Clinical Management of Venoarterial Extracorporeal Membrane Oxygenation

Hoyler, Marguerite; Flynn, Brigid C.; Iannacone, Erin; Jones, Mandisa‐Maia; Ivascu, Natalia S.

doi:10.1053/j.jvca.2019.12.047

Cited by 20 publications

(18 citation statements)

References 85 publications

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“… 9 , 10 However, conventional ECMO is conducted under MV and sedation; various complications may emerge during prolonged MV and sedation, including pneumothorax, increased risk of infection, ventilator-induced lung injury, systemic inflammation, and neurological complications. 11 , 12 In addition, pneumonia and ARDS caused by COVID-19 show an unusual pattern of disease progression. Lung inflammation and tissue destruction arise from the lower airways and involve the alveoli, and features of pulmonary edema and hyaline membrane formation cause a restrictive lung pattern.…”

Section: Discussionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Treated With Awake Extracorporeal Membrane Oxygenation in a Patient With COVID-19 Pneumonia

Yin

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionmentioning

confidence: 99%

Acute Respiratory Distress Syndrome Treated With Awake Extracorporeal Membrane Oxygenation in a Patient With COVID-19 Pneumonia

Yin

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…3,4 In addition, because of a relatively complex management, various complications may occur during ECMO support. 5,6 Abdominal computed tomography revealed a large cystic retroperitoneal mass, with extravasation of contrast consistent with a retroperitoneal hematoma. The patient remained hypotensive despite volume resuscitation with crystalloid and packed red blood cell transfusion.…”

Section: Diagnosis: Giant Retroperitoneal Hematoma Formationmentioning

confidence: 99%

Giant Retroperitoneal Hematoma During Extracorporeal Membrane Oxygenation in a Patient With Coronavirus Disease-2019 Pneumonia

Guo

Zhu

2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…Akin et al identified an association between microcirculation and successful weaning from VA-ECMO in late weaning process (11), but no study has reported the effects of changes in pump flow on microcirculation at early stage of VA-ECMO support. In current clinical practice, VA-ECMO pump flow is adjusted by achieving preset goals of macro-hemodynamic parameters like mean arterial pressure (MAP) and pulse pressure (12,13). However, dissociation between sublingual microcirculation and macrocirculation has been observed in shock states (7,14), and microcirculatory dysfunction can co-exist with normal macrocirculatory parameters (10).…”

Section: Introductionmentioning

confidence: 99%

Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow: A Prospective Observational Study

et al. 2021

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Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) pump flow is crucial for maintaining organ perfusion in patients with cardiogenic shock, but VA-ECMO pump flow optimization remains as a clinical challenge. This study aimed to investigate the response of sublingual microcirculation to changes in VA-ECMO pump flow.Methods: Sublingual microcirculation was measured before and after changing VA-ECMO pump flow according to the treatment plan of ECMO team within 24 h and at 24-48 h after VA-ECMO placement. In clinical events of increasing VA-ECMO pump flow, those events with increased perfused vessel density (PVD) were grouped into group A, and the others were grouped into group B. In clinical events of decreasing VA-ECMO pump flow, those events with increased PVD were grouped into group C, and the others were grouped into group D.Results: Increased PVD was observed in 60% (95% CI, 38.5–81.5%) of the events with increasing VA-ECMO pump flow. The probability of increasing PVD after increasing VA-ECMO pump flow were higher in the events with a PVD < 15 mm/mm2 at baseline than those with a PVD ≥ 15 mm/mm2 [100% (95% CI, 54.1–100%) vs. 42.9% (95% CI, 17.7–71.1%), P = 0.042]. Other microcirculatory and hemodynamic parameters at baseline did not differ significantly between group A and B or between group C and D.Conclusion: This study revealed contradictory and non-contradictory responses of sublingual microcirculation to changes in VA-ECMO pump flow. Tandem measurements of microcirculation before and after changing VA-ECMO pump flow may help to ensure a good microcirculation.

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Clinical Management of Venoarterial Extracorporeal Membrane Oxygenation

Cited by 20 publications

References 85 publications

Acute Respiratory Distress Syndrome Treated With Awake Extracorporeal Membrane Oxygenation in a Patient With COVID-19 Pneumonia

Acute Respiratory Distress Syndrome Treated With Awake Extracorporeal Membrane Oxygenation in a Patient With COVID-19 Pneumonia

Giant Retroperitoneal Hematoma During Extracorporeal Membrane Oxygenation in a Patient With Coronavirus Disease-2019 Pneumonia

Microcirculatory Response to Changes in Venoarterial Extracorporeal Membrane Oxygenation Pump Flow: A Prospective Observational Study

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