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Category: ECMO

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
ECMO MRI

Clinical Use of Bedside Portable Low-field Brain Magnetic Resonance Imaging in Patients on ECMO: The Results from Multicenter SAFE MRI ECMO Study

This study evaluates the safety and efficacy of ultra-low-field portable MRI (ULF-pMRI) for detecting acute brain injuries in ECMO patients across two academic centers. ULF-pMRI was successfully used in 50 patients, showing good quality images of intracranial pathologies. Adverse events occurred in 6% of cases, demonstrating the procedure’s safety. The incidence of acute brain injury was 44%, with ULF-pMRI providing more sensitive detection of ischemic injuries compared to traditional head CT scans. This suggests ULF-pMRI’s potential in improving clinical care and research on ECMO-associated brain injuries.

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February 8, 2024
Canada ECMO

Utilization of Shock Team and Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) in the Management of Cardiogenic Shock in Northern Ontario

The article reviews the introduction of a specialized shock team and the use of VA-ECMO in Northern Ontario for cardiogenic shock (CS) management. Despite advances, CS outcomes were poor until this new approach, which is now feasible even in remote areas. A study at Health Sciences North in Sudbury evaluated the Impella device and the viability of a shock team to administer VA-ECMO. The results show a significant survival rate and demonstrate the potential to bridge urban-rural healthcare disparities in Ontario.

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February 6, 2024
Infant Cannula

Bedside Repositioning of a Migrated Avalon ECMO Cannula in an Infant: Novel Technique

This article presents a novel bedside method for repositioning a migrated Avalon ECMO cannula in an infant. The Avalon Elite bi-caval dual lumen catheter, essential for veno-venous extracorporeal membranous oxygenation, requires precise placement. The new technique, involving direct access of the ECMO inflow tube with a catheter and guide wire, proved successful in two instances of catheter migration without the need for additional venous access, highlighting an advancement in pediatric critical care.

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February 6, 2024
Mechanical Support

Mechanical Circulatory Support – Primer for Consultant Specialists

This article serves as a primer on mechanical life support therapies, focusing on nonrenal extracorporeal life support for cardiac and pulmonary functions. It targets nephrologist consultants involved in treating critically ill patients, often facing acute renal injury from cardiopulmonary shock and mechanical circulatory support. The review underscores the importance of these life-sustaining tools in managing organ failure, either as a bridge to recovery or as a gateway to more permanent mechanical support solutions.

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February 5, 2024
ECMO 101

Long-Term Outcome in Patients Treated with Veno-Venous Extracorporeal Membrane Oxygenation: A Prospective Observational Study

This prospective observational study at an Italian University Hospital assessed the long-term outcomes of 33 patients treated with VV-ECMO for severe respiratory failure, from January 2018 to May 2021. Follow-up evaluations at 6 and 12 months post-ICU discharge showed good cognitive and psychological outcomes, with improvements in PTSD symptoms, especially among COVID-19 survivors. The study underscores the importance of long-term follow-up and rehabilitation for ICU survivors, highlighting that VV-ECMO patients, including those with COVID-19, have outcomes comparable to ARDS patients managed without ECMO.

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February 4, 2024
Solar ECMO

Venoarterial Extracorporeal Membrane Oxygenation for Cardiopulmonary Resuscitation: A Retrospective Study Comparing Outcomes with Fluoroscopy

This study investigates the impact of using fluoroscopy during venoarterial extracorporeal membrane oxygenation (VA-ECMO) for out-of-hospital cardiac arrest on vascular complications. Comparing procedures performed in the emergency department without fluoroscopy to those transferred to a fluoroscopy room, the research found a significant reduction in vascular complications with fluoroscopy-guided ECMO, without extending the time to ECMO initiation. These findings support fluoroscopy’s role in enhancing patient safety during ECMO, indicating that even when the emergency department and fluoroscopy room are distant, utilizing fluoroscopy does not delay treatment.

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February 4, 2024
LivaNova Protek

ProtekDuo Percutaneous Ventricular Support System: Physiology and Clinical Applications

The ProtekDuo cannula is a dual-lumen device used for right ventricular (RV) mechanical circulatory support (MCS) and extracorporeal membrane oxygenation (ECMO) support when connected to a pump and oxygenator. Inserted via the right internal jugular vein, it improves pulmonary flow, left atrial filling pressures, and left ventricular preload in RV failure cases. This review covers its clinical applications in managing critically ill patients, including RV myocardial infarction, LV assist device implantation-associated RVF, post-heart transplantation, and post-lung transplantation care. The ProtekDuo system’s easy deployment, mobility, and compatibility with various pumps and oxygenators highlight its significance in RVF management and the need for further research to optimize its use.

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February 4, 2024
ECMO Color

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

This simple review details the evolution of Extracorporeal Membrane Oxygenation (ECMO) as a crucial life-support intervention in critical care, highlighting its history, technological advancements, and significant role in treating severe respiratory or cardiac failure. It emphasizes the importance of patient selection, management strategies for complications, and ECMO’s contribution to improving survival rates, mobility, and the application of remote medical expertise, marking it as a key innovation in critical care.

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February 4, 2024
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