Are Contraindications to Extracorporeal Membrane Oxygenation Slowly Vanishing?

Betit, Peter

doi:10.4187/respcare.01407

Cited by 2 publications

(8 citation statements)

References 8 publications

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“…Traditionally, artificial circuits in which blood circulates outside the vascular system and back into the body require substantial anticoagulation to counteract the thrombogenic effect of the material from which tubes and membranes are made. However, in recent years, progress has been made in making these materials much more biosimilar so that they inhibit coagulation in a way that is close to the normal endothelium [ 10 , 11 , 12 ]. Moreover, coagulation happens way less in circuits that run with high flow rates such as ECMO circuits than in circuits that run with lower flow rates such as in renal replacement therapy.…”

Section: Factors Excluded As Contraindications/additional Contraindications Onlymentioning

confidence: 99%

“…Furthermore, this increase is supported by improvements in ECMO devices and systems that not only simplify use, but lead to improved biocompatibility through improved circuit materials and their composition [ 10 , 11 , 12 , 13 , 14 ]. With the technical issues largely resolved and increasing experience in clinical management, the biggest challenge today is selecting the right candidates for vvECMO, i.e., those who will benefit most from this invasive treatment.…”

Section: Introductionmentioning

confidence: 99%

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Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Harnisch

Moerer

2021

Membranes

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(1) Background: Extracorporeal membrane oxygenation (ECMO) is increasingly used for acute respiratory failure with few absolute but many relative contraindications. The provider in charge often has a difficult time weighing indications and contraindications to anticipate if the patient will benefit from this treatment, a decision that often decides life and death for the patient. To assist in this process in coming to a good evidence-based decision, we reviewed the available literature. (2) Methods: We performed a systematic review through a literature search of the MEDLINE database of former and current absolute and relative contraindications to the initiation of ECMO treatment. (3) Results: The following relative and absolute contraindications were identified in the literature: absolute—refusal of the use of extracorporeal techniques by the patient, advanced stage of cancer, fatal intracerebral hemorrhage/cerebral herniation/intractable intracranial hypertension, irreversible destruction of the lung parenchyma without the possibility of transplantation, and contraindications to lung transplantation; relative—advanced age, immunosuppressed patients/pharmacological immunosuppression, injurious ventilator settings > 7 days, right-heart failure, hematologic malignancies, especially bone marrow transplantation and graft-versus-host disease, SAPS II score ≥ 60 points, SOFA score > 12 points, PRESERVE score ≥ 5 points, RESP score ≤ −2 points, PRESET score ≥ 6 points, and “do not attempt resuscitation” order (DN(A)R status). (4) Conclusions: We provide a simple-to-follow algorithm that incorporates absolute and relative contraindications to the initiation of ECMO treatment. This algorithm attempts to weigh pros and cons regarding the benefit for an individual patient and hopefully assists caregivers to make better, informed decisions.

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Section: Factors Excluded As Contraindications/additional Contraindications Onlymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Harnisch

Moerer

2021

Membranes

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“…As centers gathered experience and ECMO systems improved, applications expanded, including pediatric and adult patients with respiratory and cardiac failure [2]. The hospital survival rates with these applications have not been as favorable as were those with the early neonatal experience.…”

Section: Introductionmentioning

confidence: 99%

“…The hospital survival rates with these applications have not been as favorable as were those with the early neonatal experience. However, the populations are more heterogeneous and include many diagnoses and comorbidities [2]. Nonetheless, survival rates such as 50-60% for pediatric and adult respiratory failure and 30-40% in ECMO cardiopulmonary resuscitation (CPR) support the use of ECMO beyond its proven niche [2].…”

Section: Introductionmentioning

confidence: 99%

“…However, the populations are more heterogeneous and include many diagnoses and comorbidities [2]. Nonetheless, survival rates such as 50-60% for pediatric and adult respiratory failure and 30-40% in ECMO cardiopulmonary resuscitation (CPR) support the use of ECMO beyond its proven niche [2]. Today ECMO is used in many institutions across the country.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Extracorporeal Membrane Oxygenation in Adults

A¹

2023

Int J Respir Pulm Med

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Background: With patients for whom it is difficult or near impossible to maintain adequate oxygenation by conventional means, it may become necessary to oxygenate the blood outside the body. One method used with moderate success is the procedure of extracorporeal membrane oxygenation (ECMO). The purpose of this study was to determine the effectiveness of ECMO in adult patients suffering from conditions associated with respiratory failure that is refractory to conventional means of treatment.Methods: A systematic review of available studies was utilized to answer the earlier research questions. Reputable research journals were combed for articles pertaining to ECMO use in adult, pediatric, and neonatal populations and their effectiveness. Included in this study were articles that met the eligibility criteria. Relevant information was summarized and applied to the research questions.Results: Ten Studies were identified for analysis (3 neonatal, 3 pediatric, and 4 adult). Each study showed a benefit in survivability from the use of extracorporeal life support (ECLS) in conditions of respiratory failure that was deemed refractory to conventional means of treatment. The Extracorporeal Life Support Organization (ELSO) registry contained the most comprehensive data, with the neonatal population being the most robust, followed by the pediatric and adult populations respectively. Neonatal indications for ECLS administration were less difficult to reverse than are adult conditions. Conclusion:Though not as effective as the pediatric and neonatal populations, adult ECLS was still determined to have some effectiveness. The indication or diagnosis played a significant role in the utilization and effectiveness of ECLS. Complications associated with the use of ELSC were of great concern for all patient populations. The adult population had a higher incidence of infection, cannula site bleeding, and surgical site bleeding than neonatal and pediatric populations. As the technology continues to evolve and the practice of ECLS use in adults continues to progress and increase, there is a potential to realize increasing effectiveness.

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Are Contraindications to Extracorporeal Membrane Oxygenation Slowly Vanishing?

Cited by 2 publications

References 8 publications

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Contraindications to the Initiation of Veno-Venous ECMO for Severe Acute Respiratory Failure in Adults: A Systematic Review and Practical Approach Based on the Current Literature

Effectiveness of Extracorporeal Membrane Oxygenation in Adults

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