3

Extracorporeal Cardiopulmonary Resuscitation for Refractory Cardiac Arrest: An Overview of Current Practice and Evidence

This narrative review explores the use of extracorporeal cardiopulmonary resuscitation (ECPR) for refractory cardiac arrest (CA), highlighting its role in providing haemodynamic and respiratory stabilization when conventional CPR fails. With the potential to reduce low-flow time and improve neurological outcomes, ECPR has shown promise in certain patient categories facing out-of-hospital cardiac arrest (OHCA). The possibility of pre-hospital implementation to minimize brain damage is being explored, with the ON-SCENE trial expected to offer new insights. This overview presents recent developments in ECPR, aiming to shed light on its effectiveness and integration into advanced cardiac life support protocols.

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February 21, 2024
EMCO 2

Adding Extracorporeal Membrane Oxygenation to Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest Due to Pulmonary Embolism: A Case Report

This case report presents a life-saving intervention for a 21-year-old woman experiencing out-of-hospital cardiac arrest (OHCA) due to pulmonary embolism, following a lower limb fracture. The rapid application of extracorporeal membrane oxygenation (ECMO) alongside cardiopulmonary resuscitation (CPR) and systemic thrombolysis significantly contributed to her survival. Despite facing severe complications, the collaborative effort of a multidisciplinary medical team, including vascular surgery and interventional radiology, played a crucial role in her recovery without deficits. This highlights the importance of ECMO in enhancing survival rates in critical care, especially in cases complicated by massive pulmonary embolism.

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February 21, 2024
Cannulae

Flow Characterization of Maquet and Bio-Medicus Multi-Stage Drainage Cannulae During Venoarterial Extracorporeal Membrane Oxygenation

This study employs computational fluid dynamics (CFD) to analyze the flow characteristics of Maquet and Bio-Medicus drainage cannulae used in venoarterial extracorporeal membrane oxygenation (VA ECMO). Through 3D modeling and turbulence simulation, the research identifies significant differences in flow dynamics and thrombosis risk between the two cannula designs. The Bio-Medicus model, in particular, showed a higher stagnant blood volume, suggesting an increased thrombosis risk. These findings underline the importance of cannula design in optimizing VA ECMO therapy and reducing complications.

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February 20, 2024
ECPELLA

The Impact of ECPELLA on Haemodynamics and Global Oxygen Delivery: A Comprehensive Simulation of Biventricular Failure

This study explores ECPELLA, combining veno-arterial extracorporeal membrane oxygenation (ECMO) and Impella, for severe cardiogenic shock treatment. Through comprehensive simulation, it examines ECPELLA’s effects on haemodynamics and global oxygen delivery in biventricular failure scenarios. Findings reveal ECPELLA enhances systemic flow and achieves biventricular unloading, with veno-venous ECMO further improving oxygen delivery. Optimizing ECPELLA support is crucial for maximizing benefits in severe cardiogenic shock and acute respiratory failure cases.

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February 19, 2024
Heparin ECMO

Anticoagulation Management in V-V ECMO Patients: A Multidisciplinary Pragmatic Protocol

This article presents a comprehensive review and a pragmatic protocol for anticoagulation management in patients undergoing veno-venous extracorporeal membrane oxygenation (V-V ECMO), as practiced in a high-volume ECMO Referral Centre. It underscores the variability in anticoagulation practices among centers, attributed to the lack of high-quality data for personalizing management. The protocol advocates for a tailored approach to anticoagulation and monitoring, utilizing a range of laboratory tests such as anti-Xa, aPTT, ACT, viscoelastic tests, AT levels, platelet count, fibrinogen, and FXIII levels. The goal is to balance the risk of thrombosis and bleeding by personalizing anticoagulation regimens based on a comprehensive evaluation of coagulation status.

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February 13, 2024
VV ECMP

Relationship between the Pre-ECMO and ECMO Time and Survival of Severe COVID-19 Patients: A Systematic Review and Meta-Analysis

This meta-analysis explores the impact of pre-ECMO timing and ECMO duration on the survival of severe COVID-19 patients, analyzing 54 studies involving 13,691 patients. Results indicate significant differences in pre-ECMO intervals between survivors and non-survivors, without a direct linear relationship between longer pre-ECMO times and mortality risk. The study highlights the need for further research to understand the optimal timing for ECMO initiation in severe COVID-19 cases, as current evidence does not conclusively link extended pre-ECMO periods with decreased survival rates.

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February 12, 2024
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