Improving ECMO Therapy: Monitoring Oxygenator Functionality and Identifying Key Indicators, Factors, and Considerations for Changeout

April 4, 2024 No Comments

This article reviews the crucial aspects of determining the optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-outs to enhance patient outcomes in severe cardiopulmonary failure management. It emphasizes the significance of monitoring coagulation parameters, gas exchange, fibrinogen levels, blood gases, plasma-free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. The article highlights thrombosis within the membrane oxygenator as a major concern and underlines the importance of a multidisciplinary team and thorough preparation in the change-out process, advocating for standardized protocols and personalized anticoagulation approaches to optimize ECMO therapy.

Challenges in the Monitoring of Therapeutic Plasma Exchange during Acute Heparin-Induced Thrombocytopenia in Adults under ECMO

March 29, 2024 No Comments

This study reports on the complex process of managing therapeutic plasma exchange (TPE) in patients with acute heparin-induced thrombocytopenia (HIT) on extracorporeal membrane oxygenation (ECMO), aiming to remove HIT antibodies for thoracic surgery. It highlights two cases where repeated TPE sessions allowed for successful surgery with brief heparin re-exposure, despite challenges in monitoring HIT antibody titers and platelet activation. The study emphasizes the necessity of serial HIT screening, including immunological and functional assays, and suggests that adding platelet factor 4 (PF4) to the heparin-induced platelet activation assay (HIPA) could improve detection of platelet-activating antibodies, aiding in the management of HIT in ECMO patients.

Survival and Neurological Function in Patients Treated with ECMO and Therapeutic Hypothermia: Protocol for an Updated Systematic Review

March 27, 2024 No Comments

This article outlines an updated protocol for a systematic review focused on evaluating the effects of extracorporeal membrane oxygenation (ECMO) and therapeutic hypothermia on survival rates and neurological function in cardiac arrest patients. Despite the widespread application of ECMO enhancing clinical outcomes, its effectiveness remains limited. Therapeutic hypothermia, aimed at maintaining body temperatures between 32°C and 36°C, offers potential neuroprotection and improved survival but is still controversial. This review aims to clarify these interventions’ impacts by systematically searching major databases and analyzing data from a variety of study designs.

Impact of ECMO-Related Complications on In-Hospital Mortality: A Single-Center Retrospective Study

March 26, 2024 No Comments

This study examines the association between complications arising from Extracorporeal Membrane Oxygenation (ECMO) treatment and in-hospital mortality among adult patients. It involves a retrospective analysis of 856 ECMO interventions, revealing that vascular and cerebrovascular complications occurred in 20.2% and 13.6% of cases, respectively. The overall in-hospital mortality rate was 48.7%. Surprisingly, the analysis found no significant correlation between ECMO-related complications and an increased risk of in-hospital death, suggesting that while ECMO complications are prevalent, they do not independently contribute to patient mortality.

Intra-Aortic Balloon Pump in VA-ECMO Patients: Insights from the Chinese Extracorporeal Life Support Registry

March 26, 2024 No Comments

This study from the Chinese Extracorporeal Life Support (CSECLS) registry explored the effectiveness of using an intra-aortic balloon pump (IABP) alongside venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients undergoing treatment for refractory cardiogenic shock or cardiac arrest. Covering data from over 112 member centers, the study analyzed outcomes of 4,755 patients, comparing those who received VA-ECMO with IABP to those who did not. Findings indicated no significant difference in in-hospital mortality rates between the two groups, though IABP use was associated with higher incidences of continuous renal replacement therapy (CRRT) and limb ischemia. These results suggest that while IABP use does not reduce mortality in VA-ECMO patients, it may lead to increased complications, calling for further research and careful clinical decision-making.

Mortality in Patients with Normal LV Function Requiring Emergency VA-ECMO for Postcardiotomy Cardiogenic Shock

March 22, 2024 No Comments

This retrospective study examines outcomes in patients with normal preoperative left ventricular ejection fraction (LVEF) who required venoarterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy cardiogenic shock (PCCS) related to coronary malperfusion. Among 62,125 cardiac surgeries, 59 patients with normal LVEF needed VA-ECMO due to coronary malperfusion-related PCCS, showing a 30-day mortality rate of 50.8%. Complications were common, and factors like lactate levels >9.9 mmol/l before VA-ECMO, delay in revascularization, and peripheral arterial disease were significant mortality predictors. Early VA-ECMO initiation and revascularization are crucial for survival.

Scrutinizing Mechanical Circulatory Support in Cardiogenic Shock: Have We Jumped the Gun?

March 20, 2024 No Comments

This article examines the efficacy of mechanical circulatory support (MCS) systems, like veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella devices, in treating cardiogenic shock (CS). Despite their increasing use and endorsement in ESC and AHA/ACC guidelines based on observational studies, the article highlights a critical gap: the lack of clear mortality benefit from randomized controlled trials. This gap calls for a reassessment of the current evidence supporting MCS in CS, suggesting that enthusiasm for these technologies might have outpaced their proven clinical value. The article advocates for a careful reflection on the existing evidence to better understand the role of MCS in CS management.

Temporary Extracorporeal Life Support: Single-Center Experience with a New Concept

March 17, 2024 No Comments

This study explores the efficacy of a novel ECMELLA setup combining veno-arterial extracorporeal membrane oxygenation (va-ECMO) with a micro-axial flow pump in treating cardiogenic shock (CS). Analyzing data from 67 patients treated between December 2020 and December 2022, the study found the technique feasible and effective, with a 27% myocardial recovery rate and a 24% transition rate to durable LVADs. Despite a 49% mortality rate on support, the single-artery cannulation approach showed relatively low access-related complications. This single-center experience suggests ECMELLA 2.0/2.1 as a promising therapy for severe CS with a focus on reducing complications related to access sites.

Rates, Outcomes, and Resource Burden of Extracorporeal Membrane Oxygenation Use in Hospitalizations in the United States During the Pandemic

March 16, 2024 No Comments

This study characterizes the burden and outcomes of ECMO use in U.S. hospitalizations during the pandemic, analyzing 17,520 cases from the National Inpatient Sample between 2019 and 2020. It highlights a significant increase in ECMO utilization, with a marked impact on inpatient mortality, length of hospital stay, and healthcare costs. Predominantly affecting patients with circulatory and respiratory diseases, ECMO hospitalizations showed a higher mortality rate (43.1%) compared to non-ECMO cases (2.1%), with an average hospital stay of 26 days and an average cost of US$967,647 per case. Factors like Hispanic descent, higher CCI score, age over 60, and a higher APRDRG risk were associated with increased mortality.

Identifying and Mitigating Risk of Post-Cardiotomy Cardiogenic Shock in Patients with Ischemic and Non-Ischemic Cardiomyopathy

March 14, 2024 No Comments

This study aimed to identify preoperative predictors of post-cardiotomy cardiogenic shock in patients with ischemic and non-ischemic cardiomyopathy, focusing on 238 patients undergoing cardiac surgery. It found that pulmonary artery pulsatility index and pulmonary capillary wedge pressure were key predictors, with the predictors varying between ischemic and non-ischemic conditions. The study highlights the importance of preoperative right heart catheterization in identifying patients at higher risk of cardiogenic shock. Ejection fraction improvements were noted at 12 months post-surgery.