Extracorporeal Life Support for Severe Acute Respiratory Distress Syndrome in Adults

Hemmila, Mark R.; Rowe, Stephen A.; Boules, Tamer N.; Miskulin, Judiann; McGillicuddy, John W.; Schuerer, Douglas J.E.; Haft, Jonathan W.; Swaniker, Fresca; Arbabi, Saman; Hirschl, Ronald B.; Bartlett, Robert H.

doi:10.1097/01.sla.0000141159.90676.2d

Cited by 359 publications

(267 citation statements)

References 42 publications

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“…In addition to allowing the performance of percutaneous coronary interventions (PCI) in patients with ex- Cardiogenic shock: acute coronary syndrome, fulminant myocarditis, sepsis with profound cardiac depression, massive pulmonary embolism Post-cardiotomy: inability to wean from cardiopulmonary bypass Post-heart transplant: primary graft failure End-stage heart failure: as a bridge to heart transplantation, implantation of VAD support or as a bridge to decision Murrayjev je zbroj bodovni sustav koji se temelji na četiri-ma parametrima (omjeru PaO 2 /FiO 2 , PEEP-u (pozitivan tlak na kraju izdisaja, engl. positive end-expiratory pressure), dinamičkoj popustljivosti pluća, broju plućnih kvadranata s alveolarnom infiltracijom na radiogramu prsnih organa), a upućuje na težinu respiracijske insuficijencije 31 . Pri procjeni je li riječ o reverzibilnom oštećenju plućne funkcije u obzir treba uzeti etiologiju osnovne bolesti, dob, prethodno bolesnikovo stanje i trajanje mehaničke ventilacije.…”

Section: Indication For Va Ecmounclassified

“…Ako je riječ o većim ili rastućim ugrušcima, potrebno je zamijeniti pojedine ili sve sastavnice cirkulacijskoga kruga jer mogu uzrokovati poremećaj rada crpke ili oksigenatora, sustavnu tromboemboliju ili pak razvoj diseminirane intravaskularne koagulopatije. Prodor zraka u cirkulacijski krug rijetka je, ali životno ugrožavajuća komplikacija koja zahtijeva trenutačno klemanje kanila i zaustavljanje protoka 31 .…”

Section: Komplikacije Vezane Za Cirkulacijski Krugunclassified

“…The Murray score is a scoring system based on four parameters (Pa0 2 /Fi0 2 ratio, PEEP (Positive End Expiratory Pressure), dynamic pulmonary compliance, the number of pulmonary quadrants with alveolar infiltration on chest x-ray) and indicates the severity of respiratory insufficiency 31 . When assessing whether the damage to lung function is reversible, the etiology of the primary disease, age, previous state of the patient, and the duration of mechanical ventilation should be taken into consideration.…”

Section: Indications For Vv Ecmomentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation in Adults

Bačić

Tomulić

Medved

et al. 2017

Cardiologia Croatica

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SAŽETAK: Izvantjelesna membranska oksigenacija (engl. Extracorporeal Membrane Oxygenation, ECMO) postupak je izvantjelesne mehaničke cirkulacijske ili respiracijske potpore koji se primjenjuje primarno u bolesnika sa životno ugrožavajućim oblicima zatajivanja rada srca ili pluća. Dva su osnovna oblika ECMO potpore: vensko-venski (V-V) i vensko-arterijski (V-A) ECMO. V-V ECMO osigurava funkciju izmjene plinova u krvi i primjenjuje se u slučaju teške reverzibilne respiracijske insuficijencije. V-A ECMO podržava funkciju rada srca i pluća, a, osim pri reverzibilnim oblicima oštećenja srčane funkcije, može se rabiti i pri njezinu ireverzibilnom oštećenju, kao premoštenje do transplantacije srca ili ugradnje uređaja za mehaničku cirkulacijsku potporu. ECMO je invazivan i tehnički složen postupak koji se obavlja u kritično bolesnih pa stoga nosi visok rizik od pojave komplikacija. Rezultati liječe-nja ECMO-om razlikuju se ovisno o indikaciji za sam postupak. Bolesnici u kojih je ECMO primijenjen radi respiracijske potpore imaju bolje ishode u usporedbi s onima s kardiogenim šokom ili zastojem srca. Iako nedostaju dokazi temeljeni na velikim randomiziranim studijama koji bi poduprli njegovu primjenu, ECMO je u kliničkoj praksi spasonosna metoda liječenja u dobro odabranih, kritičnih bolesnika. SUMMARY:Extracorporeal membrane oxygenation (ECMO) is a procedure that provides extracorporeal mechanical circulatory or respiratory support and is used primarily in patients with life-threatening forms of heart or respiratory failure. There are two basic types of ECMO support: veno-venous (VV) and veno-arterial (VA) ECMO. VV ECMO ensures blood gas exchange and is applied in cases of severe reversible respiratory insufficiency. VA ECMO supports the function of the heart and lungs; other than in reversible forms of damaged heart function, it can also be used in irreversible forms of heart failure as a bridge to heart transplantation or to the implantation of mechanical circulatory support device. ECMO is an invasive and technically complex procedure that is performed in critically ill patients and thus has a high risk of complications. Results of ECMO treatment vary depending on the indications for the procedure itself. Patients in whom ECMO was applied for respiratory support show better outcomes compared with those with cardiogenic shock or cardiac arrest. Despite a lack of evidence based on large randomized studies to support its application, in clinical practice ECMO represents a life-saving method of treatment in well-selected critical patients.KLJUČNE RIJEČI: izvantjelesna membranska oksigenacija, kardiogeni šok, respiracijska insuficijencija.

