Extracorporeal membrane oxygenation: evolving epidemiology and mortality

Karagiannidis, Christian; Brodie, Daniel; Straßmann, Stephan; Stoelben, Erich; Philipp, Alois; Bein, Thomas; Müller, Thomas; Windisch, Wolfram

doi:10.1007/s00134-016-4273-z

Cited by 384 publications

(283 citation statements)

References 32 publications

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“…Owing to rapid technical improvements, the use of ECMO has been dramatically increasing over the last decade (5). ECMO was traditionally contraindicated in cases of sepsis or severe infection due to the concern for infecting the circuit (6,7).…”

Section: Introductionmentioning

confidence: 99%

A Case Treated with Extracorporeal Membrane Oxygenation for Disseminated Cytomegalovirus Infection after Liver Transplantation

Park

Lee

Choi

et al. 2017

Korean J Transplant

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Cytomegalovirus (CMV) is a clinically important pathogen in immunocompromised patients, especially after organ transplantation. However, there have been several reports of severe CMV infections in immunocompetent patients. This report presents a case of an immunocompetent patient who presented with fulminant hepatitis requiring liver transplantation. Because CMV was detected upon histopathologic review of the explanted liver, it was later assumed that CMV may be the primary cause of hepatitis. However, at the time of transplantation, we did not suspect CMV hepatitis. Following transplantation and initiation of immunosuppression, the patient developed viral sepsis with a disseminated CMV infection. Respiratory failure because of CMV pneumonia worsened despite antiviral therapy, and venovenous extracorporeal membrane oxygenation (ECMO) was initiated. Although ECMO has been traditionally contraindicated in patients with sepsis, this patient recovered and was successfully weaned off ECMO. CMV should be included in the differential diagnosis of fulminant hepatitis, even in immunocompetent patients, especially when liver transplantation is considered.

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Section: Introductionmentioning

confidence: 99%

A Case Treated with Extracorporeal Membrane Oxygenation for Disseminated Cytomegalovirus Infection after Liver Transplantation

Park

Lee

Choi

et al. 2017

Korean J Transplant

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“…However, after presentation of the IABP-SHOCK II trial in 2012/2013 (4,5) with neutral results of IABP in patients with myocardial infarction complicated by cardiogenic shock, IABP use in Germany dropped nearly by half, from about 8,500 in 2012 to about 5,000 in 2014 (6). Vice versa, the application numbers for other percutaneous mechanical support devices increased, for instance, for VA-ECMO in Germany from about 500 in 2012 to about 3,000 in 2014 (6).…”

mentioning

confidence: 99%

“…Vice versa, the application numbers for other percutaneous mechanical support devices increased, for instance, for VA-ECMO in Germany from about 500 in 2012 to about 3,000 in 2014 (6).…”

mentioning

confidence: 99%

Extracorporeal life support during cardiac arrest and cardiogenic shock—how good is the evidence really?

Prondzinsky¹,

Werdan

2017

Ann. Transl. Med.

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“…A recent German survey showed that the incidence of vv-ECMO in the population increased from 1.0:100,000 inhabitants/year in 2007 to a maximum of 3.0:100,000 in 2012, and then stabilised at 2.4:100,000 in 2014 [1]. The in-hospital mortality slightly decreased over time but remained high, at 58.1% in 2014.…”

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confidence: 99%

Focus on ECMO and ECCO2R in ARDS patients

Bein

Aubron²,

Papazian

2017

Intensive Care Med

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The technical aspects of veno-venous extracorporeal membrane oxygenation (vv-ECMO) are still improving, permitting the treatment of ARDS patients with very severe hypoxaemia. A recent German survey showed that the incidence of vv-ECMO in the population increased from 1.0:100,000 inhabitants/year in 2007 to a maximum of 3.0:100,000 in 2012, and then stabilised at 2.4:100,000 in 2014 [1]. The in-hospital mortality slightly decreased over time but remained high, at 58.1% in 2014. This real-life mortality rates in an unselected population of patients undergoing ECMO for ARDS is even higher than previously reported. The extracorporeal CO 2 -removal (ECCO 2 -R) is a modification of ECMO characterised by a reduction in extracorporeal blood and sweep gas flow. The aims of ECCO 2 -R are: (1) the management of acute 'isolated' hypercapnic respiratory failure, (2) the reduction of tidal volume (3-4 ml/kg) and the control of hypercapnia, and (3) the avoidance of intubation in exacerbated chronic obstructive lung disease. While in the latter situation a number of small observational studies or case reports exerted promising results, the scientific evidence for the use and benefit of ECCO 2 -R in ARDS patients is limited [2].The prospective observational study by Hermann et al. [3], investigating the efficacy and safety of a novel pumpdriven ECCO2-R-system demonstrated a significant, but 'intensity'-dependent, amount of CO 2 removal between 40 and 70 ml/min. The CO 2 transfer was dependent on the amount of blood flow (0.5-2.0 l/min) and sweep gas flow. A rapid normalisation of hypercapnia secondary to higher blood flows (>1.0 l/min) and a moderate increase in oxygenation were found. However, very high sweep gas flows (higher than 10 l/min) were associated with a deterioration in O 2 and CO 2 transfer. Based on these study results, it is recommended to use ECCO 2 -R settings that combine moderate blood flow (1-1.5 l/min) and sweep gas flow (2-8 l/min) to achieve the best clinical effect and to avoid adverse effects. The combination of ECCO 2 -R and renal replacement therapy was investigated in 11 patients with ARDS and acute renal failure [4]. A membrane oxygenator was inserted in a continuous RRT system, resulting in an average CO 2 removal rate of 80 ml/ min (corresponds to a reduction of ≈20% of the arterial PaCO 2 level). Consequently, the tidal volume was lowered from 6 to 4 ml/kg and the plateau pressure could be reduced from 25 to 21 cm H 2 O (p < 0.01); no adverse events were reported. It is concluded that the combination of ECCO 2 -R with renal replacement therapy allows a safe and adequate blood 'purification' of renal-and pulmonary-associated substances together while enhancing lung protective ventilation in critically ill patients. The trend towards a 'personalised medicine' has reached intensive care medicine and the management of ARDS patients should be revisited accordingly [5]. ECCO 2 -R could become an important part of such a project in a 'balanced' portfolio of extracorporeal lung support. Although vv-ECMO r...

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Extracorporeal membrane oxygenation: evolving epidemiology and mortality

Cited by 384 publications

References 32 publications

A Case Treated with Extracorporeal Membrane Oxygenation for Disseminated Cytomegalovirus Infection after Liver Transplantation

A Case Treated with Extracorporeal Membrane Oxygenation for Disseminated Cytomegalovirus Infection after Liver Transplantation

Extracorporeal life support during cardiac arrest and cardiogenic shock—how good is the evidence really?

Focus on ECMO and ECCO2R in ARDS patients

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