Extracorporeal life support for acute respiratory distress syndromes

Hayes, Don; Tobias, Joseph D.; Kukreja, Jasleen; Preston, Thomas J.; Yates, Andrew R.; Kirkby, Stephen; Whitson, Bryan A.

doi:10.4103/1817-1737.114290

Cited by 11 publications

(6 citation statements)

References 97 publications

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“…1 The 2 principal modes of ECMO allow either combined cardiovascular and respiratory support by venoarterial (VA) access or sole respiratory support by venovenous (VV) access. 2 Although patients often reach respiratory or hemodynamic stability within the first few days after ECMO initiation, the early initiation of enteral nutrition (EN) in pediatric ECMO and reaching caloric goals remain significant clinical challenges. Barriers identified in initiating EN in the context of neonatal and pediatric ECMO include underlying diagnosis (severe sepsis, shock, etc) and vasopressor requirement.…”

Section: Introductionmentioning

confidence: 99%

Impact of Early Initiation of Enteral Nutrition on Survival During Pediatric Extracorporeal Membrane Oxygenation

Greathouse

Sakellaris

Tumin

et al. 2017

J Parenter Enteral Nutr

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Introduction: Pediatric data related to safety, tolerance, and outcomes of enteral nutrition (EN) for patients requiring extracorporeal membrane oxygenation (ECMO) are lacking. The objectives of this study were to evaluate early nutrition status and timing of EN initiation on survival during pediatric ECMO.Methods: A single center institutional review board–approved retrospective chart review was performed on all pediatric patients requiring ECMO from October 2008 through December 2013. Demographics, ECMO variables, laboratory values, vasoactive inotropic score (VIS), and nutrition data on day 5 (d5) were collected. Patients receiving parenteral nutrition (PN) were compared with those receiving any EN on d5. Analyses were conducted to identify factors influencing survival to completion of ECMO and to discharge.Results: Forty‐nine patients aged 53 ± 76 months met inclusion criteria. Kaplan‐Meier curves demonstrated greater survival to discharge in patients receiving any EN, compared with only receiving PN (P = .031). EN on d5 of ECMO support (P = .040) and a higher percentage of daily energy intake achieved (P = .013) were protective, whereas a higher VIS was associated with increased mortality (P = .010). Multivariable analysis demonstrated EN was no longer associated with survival to discharge (P = .139), whereas energy intake (P = .021) and VIS (P = .013) remained significant.Conclusions: Pediatric patients who received nutrition that was closer to goal energy intake, as well as those who received any EN early during ECMO, had improved survival to hospital discharge.

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Section: Introductionmentioning

confidence: 99%

Impact of Early Initiation of Enteral Nutrition on Survival During Pediatric Extracorporeal Membrane Oxygenation

Greathouse

Sakellaris

Tumin

et al. 2017

J Parenter Enteral Nutr

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“…Patient selection, timing of the application of ECMO and mode of ECMO continue to be important factors in predicting eventual outcomes in these cohorts of patients [ 10 ]. VA-ECMO, unlike VV- ECMO, results in mixture of pulsatile and non-pulsatile blood flow and may exquisitely alter blood flow patterns to the cerebrum, pulmonary vasculature, and renal vasculature; not appreciated as much in VV-ECMO as there is less competition with native blood flow [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Diverse Morbidity and Mortality Among Infants Treated with Venoarterial Extracorporeal Membrane Oxygenation

Bairdain¹,

Betit²,

Craig³

et al. 2015

Cureus

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Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is utilized for cardiopulmonary failure. We aimed to qualify and quantify the predictors of morbidity and mortality in infants requiring VA-ECMO.Methods: Data was collected from 170 centers participating in the extracorporeal life support organization (ELSO) registry. Relationships between in-hospital mortality and risk factors were assessed using logistic regression. Survival was defined as being discharged from the hospital.Results: Six hundred and sixty-two eligible records were reviewed. Mortality occurred in 303 (46%) infants. Congenital diaphragmatic hernia patients (OR=3.83, 95% CI 1.96-7.49, p<0.001), cardiac failure with associated shock (OR= 2.90, 95% CI 1.46-5.77, p=0.002), and pulmonary failure including respiratory distress syndrome (OR=4.06, 95% CI 1.72-9.58, p=0.001) had the highest odds of mortality in this cohort. Birth weight (BW) < 3 kg (OR=1.83, 95% CI 1.21-2.78, p=0.004), E-CPR (OR=3.35, 95% CI 1.57-7.15, p=0.002), hemofiltration (OR=2.04, 95% CI 1.32-3.16, p=0.001), and dialysis (OR=6.13, 95% CI 1.70-22.1, p<0.001) were all independent predictors of mortality.Conclusion: Infants requiring VA-ECMO experience diverse sequelae and their mortality are high.

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“…1 Veno-venous ECMO is usually the mode of choice for patients with an isolated respiratory failure. 2 However, in some respiratory patients, you may also find a circulatory component. For instance, in acute respiratory distress syndrome there is a risk of development of right ventricular failure which influence the choice of ECMO support.…”

Section: Introductionmentioning

confidence: 99%

Differential hypoxemia and the clinical significance of venous drainage position during extracorporeal membrane oxygenation

2022

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Differential hypoxemia (DH) has been recognized as a clinical problem during veno-arterial extracorporeal membrane oxygenation (VA ECMO) although its features and consequences have not been fully elucidated. This single center retrospective study aimed to investigate the clinical characteristics of patients manifesting DH as well as the impact of repositioning the drainage point from the inferior vena cava (IVC) to the superior vena cava to alleviate DH. All patients (>15 years) commenced on VA ECMO at our center between 2009 and 2020 were screened. Of 472 eligible patients seven were identified with severe DH. All patients had the drainage cannula tip in the IVC or at the junction between the IVC and right atrium. The mean peripheral capillary saturation increased from 54 (±6.6) to 86 (±6.6) %, ( p = <0.001) after repositioning of the cannula. Pre-oxygenator saturation increased from 62 (±8.9) % prior to adjustment to 74 (±3.7) %, ( p = 0.016) after repositioning. Plasma lactate tended to decrease within 24 h after adjustment. Five patients (71%) survived ECMO treatment, to discharge from hospital, and were alive at 1-year follow-up. Although DH has been described in several studies, the condition has not been investigated in a clinical setting comparing the effect on upper body saturation before and after repositioning of the drainage cannula. This study shows that moving the drainage zone into the upper part of the body has a marked positive effect on upper body saturation in patients with DH.

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Extracorporeal life support for acute respiratory distress syndromes

Cited by 11 publications

References 97 publications

Impact of Early Initiation of Enteral Nutrition on Survival During Pediatric Extracorporeal Membrane Oxygenation

Impact of Early Initiation of Enteral Nutrition on Survival During Pediatric Extracorporeal Membrane Oxygenation

Diverse Morbidity and Mortality Among Infants Treated with Venoarterial Extracorporeal Membrane Oxygenation

Differential hypoxemia and the clinical significance of venous drainage position during extracorporeal membrane oxygenation

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