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Section: Indication For Va Ecmounclassified

Section: Komplikacije Vezane Za Cirkulacijski Krugunclassified

Section: Indications For Vv Ecmomentioning

confidence: 99%

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Extracorporeal Membrane Oxygenation in Adults

Bačić

Tomulić

Medved

et al. 2017

Cardiologia Croatica

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“…The benefit of ECMO in the presence of multiorgan failure is dramatically attenuated, and ECMO is associated with poor outcomes in patients who have already been mechanically ventilated for >10 to 14 days at the time of cannulation. 8,9 Patients on ECMO require therapeutic-dose anticoagulation to prevent thrombosis in the setting of indwelling prosthetic tubing and extracorporeal circulation. Hence, ECMO is usually contraindicated in patients with contraindications to anticoagulation, including active bleeding, recent noncardiothoracic surgery, or a hemorrhagic intracranial event.…”

Section: Contraindicationsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation in Adults With Cardiogenic Shock

et al. 2015

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A 28-year-old previously healthy woman was brought to the hospital after out-of-hospital resuscitated cardiac arrest attributable to ventricular fibrillation. On the evening of presentation, she was found unconscious at home by family members. Bystander cardiopulmonary resuscitation (CPR) was immediately initiated. The patient was defibrillated in the field by emergency medical response providers with return of spontaneous circulation. She aspirated during intubation in the field, and arrived to the hospital in shock, with blood pressure 88/71 mm Hg on norepinephrine 20 μg/min and vasopressin 0.04 U/min. She did not have purposeful movements, and therapeutic hypothermia was initiated in the Emergency Department. She had a metabolic acidosis and concomitant type I acute respiratory failure, with PaO 2 66 mm Hg on volume-cycled assist/control mode with tidal volumes of 400 cc, FiO 2 1.0, positive end-expiratory pressure 10 cm H 2 O, and a respiratory rate of 26 breaths/min. Her ECG did not demonstrate stigmata of ischemia or infarction. However, a type I Brugada pattern was noted in leads V1 and V2 before cooling.Over the ensuing several hours, vasopressor requirements escalated. A SwanGanz catheter demonstrated severely depressed cardiac index and elevated pulmonary capillary wedge pressure. She remained severely hypoxic despite maximal ventilator support. Chest x-ray showed diffuse bilateral pulmonary infiltrates, consistent with severe aspiration pneumonitis. PaO 2 decreased to 49 mm Hg despite increased positive end-expiratory pressure and chemical paralysis, meeting Berlin criteria for severe acute respiratory distress syndrome. 1 Options for percutaneous hemodynamic support were considered (including extracorporeal membrane oxygenation [ECMO] or percutaneous ventricular assist device [VAD], such as Impella and TandemHeart), and the patient was placed on veno-arterial ECMO (VA ECMO) for both hemodynamic and respiratory rescue 6 hours after presentation.Cardiopulmonary bypass was first developed in 1954 to facilitate openheart surgery and used successfully 1 year later. 2,3 Although substantially different from early cardiopulmonary bypass systems, ECMO evolved from cardiopulmonary bypass and provides prolonged cardiopulmonary support outside of the operating suite. With increasing technological advances and safety, the uses of ECMO have expanded, with increasing interest as combined shortterm circulatory and respiratory support in patients with cardiogenic shock. 4 Although potentially life-saving, ECMO is invasive, complex, resource intensive, and can be associated with serious complications. This Clinician Update will introduce ECMO technology, review indications and contraindications, discuss management, including maintaining and weaning support, and underscore potential complications.

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“…Nonetheless, survival rates such as 50 -60% for pediatric and adult respiratory failure and 30 -40% in ECMO-CPR support the use of ECMO beyond its proven niche. [3][4][5] SEE THE ORIGINAL STUDY ON PAGE 941 In this issue of RESPIRATORY CARE, Turner and colleagues add to the growing body of case series describing the successful use of ECMO for severe respiratory failure. 6 They present 7 patients with profound respiratory failure associated with the 2009 H1N1 influenza pandemic and who were refractory to advanced therapies and ventilation strategies.…”

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confidence: 99%