Emergency department extracorporeal membrane oxygenation may also include noncardiac arrest patients

Abstract

Background/aim: The primary purpose of this study is to report the experience on the extracorporeal membrane oxygenation (ECMO) process for patients in the critical care unit (CCU) of an Emergency Department of a tertiary hospital in Turkey, from cannulation to decannulation, including follow-up procedures. Materials and Methods: This retrospective, observational study included eight patients who received Extracorporeal Membrane Oxygenation from Jan 2018-Jan 2020. We evaluated the demographics, indications for ECMO, laboratory values, Respiratory ECMO Survival Prediction, Survival After Veno-Arterial ECMO and ECMOnet scores, the management process, and patient outcomes. Blood gas analyses from after the first hour of ECMO initiation and the re-evaluation of the patients' Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores at the 24 th hour of ECMO were recorded. Results: The mean age was 52.7 ± 14.2 years. The median duration of the ECMO run was 81 (min-max: 4-267) hours, and the mean length of CCU stay was 10.2 ± 6.7 days. Of the 8 patients studied, 5 (62.5%) had veno-arterial and 3 (37.5%) had veno-venous ECMO. Three patients were successfully weaned (37.5%). The overall survival-to-discharge rate was 25%. Carbon dioxide levels were significantly decreased 1 hour after ECMO initiation (p=0.038) as well as the need for vasopressors. Lactate levels were lower in decannulated patients. Changes in the 2 APACHE II score were more consistent with the clinical deterioration in patients than were SOFA score changes. Conclusions: In the early phase of ECMO, vital signs improve, and the need for vasopressors and carbon dioxide levels decreases. Thus, CCUs in Emergency Departments with ECMO capabilities could potentially be designed, and emergency department ECMO algorithms could be tailored for critically ill in addition to outof-hospital cardiac arrest (OHCA) patients.

Efficacy of a single‐day task trainer–based extracorporeal membrane oxygenation training course

“…Recently, a study was prematurely terminated by reviewers given that survival in the ECMO arm was greater compared to therapy (33% vs. 7%) and thus, enrollment of patients into the control arm was considered unethical 13 . The coronavirus disease 2019 (COVID‐19) pandemic resulted in a significant increase in ECMO demand worldwide and the initiation of ECMO in emergency departments, despite a sufficient number of ECMO specialty teams 14–18 …”

“…13 The coronavirus disease 2019 (COVID-19) pandemic resulted in a significant increase in ECMO demand worldwide and the initiation of ECMO in emergency departments, despite a sufficient number of ECMO specialty teams. [14][15][16][17][18] When a trauma patient is received at the hospital, handoff primarily occurs in the Emergency Department from Emergency Medical Services (EMS) to Emergency Medicine (EM) and Critical Care (CC) physicians and staff. It is there that the EM team will need to identify the need for ECMO, call for the ECMO team, and act quickly to initiate ECMO, especially if the ECMO specialty team is not nearby.…”